Parkinson's Disease

Parkinson's disease is a progressive neurodegenerative disorder caused by the loss of dopamine-producing neurons in the substantia nigra, with the abnormal accumulation of alpha-synuclein protein. It is defined clinically by bradykinesia — slowness of movement — together with rest tremor and/or rigidity, and it involves a great deal more than movement.

Two things are worth knowing early. First, the disease often announces itself years or decades before the tremor: acting out dreams during sleep (REM sleep behaviour disorder), a lost sense of smell, and long-standing constipation are among the strongest prodromal signs known in neurology — which is why the gut and Parkinson's now appear in the same sentence. Second, no treatment has been shown to slow the disease, and the supplements most often sold for it — coenzyme Q10 and creatine — have both been tested in large trials and both failed. Exercise is the only intervention with a serious claim to modify its course, and even that claim is moderate rather than proven.

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   FoundationBrain & Cognitive HealthThe best place to understand what actually protects the brain — and why most nootropics don't.
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   BiomarkerVitamin B12A reversible cause of cognitive and neurological symptoms
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   Signal RecordCoenzyme Q10 (CoQ10)Ubiquinone / ubiquinol — mitochondrial electron carrier
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   Body SystemBrainCognition, mood, memory, and neurological health.
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   ConditionChronic ConstipationInfrequent, difficult, or incomplete bowel movements

1. Recognize risk factors
2. Get diagnosed
3. Track key biomarkers
4. Lifestyle first
5. Evidence-based treatment
6. Long-term monitoring

An orientation to how this topic is typically approached — not medical advice.

• Exercise, vigorously and regularly — this is the single most important thing on the list
• Resistance and balance training to reduce falls
• Manage constipation actively; it is a symptom of the disease, not an inconvenience
• Protect sleep and have REM sleep behaviour disorder assessed
• Guard against falls and fractures — bone health matters more here than most people realise

Levodopa is the most effective symptomatic treatment for Parkinson's disease; the belief that early initiation accelerates motor complications is not supported by the trial evidence, and levodopa-sparing strategies are no longer favoured. No pharmacological or nutritional intervention has demonstrated disease modification. Large randomised trials of high-dose coenzyme Q10 (halted for futility) and of creatine (no benefit on clinical progression) were negative, as were trials of vitamin E. Exercise — particularly high-intensity aerobic training — improves motor function, balance, and quality of life, and randomised work has shown a signal of slowed motor progression; confidence in disease modification is moderate. Deep brain stimulation has strong evidence for motor fluctuations in selected patients. REM sleep behaviour disorder, hyposmia, and constipation are established prodromal features, frequently preceding motor symptoms by years.

• MDS Clinical Diagnostic Criteria for Parkinson's Disease
• NICE guideline: Parkinson's disease in adults
• QE3 trial of coenzyme Q10 in early Parkinson's disease (halted for futility)
• NET-PD LS-1 long-term creatine trial in Parkinson's disease (negative)
• SPARX randomised trial of exercise intensity in de novo Parkinson's disease