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Parkinson's disease occurs when certain neurons in an area of the brain called the substantia nigra are damaged or destroyed. Normally, these nerve cells release dopamine — a chemical that transmits signals between the substantia nigra and another part of the brain, the corpus striatum. These signals cause your muscles to make smooth, controlled movements.

Everyone loses some dopamine-producing neurons as a normal part of aging. But people with Parkinson's disease lose at least 60 percent of neurons in the substantia nigra. Just what causes this is a subject of intense research. Right now scientists believe Parkinson's disease may result from a combination of genetic and environmental factors. Certain drugs, diseases and toxins also may cause symptoms similar to those of Parkinson's disease.

Genetic factors
Until recently, scientists believed that genes played a role primarily in an unusual type of Parkinson's disease that affects young people. But new research shows that a strong genetic component also occurs in older adults. In fact, people who have a first degree relative with Parkinson's disease, such as a parent, sibling or child, are at three times greater risk of developing the disease themselves, regardless of their age. And one study found that having two first degree relatives with Parkinson's disease can increase risk as much as 10 times.

Environmental factors
People with unusual exposure to herbicides and pesticides are three times more likely to develop Parkinson's disease than people who don't have this exposure. Unfortunately, researchers haven't yet been able to connect a specific herbicide or pesticide to the disease.

Medications
A number of drugs taken for long periods of time or in excessive dosages can cause symptoms of Parkinson's disease. These include medications such as haloperidol (Haldol, Halperon) and chlorpromazine (Thorazine, Sonazine), which are prescribed for certain psychiatric disorders, as well as drugs used to treat nausea, such as metoclopramide (Reglan) and prochlorperazine (Compazine, Compro). The epilepsy drug valproate (Depacon) may also cause some of the features of parkinsonism, especially severe tremors.

Toxins
Exposure to toxins such as manganese dust or the chemical MPTP, a byproduct of heroin production, can lead to parkinsonism. Scientists first became aware of MPTP-induced parkinsonism in the 1980s when heroin addicts using a street drug contaminated with MPTP developed all of the symptoms of Parkinson's disease. These cases are rare, however.

• Epilepsy

Age is one of the main risk factors for Parkinson's disease. Although the disease can affect adults in their 20s, it ordinarily starts in middle or late life. The risk continues to increase with age. Some researchers theorize that people with Parkinson's disease may have neural damage from genetic or environmental factors that becomes worse over time.

Other risk factors include:

• Heredity. Having one close relative with Parkinson's increases the chances that you'll also develop the disease. If you have two or more close relatives with Parkinson's, your risk increases ten-fold.

• Exposure to pesticides and herbicides. Direct contact with herbicides and pesticides puts you at increased risk of Parkinson's. The disease is also more common in people who are involved in farming, live in a rural area or drink well water. It's likely that herbicide and pesticide exposure plays a role in these cases as well.

• Reduced estrogen levels. Reduced estrogen levels may increase the risk of Parkinson's disease. This means that menopausal women who receive little or no hormone replacement therapy (HRT) and those who have had hysterectomies may be at higher risk. Menopausal women using HRT appear to have a decreased risk. But not all effects of HRT are positive. Taking HRT as a combination therapy — estrogen plus progestin — can result in serious side effects and health risks. Work with your doctor to evaluate the options and decide what's best for you.

• Reduced folate levels. Folate naturally occurs in dark green vegetables such as spinach, in citrus fruits, and in whole-wheat bread. Half a cup of cooked spinach contains about 130 micrograms of folate.

It's important to see your doctor if you have any of the symptoms associated with Parkinson's disease — not only to diagnose the illness but also to rule out other causes for your symptoms. For instance, tremors are often an early sign of Parkinson's disease yet the most common type of tremor, known as essential tremor, isn't caused by Parkinson's.

Although Parkinson's disease can sometimes be difficult to pin down, getting an accurate diagnosis is the key to starting appropriate treatment that may help delay or manage symptoms for years.

Because no definitive tests exist for Parkinson's, the disease can be difficult to diagnose, especially in the early stages. What's more, symptoms of Parkinson's disease — including an unsteady walk, trembling and trouble speaking or writing — may be dismissed as the effects of aging, particularly in older adults with the disease. At the same time, doctors sometimes miss Parkinson's disease in young people because they believe it mainly affects older adults.

A diagnosis of Parkinson's disease is based on your medical history, observations of your symptoms and a neurologic examination. As part of your medical history, your doctor will want to know about any medications you take and whether you have a family history of Parkinson's. The neurologic examination includes an evaluation of your walking, coordination and some simple tasks of dexterity. Your doctor may also notice subtle signs of parkinsonism — such as reduced facial expressions, a lack of gestures or a subtle tremor — when he or she takes your history.

Approximately 40 percent of people with Parkinson's disease develop depression. In about one in four of these people, symptoms of depression may occur months or even years before Parkinson's disease is diagnosed. Although physical limitations resulting from Parkinson's disease can be frustrating and stressful, depression in someone with Parkinson's isn't usually a reaction to physical disability. Instead, it more likely arises from underlying brain changes associated with the disease itself.

• Depression

• Epilepsy

In addition, as many as a third of people with Parkinson's disease eventually develop dementia, a condition that can include memory loss, impaired judgment and personality changes.

Medications for Parkinson's disease also may cause a number of complications, including involuntary twitching or jerking movements of the arms and legs (dyskinesia), hallucinations, sleepiness, and a drop in blood pressure when standing up (orthostatic hypotension).

Other complications of Parkinson's disease include:

• Difficulty chewing and swallowing. In the later stages of the disease, the muscles you use to swallow may be affected, making eating difficult.

• Urinary problems. Parkinson's disease may cause either urinary incontinence or urine retention. Certain medications used to treat the disease, especially anticholinergic drugs, also can make it hard to urinate.

• Constipation. Many people with Parkinson's disease develop constipation because the digestive tract works more slowly. Constipation may also be a side effect of medications used to treat the disease.

• Sleep problems. People with Parkinson's disease often have trouble falling asleep and may wake up frequently throughout the night. They also may experience restless sleep and even act out their dreams (rapid eye movement sleep behavior disorder). Some of the problems with sleep may be related to depression.

• Sexual dysfunction. Some people with Parkinson's disease may notice a decrease in sexual desire (libido). This may stem from a combination of psychological and physical factors, or it may be the result of physical factors alone.

• constipation
• Depression
• Epilepsy
• Incontinence, bowel
• Incontinence, fecal
• Incontinence, urinary
• Urinary incontinence

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