Parkinson’s Disease 101: Understanding Symptoms, Stages, and Treatment Basics

June 28, 2025
Parkinson's Disease

Who this is for: people newly diagnosed with Parkinson’s and those who love and care for them.
What you’ll get: a clear, compassionate overview of what Parkinson’s is, how it progresses, and the most common ways to manage it—so you can plan confidently for the road ahead.

The big picture—what Parkinson’s is (in plain English)

Parkinson’s disease (PD) is a progressive neurological condition. Over time, certain brain cells that help coordinate smooth, automatic movement gradually stop working as they should—mainly cells that make dopamine in a region called the substantia nigra. This shortage leads to the hallmark movement symptoms (like slowness and tremor) and many non‑movement symptoms (like constipation or sleep changes). While there is currently no cure, today’s treatments can control symptoms very well for many years, and research is advancing quickly. (NINDS)

Common symptoms (movement and beyond)

Core movement symptoms

Bradykinesia (slowness)—small, slower movements; trouble with buttons, handwriting getting smaller.
Rigidity (stiffness)—muscle tightness; decreased arm swing.
Tremor—often a “resting” tremor that eases when using the hand.
Balance/postural changes—more common later. (NINDS)

Non‑movement symptoms (very common, sometimes earlier than motor symptoms)

Constipation, reduced sense of smell, anxiety or depression, sleep problems (including REM Sleep Behavior Disorder—acting out dreams), urinary changes, lightheadedness on standing, pain, and thinking changes (usually many years into the condition). Recognizing and treating these non‑motor symptoms is a core part of good PD care. (NINDS)

How Parkinson’s is diagnosed

Diagnosis is clinical—made by a neurologist (ideally a movement‑disorders specialist) based on history and examination. There’s no single blood test. A brain scan called DaTscan® (ioflupane I‑123 SPECT) can help support a diagnosis when there’s uncertainty (for example, to help distinguish PD from essential tremor), but it isn’t required and cannot reliably separate PD from some related conditions. (NINDS, Parkinson’s Foundation, PMC)

Stages and progression

Doctors often describe motor progression using Hoehn & Yahr stages (1–5). Many people live for years—sometimes decades—in the earlier stages, especially with good symptom control and exercise. Progression speed varies widely. The Parkinson’s Foundation also describes “preclinical,” “prodromal,” and “clinical” phases to capture the years before a clear diagnosis (loss of smell, constipation, certain sleep disorders can precede motor symptoms). (Parkinson’s Foundation)

What about life expectancy? With modern care, average life expectancy can be close to normal, though it depends on age at diagnosis, overall health, and specific features (for example, dementia increases risks). Some studies show only small differences compared to peers without PD—especially when cognition is preserved. (NINDS, American Academy of Neurology)

Treatment basics: building your plan

1) Daily medications (foundation of care)

Levodopa/carbidopa remains the most effective medicine for motor symptoms. In 2024, the FDA approved Crexont® (carbidopa/levodopa extended‑release capsules), a newer long‑acting oral formulation that can reduce “OFF” time with fewer daily doses than immediate‑release tablets. (American Academy of Neurology, FDA Access Data)
MAO‑B inhibitors (rasagiline, selegiline, safinamide) can be used early or added later to smooth fluctuations and reduce OFF time. Safinamide (Xadago®) has evidence for increasing “ON” time without troublesome dyskinesia when added to levodopa. (American Academy of Neurology, FDA Access Data)
Dopamine agonists (pramipexole, ropinirole, rotigotine) may help selected people (often younger), but can cause sleepiness, leg swelling, and impulse‑control disorders (e.g., gambling). Your team will weigh these carefully. (American Academy of Neurology)
COMT inhibitors (entacapone, opicapone/Ongentys®) prolong levodopa’s effect and reduce OFF time. (FDA Access Data)
Adenosine A2A antagonist istradefylline (Nourianz®)—an add‑on to levodopa that can reduce OFF episodes via a non‑dopamine pathway. (FDA Access Data)

Starting therapy: The American Academy of Neurology recommends not delaying treatment when symptoms affect quality of life. For most people with early PD, levodopa provides the greatest motor benefit; medication choice should be individualized by age, lifestyle, and side‑effect risks. (American Academy of Neurology)

Timing with meals: Protein can compete with levodopa for absorption in some people. Taking levodopa 30–60 minutes before meals or redistributing protein to later in the day can help—your clinician or dietitian can tailor this. (American Parkinson Disease Association, Frontiers)

Important safety note (hospital/ER): Some common anti‑nausea and antipsychotic drugs block dopamine and can dramatically worsen PD symptoms. Examples to avoid unless a specialist says otherwise: metoclopramide, prochlorperazine, haloperidol. Keep a medication list with timing, and bring it to any hospital visit. (Parkinson’s Foundation, American Parkinson Disease Association)

2) On‑demand “rescue” options for sudden OFF episodes

Apomorphine as a quick injection (Apokyn®) or sublingual film (Kynmobi®) can turn an OFF period back to ON within minutes. In 2025, the FDA also approved Onapgo™, a continuous subcutaneous apomorphine system. These are typically prescribed by specialists after careful teaching. (FDA Access Data, Reuters)

3) Device‑assisted and infusion therapies (for more advanced, fluctuating PD)

Deep Brain Stimulation (DBS): Implanted electrodes modulate movement circuits and can markedly reduce fluctuations and dyskinesia in appropriately chosen patients. Your team will evaluate candidacy. (NINDS)
Focused ultrasound (FUS): An incisionless MRI‑guided procedure that creates a small lesion in targeted brain areas. Initially FDA‑approved for one‑sided PD tremor (2018), coverage expanded (2021) to additional motor symptoms/dyskinesia; in July 2025, the FDA approved staged bilateral treatment (two procedures, months apart) for selected patients. (Michael J. Fox Foundation, Insightec)
Levodopa infusions:
- Duopa® (intestinal gel via a small tube to the small intestine) delivers continuous levodopa during the day and reduces OFF time. (FDA Access Data, PMC)
- Vyalev™ (foscarbidopa/foslevodopa) is a 24‑hour subcutaneous infusion of levodopa prodrugs approved in Oct 2024 for adults with advanced PD and motor fluctuations. It increased good “ON” time compared with immediate‑release tablets in phase 3 trials. (FDA Access Data, Michael J. Fox Foundation)

Which option is right for me? Decisions depend on your symptoms, goals, other health issues, and practical factors (care partner support, device management). A movement‑disorders team will guide you through a structured evaluation.

Rehabilitation, exercise, and daily living—what you can do

Exercise is medicine for PD. Regular aerobic + strength + balance training improves motor symptoms and walking speed; dancing and tai chi are excellent options. Aim for ≥150 minutes/week of moderate activity, progressing safely. A physical therapist can tailor a plan. (AAN, PLOS)
Targeted therapies:
- LSVT® BIG (physical/occupational therapy) can improve movement amplitude, balance, and daily function. (SpringerLink)
- LSVT® LOUD (speech therapy) improves voice loudness and communication. Telehealth‑delivered programs are increasingly supported. (PubMed)
Sleep & REM Sleep Behavior Disorder (RBD): If you act out dreams, tell your clinician. Evidence‑based options include melatonin or clonazepam in selected cases, alongside bedroom safety measures. (PMC)
Constipation: Increase fiber, fluids, and activity; your clinician may add medications if needed. (Parkinson’s Foundation)
Mood & thinking: Depression/anxiety are common and treatable. For PD psychosis (hallucinations/delusions), pimavanserin (Nuplazid®) is FDA‑approved; cholinesterase inhibitors (e.g., rivastigmine patch) can help PD dementia. Never stop or change PD meds on your own—ask first. (FDA Access Data, NCBI)
Team‑based care matters. Multidisciplinary models (neurology, rehab, social work, mental health, nutrition) improve outcomes and quality of life. Consider palliative‑care support early to help with symptom relief, planning, and caregiver well‑being. (PMC, JAMA Network)

Your first 90 days after diagnosis: a simple checklist

Meet your team. Ask for referral to a movement‑disorders specialist and rehabilitation (PT/OT/Speech). Bring questions and a medication/supplement list. (PMC)
Start moving. Pick activities you’ll stick with (walking, cycling, dance, tai chi). Schedule them on your calendar. (AAN)
Track patterns. A symptom + medication diary helps your clinician fine‑tune dosing and timing. (Parkinson’s Foundation)
Set up safety. Share a hospital/ER medication timing sheet with loved ones; note meds to avoid. (Parkinson’s Foundation)
Care partner support. Invite a family member or friend to appointments; ask about local support groups. (Parkinson’s Foundation)

Frequently asked questions

Is Parkinson’s fatal?
PD itself isn’t considered “fatal,” and many people live long, full lives. Risks relate to falls, infections, and swallowing problems in advanced stages—issues your team works to prevent. (NINDS)

Will I always develop dementia?
No. Some people never do. When thinking changes arise, they often develop gradually and are treatable to some degree. (NINDS)

Should I change my diet now?
Emphasize balanced nutrition and hydration; fine‑tune protein timing if levodopa’s effect is inconsistent. Ask for a dietitian familiar with PD. (American Parkinson Disease Association)

A note on hope—and research you can join

There’s real momentum in PD research: new oral and infusion formulations of levodopa, incisionless focused ultrasound now approved bilaterally in staged fashion for select patients, and better on‑demand therapies for OFF time. While nothing stops PD yet, participation in clinical studies accelerates the breakthroughs of tomorrow—and often gives access to cutting‑edge options today. (FDA Access Data, Michael J. Fox Foundation, Reuters)

How Aqualane Clinical Research can help

At Aqualane Clinical Research, our mission is patient‑first: clear education, careful screening, and safe participation in studies that advance care. If you or a loved one has PD and want to explore current or upcoming clinical trials, we can pre‑screen, answer questions in plain language, and coordinate with your neurologist. Joining a study is always voluntary—you keep full control of your care.

Call to action: Interested in research or a no‑pressure conversation about options? Tell us your diagnosis date, current medications, and zip code. We’ll share studies you may qualify for and what participation would look like.

Quick glossary

ON/OFF: Periods when medication is working well (ON) or wearing off (OFF).
Dyskinesia: Involuntary, often writhing movements—usually when medication is ON.
DBS: Deep Brain Stimulation (implanted electrodes to steady circuits).
FUS: Focused Ultrasound (incisionless lesioning guided by MRI). (NINDS, Michael J. Fox Foundation)