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Parkinson’s Disease

A progressive condition in which brain cells that make dopamine are lost, causing tremor, stiffness, slowness and many non-movement symptoms. There is no cure yet, but medicines, exercise, therapy and sometimes surgery can ease symptoms — and stopping Parkinson’s medicine suddenly, choking, or a fall with injury needs urgent care.

Call 911 if someone with Parkinson’s is choking, can’t breathe, or suddenly can’t swallow. Food stuck in the throat can block the airway, and a brain without oxygen for more than four minutes can be damaged (MedlinePlus). Coughing or choking with meals, a wet, gurgly voice after eating or repeated chest infections need prompt medical advice (NHS).

Never stop levodopa or other Parkinson’s medicines suddenly, and don’t skip doses. FDA labels warn that abruptly cutting or stopping them can trigger a rare, life-threatening illness resembling neuroleptic malignant syndrome: fever, marked muscle rigidity, confusion and a racing heart (FDA label, Sinemet). Stopping amantadine suddenly has caused a “parkinsonian crisis,” a sudden marked decline (FDA label, amantadine). Fever with new stiffness and confusion after missed or stopped medicine is a reason to call 911.

Get emergency care after a fall with a head injury or suspected broken bone, or if you can’t get up. Most people with Parkinson’s fall at least once (Cochrane review, 2022).

Call the prescriber promptly about new hallucinations, delusions or confusion. Parkinson’s medicines can cause them, and they may respond to a dose change — made only by the prescriber (FDA label, Sinemet). Call 911 if the person is in danger.

Some common medicines make Parkinson’s worse. The metoclopramide (reflux and stomach-emptying medicine) label says to avoid it in Parkinson’s (FDA label, metoclopramide), and haloperidol’s label lists Parkinson’s as a contraindication (FDA label, haloperidol). Tell every emergency room, hospital and pharmacist you have Parkinson’s (see Medicines that can make Parkinson’s worse below).

If you have thoughts of suicide, call or text 988 (24/7) (988 Lifeline). Levodopa labels ask that people be watched for depression with suicidal thoughts (FDA label, Sinemet).

What is Parkinson’s disease?

Parkinson’s disease (PD) is a movement disorder that happens when nerve cells in the brain don’t make enough of the chemical dopamine (MedlinePlus). The loss is in a part of the brain called the substantia nigra (NHS). It is the most common form of parkinsonism, the group of conditions with Parkinson-like slowness, stiffness and tremor (JAMA review, 2020). Symptoms begin gradually, often on one side of the body, and later reach both sides (MedlinePlus). There is no cure, and no disease-modifying medicines are available yet (JAMA review, 2020). It varies a lot: one review describes a mild, slowly progressing form in about half of people (49–53%) and a faster, more severe form in 9–16% (JAMA review, 2020).

Who gets it, and why?

Symptoms usually begin around age 60 but can start earlier, and it is more common in men (MedlinePlus). More than 6 million people worldwide have it (JAMA review, 2020). Most experts think a combination of genetic and environmental factors is responsible (NHS). About 15% of people have a family history, and changes in genes such as LRRK2, SNCA, PINK1 and PRKN can cause familial cases; most cases appear with no family history (MedlinePlus Genetics).

Early signs and symptoms

The order and severity differ for each person, and few people have all of them (NHS).

Movement (motor) symptoms

  • Tremor — usually starting in a hand or arm, more likely when the limb is resting.
  • Slowness (bradykinesia) — everyday tasks get harder and walking may become a shuffle with very small steps.
  • Stiffness (rigidity) — muscle tension that makes movement and facial expressions difficult and can cause painful cramps (dystonia) (NHS); see our Dystonia guide.
  • Poor balance, which can lead to falls (NHS).

Non-movement (non-motor) symptoms

These can be as troubling as the movement symptoms: loss of smell (sometimes years before other symptoms), nerve pain, bladder problems, constipation, dizziness or fainting on standing, swallowing trouble, drooling, poor sleep, depression, anxiety, memory and planning problems and, in some people, dementia with hallucinations (NHS). Acting out dreams (REM sleep behavior disorder), loss of smell and constipation can come before the movement symptoms (JAMA review, 2020). Constipation was linked to a higher chance of later developing Parkinson’s in a 2023 analysis (meta-analysis, PubMed), but constipation is very common and by itself rarely means Parkinson’s. See our Bowel Problems, Bladder Problems and Nerve Damage guides.

How it’s diagnosed

There is no specific test. Doctors use your medical history and a neurological exam (MedlinePlus); early on, even a doctor may not be sure (NHS). If Parkinson’s is suspected, you will usually be referred to a neurologist or geriatrician (NHS).

  • DaTscan is a nuclear-medicine brain scan (SPECT) of dopamine transporters. Its FDA label calls it an adjunct to other evaluations in adults with suspected parkinsonian syndromes or dementia with Lewy bodies, and notes it was not designed to tell Parkinson’s from multiple system atrophy or progressive supranuclear palsy (FDA label, DaTscan). It can improve accuracy when it is uncertain whether parkinsonism is present (JAMA review, 2020).
  • Accuracy. In a 2002 study, a specialist service’s clinical diagnosis of Parkinson’s was confirmed in 72 of 73 cases (study, PubMed). In a 2025 study of 1,626 people diagnosed by neurologists, about 13% of diagnoses were later revised, mostly within two years (study, PubMed). If your picture changes, it is reasonable to ask for a second look.
  • Medicine-caused parkinsonism. Metoclopramide can cause Parkinson-like symptoms that generally fade 2 to 3 months after stopping (FDA label, metoclopramide). Give your doctor a full medicine list.

Outlook

Parkinson’s progresses over many years. The NHS says many people respond well to treatment and have only mild to moderate disability, while a minority become more severely disabled. It doesn’t directly cause death, but can make people more vulnerable to serious infections, and most people now have a normal or near-normal life expectancy (NHS). That is a UK summary; ask your neurologist about your own outlook.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Care from a neurologist, ideally one who focuses on movement disorders: levodopa (with carbidopa) and other medicine classes — dopamine agonists, MAO-B inhibitors, COMT inhibitors, amantadine and anticholinergics — plus physical, occupational and speech therapy, and for selected people deep brain stimulation, focused ultrasound or pump-delivered medicine. Medicare Part B covers medically necessary outpatient physical, occupational and speech-language therapy (20% after the deductible). Self-pay therapy, medicines, specialist visits, scans and surgery: cost estimate being researched. No cure, but medicines can sometimes help symptoms dramatically, especially early. Over the years, doses wear off sooner and involuntary movements (dyskinesias) can appear, and medicines can cause sleepiness, hallucinations or compulsive behaviors. Surgery helps selected people but has real risks.
Chiropractic No chiropractic treatment has been shown to treat Parkinson’s disease. At most, gentle soft-tissue work or posture advice from a practitioner who understands Parkinson’s and works with your neurologist. About $90–$200 for a first appointment and $55–$100 for a self-pay follow-up visit. We found only case reports and a tiny pilot study that measured brain-wave recordings, not symptoms. Neck manipulation has been linked to rare artery tears and stroke. Avoid high-velocity neck manipulation.
Acupuncture Fine needles, usually added to regular medical care, tried for movement symptoms, constipation, sleep and mood. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Several small reviews report benefits, but the studies differ a great deal in design and quality, so the evidence is promising but not firm. It is a comfort-focused add-on, not a treatment for the disease itself.
Herbal medicine No herb or supplement has been shown to slow or treat Parkinson’s. Mucuna pruriens contains levodopa, so it acts as a real dopamine medicine; coenzyme Q10 and vitamin E did not help in large trials. Cost estimate being researched. Supplements can interfere with Parkinson’s medicines — iron multivitamins can lower levodopa absorption and St. John’s wort can interact unpredictably. Tell your neurologist and pharmacist about everything you take.
Massage therapy Therapeutic massage to ease muscle tension, pain and stress. One national chain: about $125–$160 for a 60-minute massage for non-members, or a $70–$90 monthly membership. Small studies suggest it may help relaxation, sleep, mood and some movement scores, though the research is limited. It does not treat the disease itself. Risk of harm appears low; avoid very deep, vigorous work.
MBHA Wellness Coach Building routines around your care team’s plan: on-time medicine habits, a regular exercise program, a symptom diary, sleep and stress habits, constipation and fall-proofing routines, mood support and planning ahead. MBHA coaching cost estimate being researched. Supports — but doesn’t replace — medical care. Exercise is one of the best-supported things people with Parkinson’s can do, and steady medicine timing and fall-proofing matter day to day.

Approach 1 of 6

Conventional medicine (AMA)

There is no cure, but treatment can relieve symptoms and maintain quality of life: supportive therapies, medicine and, for some, surgery (NHS). You may not need medicine while symptoms are mild, but regular specialist visits let your condition be monitored (NHS). We don’t list doses — only your prescriber sets or changes them. The safety points below come from FDA drug labels on DailyMed.

1. Levodopa with carbidopa

Most people eventually need levodopa, which the brain turns into dopamine (NHS). Carbidopa keeps levodopa from breaking down outside the brain, so much lower levodopa doses can be used and nausea is reduced (FDA label, Sinemet). At first it can cause a dramatic improvement, but over the years the effect lasts less long, and long-term use is linked to jerky involuntary movements (dyskinesias) and “on-off” swings (NHS).

  • Timing and food: take it at regular intervals on your doctor’s schedule. A high-protein meal may delay absorption, and iron salts — including multivitamins with iron — can reduce how much levodopa the body uses (FDA label, Sinemet).
  • Sudden sleep: people have fallen asleep suddenly, without warning, during daily activities including driving, and road accidents have been reported (FDA label, Sinemet).
  • Impulse-control problems: intense urges to gamble, spend, eat or have sex. People may not see it as abnormal; family often notice first. In some cases it stopped when the dose was lowered (FDA label, Sinemet).
  • Also on the label: hallucinations; and a 2- to 6-fold higher melanoma risk in people with Parkinson’s (unclear whether from the disease or treatment), so regular skin checks are advised (FDA label, Sinemet).

2. Dopamine agonists

Pramipexole, ropinirole and the rotigotine patch substitute for dopamine, with a milder effect than levodopa (NHS). Their labels list sudden sleep onset without warning (the NHS says people are usually advised not to drive while the dose is raised), impulse-control disorders, hallucinations and low blood pressure on standing (FDA label, pramipexole, FDA label, ropinirole, NHS). Hallucinations were reported in 16.5% of people with advanced disease taking pramipexole versus 3.8% on placebo, and the risk rises with age (FDA label, pramipexole). The ropinirole label recommends tapering to avoid the fever-and-rigidity illness above, and notes withdrawal symptoms (insomnia, apathy, anxiety, depression, pain) after stopping dopamine agonists (FDA label, ropinirole).

3. MAO-B inhibitors

Selegiline and rasagiline block an enzyme that breaks down dopamine. Their effects are small compared with levodopa, but they can be used early or alongside it (NHS). In a 1993 trial of 800 people, selegiline (then called deprenyl) delayed the need for levodopa by about nine months (DATATOP trial, PubMed). Rasagiline’s label warns against combining it with meperidine, tramadol, methadone, other MAO inhibitors and many antidepressants (serotonin syndrome), and notes it can raise blood pressure (FDA label, Azilect). The Zelapar label describes selegiline as an add-on for people whose levodopa response has worsened (FDA label, Zelapar).

4. COMT inhibitors

Entacapone, opicapone and tolcapone keep levodopa from being broken down and are add-ons for “wearing-off” in later stages (NHS, FDA label, entacapone, FDA label, Ongentys). Entacapone caused diarrhea in 10% of people versus 4% on placebo, which can signal drug-induced colitis (FDA label, entacapone). Tolcapone has a boxed warning for potentially fatal liver failure, so it is generally reserved for people who can’t use other add-ons (FDA label, Tasmar).

5. Amantadine

Amantadine is less effective than levodopa (FDA label, amantadine); an extended-release form is approved for dyskinesia in people on levodopa (FDA label, Gocovri). Side effects include hallucinations, confusion, dry mouth, constipation and low blood pressure on standing; it shouldn’t be stopped suddenly (FDA label, amantadine).

6. Anticholinergics

Trihexyphenidyl is used with other medicines for Parkinson’s symptoms. People 65 and older should not usually take it because it is not as safe or effective as other options; dry mouth, constipation and confusion are common (MedlinePlus). Benztropine’s label warns of confusion, occasional visual hallucinations, and reduced sweating that can lead to heat stroke (FDA label, benztropine).

7. When pills aren’t enough

Apomorphine, injected under the skin, treats acute, intermittent “off” episodes in advanced disease; its label contraindicates ondansetron-type anti-nausea drugs because of profound low blood pressure and fainting (FDA label, Apokyn). The NHS also describes continuous pump infusions, including a medicine pumped into the stomach through a tube, for severe fluctuations (NHS).

8. Deep brain stimulation (DBS)

In DBS, electrodes in the brain send electrical pulses to the areas that control movement (MedlinePlus), powered by a pacemaker-like device in the chest. It doesn’t cure Parkinson’s, and isn’t suitable for everyone (NHS). In the PD SURG trial of 366 people, quality-of-life scores improved by 5.0 points with surgery plus medicine versus 0.3 with medicine alone at one year; 19% had serious surgery-related adverse events and one person died from the procedure (PD SURG trial, PubMed). A 2024 review of seven trials rated the evidence very low certainty and found more serious adverse events, mainly brain bleeds, confusion after surgery and device problems (meta-analysis, PubMed).

9. Focused ultrasound

Focused ultrasound uses imaging-guided sound waves to make a small lesion in a deep brain target on one side, without an incision. Sham-controlled trials found tremor improved 62% versus 22% in 27 people with tremor-dominant disease, with two cases of mild weakness (2017 trial, PubMed); a motor-score gain in 40 people with one-sided symptoms, with speech disturbance in 15 (persisting in 3) and gait disturbance in 13 (persisting in 2) (2020 trial, PubMed); and a response in 69% versus 32% of 94 people with dyskinesias or fluctuations, with slurred speech, gait, taste, vision and facial-weakness side effects. The authors called for longer, larger trials (2023 trial, PubMed). Ask your neurologist whether you might be a candidate; the lesions are permanent.

10. Physical, occupational and speech therapy

Physiotherapists ease stiffness and improve walking, occupational therapists help with daily tasks and a safe home, and speech and language therapists teach speaking and swallowing exercises (NHS). A Cochrane review of 39 trials (1,827 people) found physiotherapy improved walking speed, balance and clinician-rated disability in the short term, but not self-rated quality of life; most differences were small (Cochrane review, PubMed). For swallowing, a 2026 Cochrane review found rehabilitation evidence very uncertain, so start with a swallowing evaluation by a speech-language pathologist (Cochrane review, PubMed).

What it costs

How well it works — what to expect

Medicines sometimes help symptoms dramatically, and surgery can help severe cases (MedlinePlus), but nothing cures Parkinson’s, and the plan is revisited as needs change.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic is a licensed health profession whose treatment usually involves hands-on therapy, often spinal manipulation. We found no good evidence that chiropractic care treats Parkinson’s disease. What exists is thin: a case report of one woman who felt better after 9 months of chiropractic rehabilitation, with no comparison (case report, PubMed), and a 2024 crossover pilot of 14 people with Parkinson’s that tracked brain-wave recordings after one adjustment, not symptoms, whose authors urged caution (pilot trial, PubMed).

Avoid high-velocity neck manipulation. Neck manipulation has been linked to small tears in neck arteries that are rare but can lead to a stroke (NCCIH). Because balance problems and falls are common in Parkinson’s, MBHA suggests keeping any care gentle (soft-tissue work, stretching, posture advice), telling the practitioner about your condition and medicines, and not letting it replace your neurologist’s plan or exercise.

What it costs

About $90–$200 for a first appointment and $55–$100 for a self-pay follow-up visit (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is promising but not proven for Parkinson’s. The reviews below are mostly of small trials that added acupuncture to usual medicine:

There is an encouraging signal, but not enough high-quality evidence to say it treats the disease. If you try it, use it for comfort alongside your neurologist’s care.

Safety

Relatively few complications are reported, but nonsterile needles or improper delivery can cause infections, punctured organs and nervous-system injury (NCCIH). Choose a licensed acupuncturist, and get up slowly after sessions if you get dizzy on standing.

What it costs

About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has been proven to treat or slow Parkinson’s. The NHS says there is no clinical evidence that complementary treatments control the symptoms, that some can be harmful, and that they should not replace prescribed medicines (NHS).

Mucuna pruriens

This tropical legume naturally contains levodopa, so it is a real dopamine drug (review, PubMed). A small 2026 open-label trial in sub-Saharan Africa (32 untreated people, where levodopa is hard to get) found similar outcomes to standard levodopa-carbidopa over 12 months, with more side effects on mucuna (56% versus 37.5%, not statistically significant) (randomized trial, PubMed). Specialists caution that overuse and self-treatment have been linked to dyskinesia, compulsive medicine use and psychiatric problems, and badly prepared seeds to toxicity, and advise limiting use to trials or neurologist-led plans until long-term safety is clearer (review, PubMed, expert recommendations, PubMed). Levodopa labels also say not to add other levodopa preparations without asking your doctor (FDA label, Sinemet).

Antioxidants

Interactions with your medicines

Talk to your neurologist and pharmacist before taking any supplement or herb. We don’t list doses here.

Approach 5 of 6

Massage therapy

Massage doesn’t treat the cause of Parkinson’s, but it may ease tension, pain and stress, and some research hints at movement benefits.

  • 2022 meta-analysis: eight small studies (363 people) found therapeutic massage improved motor scores more than controls, but not daily living activities (meta-analysis, PubMed).
  • 2020 review: 12 studies suggested better relaxation, sleep, pain, anxiety and quality of life with several styles; one technique combined with acupuncture was linked to worse motor scores. The authors noted methodological concerns (systematic review, PubMed).

The evidence is encouraging for comfort and well-being but too limited to call massage a treatment for the disease.

Safety

The risk of harm appears low, but rare serious problems (a blood clot, nerve injury, bone fracture) have been reported, some after vigorous deep-tissue massage or in people at higher risk of injury, such as older adults (NCCIH). MBHA suggests a therapist who knows you have Parkinson’s, moderate pressure, and getting up slowly from the table.

What it costs

At one national chain, a 60-minute massage costs about $125–$160 for non-members at the locations The Pricer checked, and memberships run about $70–$90 a month for one session (The Pricer). Tips are extra.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build habits around your care team’s plan — always alongside medical care, never instead of it. Coaching doesn’t diagnose, adjust medicines or treat the disease.

Medicine routines

Levodopa is meant to be taken at regular intervals (FDA label, Sinemet), and timing slips easily: in a study of unplanned hospital stays, 51.7% of doses were given more than 30 minutes late (hospital study, PubMed). A coach can help you set reminders, carry a current medicine list, and prepare a one-page sheet with your dose times for hospital visits.

Symptom diary

The levodopa label notes that “wearing-off” can happen at the end of a dose interval and should be reported if it causes problems (FDA label, Sinemet). A diary of your best and worst times, meals, sleepiness, dizziness and mood gives your neurologist what they need.

Exercise, food, sleep and mood

Regular exercise relieves stiffness, improves mood and eases stress; the NHS suggests vigorous activity if symptoms are mild and gentler walking, stretching and strengthening if they are advancing (NHS). A coach can help you pick an activity (see the exercise section below) and keep to it. The NHS suggests more fiber and fluids for constipation, and bedtime-routine changes for insomnia (NHS). For low mood, see our Anxiety and Depression guides; support groups help many people (NHS). If you have thoughts of suicide, call or text 988 (988 Lifeline).

Care partners

Partners and carers often feel anxious or frustrated too; being open about how you feel and what would help can ease the strain (NHS). MBHA coaching cost estimate being researched.

Another approach

Medicines that can make Parkinson’s worse

Not every medicine is safe in Parkinson’s. These examples come from FDA labels and are not a complete list: check with your neurologist or pharmacist before any new prescription, over-the-counter product or hospital medicine. See also our Medication Safety guide.

In hospital, ask that your medicines be given on your schedule. A study of unplanned admissions found errors in the timing of time-critical Parkinson’s medicines at admission in about a third of cases (hospital study, PubMed).

Another approach

Exercise, tai chi, dance, boxing and speech therapy

Exercise is one of the best-supported things people with Parkinson’s can do. A Cochrane analysis of 154 trials (7,837 people) found benefits for most exercise types versus no exercise. Dance and gait, balance and functional training probably have a moderate benefit on motor signs, aquatic training probably a large benefit on quality of life, and there was little evidence that one type beats the others. Falls and pain were the most commonly reported problems (Cochrane review, 2024). Pick something you’ll keep doing, ideally in a program built for Parkinson’s.

Another approach

Preventing falls and dizziness on standing

A Cochrane review of 32 trials (3,370 people) found that exercise probably reduces the rate of falls in Parkinson’s by about 26%, and slightly reduces the number of people who fall; effects on fractures were uncertain (Cochrane review, 2022).

For more on home safety and other causes of unsteadiness, see our Balance guide.

Another approach

Constipation, sleep, mood and swallowing

Another approach

Driving and working

A review found driving is impaired in people with Parkinson’s compared with healthy drivers (evidence review, PubMed). A 2024 review of 15 guidelines found a driving evaluation should include movement, thinking, vision and sleep assessment and a medication review, and that most allowed conditional licenses (guideline review, PubMed).

  • Anyone who has had sudden sleep episodes or significant sleepiness on levodopa should not drive (FDA label, Sinemet).
  • Ask your neurologist when to be assessed. Rules differ by place; in the UK, people must tell the driving agency and their insurer but needn’t necessarily stop (NHS). Check your own state’s rules.
  • A diagnosis doesn’t mean you must stop working; many people keep working for years (NHS).

Another approach

Advanced Parkinson’s and planning ahead

Over time, medicines may stop controlling symptoms consistently. The NHS calls this complex Parkinson’s; it can still be helped by adjusting medicines under a specialist (NHS), and pumps or DBS may be considered (JAMA review, 2020). Hallucinations and dementia can occur (NHS).

Palliative care is for symptom relief and support at any stage, not only the end of life (NHS). In a trial of 210 people with Parkinson’s and related disorders, outpatient palliative care improved quality of life at 6 months and, by 12 months, was linked to less severe symptoms, more completed advance directives and less caregiver anxiety (randomized trial, PubMed). Consider writing down your wishes and talking with family early. Our ALS guide also covers advance care planning for another progressive nerve disease.

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