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Parkinson's Disease Overview







Population Characteristics1,2,3   

  • 1.6 million people estimated to have Parkinson's Disease (PD) in USA
    • 60,000 new diagnoses per year year 
  • Second to Alzheimer's as the most prevalent neurodegenerative disease in the US 
  • Average age of onset is late 50's and early 60's, incidence increases with age
  • Men 1.5x more likely to have PD than women


  • Cell death and degeneration within the substantia nigra decreases dopamine production
  • Reduction in dopamine interferes with the basal ganglia motor circuit, leading to excitation of the indirect pathway and inhibition of the direct pathway of the basal ganglia circutry to the thalamus
  • These changes in firing of the indirect/direct pathways of the basal ganglia lead to inhibition of the thalamus, decreasing output to the moter cortex thereby inhibiting movement

Signs and Symptoms:2


  • Diagnosis is currently based on clincial judgment
    • Diagnosis is based on identifying cardinal signs and symptoms of PD while excluding other similar disorders (eg multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration)
  • PET, MRI, and CT scans can be done to rule out other potential diagnoses

Prognosis: 6,7

  • Currently, no treatments or interventions exist that significantly slow the actual physiological progression of PD despite the presence of effective symptomatic medications
  • Left completely untreated, patients with PD can be bedridden in as soon as 10 years
  • The rate of decline in motor function is not linear and is faster in those with mild impairments compared to more severe impairments
    • Motor impairment tends to plateau while cognitive deficits in people with PD continue to progress, leading to disability to be often caused by the nonmotor aspects of PD

Physical Therapy Interventions: 8-13

  • Regular aerobic exercise, stretching, balance traning, and resistance exercise has been shown to have beneficial effects on gait speed, posture, muscle strength, balance, overall fitness levels, overall function, and reduced risk of falls
  • Training with external sensory cuing (visual, auditory, sensory) has been shown to improve functional status
  • Tai chi training and postural stability exercises are correlated with a decreased risk of falls and increased stride length
  • Greatest improvements in function are within first 3 months of therapy 
  • Exercises should be performed with dopamine agonists as perscribed in order to maximize benefits 
  • Currently there is no "best practice" for PD and more research needs to be done in order to determine the best combination of interventions 







1. The University of Chicago Medical Center. Overview of Parkinson's Disease. The Center for Parkinson's Disease and Movement Disorders.

2. Parkinson's Disease Foundation. Statistics on Parkinson's. Parkinson's Disease Foundation. 

3. Willis AW. Parkinson disease in the elderly. Mo Med. 2013;110(5): 406-410.  

4. Boeso JA, Rodriguez-Oroz MC, Benitez-Temino B, et al. Functional organizatino of the basal ganglia: therapeutic implications for Parkinson's disease. Mov Disord. 2008;23 Suppl 3:S548-549.

5. Bergman H, Deuschl G. Pathophysiology of Parkinson's disease: from clincal neurology to basic neuroscience and back. Mov Disord. 2002;17 Suppl 3: S28-40.

6. Obeso JA, Rodriguez-Oroz MC, Goetz CG, et al. Missing pieces in the Parkinson's disease puzzle. Nat Med. 2010;16(6): 653-661. 

7. Poewe W. The natural history of Parkinson's disease. J Neurol. 2006;253 Suppl 7: V112-6.

8. Ahlskog JE. Does vigorous exercise have a neuroprotective effect in Parkinson's disease? Neurology. 2011;77(3): 288-294. 

9. Li F, Harmer P, Fitzgerald K. Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med. 2012; 366(6): 511-519. 

10. Shulman LM, Katzel LI, Ivey FM, et al. Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. JAMA Neurol. 2013;70(2): 183-190. 

11. Tomlinson CL, Patel S, Meek C, et al. Physiotherapy versus placebo or no intervention in Parkinson's disease. Cochrane Database Syst Rev. 2013; 9:CD002817.

12. Hirsch MA, Toole T, Maitland CG, et al. The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease. Arch Phys Med Rehabil. 2003;84(8): 1109-1117.

13. Marchese R, Diverio M, Zucchi F, et al. The role of sensory cues in the rehabilitation of parkinsonian patients: a comparison of two physical therapy protocols. Mov Disord. 2000;15(5): 879-893.