Parkinson’s disease: The brain disorder that often begins silently years before tremors appear | India News
Meet Mr Bipin. He is close to 62. These days, he pauses before signing his name, his hand shaking as he tries to steady the pen. What was once an easy task now takes a lot of work. His gait is slowed, his steps are shortened, and he sometimes stumbles or loses balance without warning.Mr. Bipin, who once never missed an evening walk around the house, now skips it almost every day. His body often stiffened, his face less expressive than before. At night, his sleep is restless, and during the day, an overwhelming fatigue and anxiety leave him constantly restless and drained.At first, it’s easy to dismiss the symptoms as aging, stress, or just “weakness,” as some say. Sudden tremors attract curious attention, slowness attracts impatience, sometimes even from members of his family. Conversations begin to feel strained, and gradually, he begins to withdraw, unwilling to explain what he himself does not fully understand.For months, the symptoms remain nameless, often dismissed as stress or old age, until a clinical diagnosis brings hard clarity: he has Parkinson’s disease, one of the fastest-growing neurological conditions worldwide, affecting nearly 10 million people worldwide.
What is Parkinson’s disease?
According to the WHO, Parkinson’s disease (PD) is a progressive neurodegenerative brain disorder that causes problems with movement, mental health, sleep, pain and other health problems.It develops when nerve cells in a part of the brain called the substantia nigra are gradually damaged or die. These cells normally produce dopamine, a chemical that helps coordinate smooth and controlled muscle movements. As dopamine levels decrease, the brain’s ability to control movement is impaired.The condition usually affects motor skills, coordination, and causes tremors (involuntary tremors), slowness of movement (bradykinesia), muscle stiffness, and problems with balance and coordination. Over time, people may also experience changes in posture, decreased facial expression, slurred speech, and shorter handwriting. Beyond movement-related symptoms, Parkinson’s can also affect sleep, cognition, hearing, mood, memory, and overall energy levels.Parkinson’s disease is long-term and progressive, meaning that symptoms usually get progressively worse over time, although the rate of progression varies widely from person to person.
What causes Parkinson’s disease?
The exact cause of Parkinson’s disease is still not fully understood. It is now widely recognized that the condition develops due to a combination of biological changes in the brain with genetic and environmental risk factors over time.The disease is rooted in the gradual loss of dopamine-producing neurons in an area of the brain called the substantia nigra. This leads to a decrease in dopamine levels, which disrupts brain circuits responsible for smooth and coordinated movement.Another key feature of Parkinson’s is the abnormal accumulation of a protein called alpha-synuclein. This protein forms clumps inside nerve cells known as Lewy bodies and is strongly associated with nerve cell dysfunction and degeneration.Researchers believe that several factors may contribute to these changes, including age, genetic susceptibility in a few cases, and environmental exposures such as pesticides and certain toxins. However, no single cause has been identified, and in most patients, the disease appears to develop sporadically without a clear trigger.
Beyond tremors: the hidden side of Parkinson’s
Parkinson’s is often associated with visual symptoms: tremors, stiffness, and slowness of movement. But clinically, it is a progressive neurological condition that begins deep in the brain. It develops when nerve cells that produce dopamine, a chemical needed for smooth, coordinated movement, slowly deteriorate. As dopamine levels decrease, the brain’s ability to control movement and coordination weakens.
Parkinson’s disease
Although motor symptoms are most recognized, the disease extends beyond movement. Non-motor symptoms, often subtle and easy to miss, may appear years before tremors or stiffness. These include sleep disturbances, fatigue, mood swings, loss of smell, and cognitive slowing, making Parkinson’s a behavioral and emotional condition as much as a physical one.
Non-motor signs: missed early warning signs
Speaking to TOI, Dr Riaz Ahmed Syed, a pediatric neurologist with over four decades of experience, explained that Parkinson’s is often misunderstood as a movement disorder alone, when a large part of its understanding comes from less visible symptoms.“Most people think of tremors, rigidity and slowness. But a large part of the disease lies in non-motor symptoms, which are often missed,” he said.According to him, mood-related changes such as anxiety, depression and apathy along with slowed thinking and cognitive decline are common but under-recognized. Patients may experience dystonia, constipation, urinary urgency, sleep disturbances, and difficulty swallowing, which may appear years before classic motor symptoms.
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“These symptoms are non-specific and often overlooked. But if detected early, we can start treatment sooner and manage the situation better,” he added.
Treatment and management of symptoms
Parkinson’s is a progressive and degenerative condition, meaning symptoms tend to get worse over time. Currently, there is no definitive cure, but treatment can significantly improve quality of life.“In younger patients, we can start with dopamine agonists, which help increase dopamine activity in the brain. After the age of 50, drugs like levodopa are more commonly used,” explains Dr. Syed.Other drugs including MAO inhibitors and amantadine may also be prescribed depending on the patient’s condition. In more advanced cases, therapies such as deep brain stimulation can help control severe tremors.“The focus should be on consistent medication, regular follow-up and proper management rather than looking for a permanent cure,” he said.
Who is at risk?
Age remains the strongest risk factor, with most cases developing after age 60. However, Parkinson’s is not exclusively a disease of the elderly; Early onset can occur in cases, sometimes even before 50.The exact cause is still unclear, but experts believe a mix of genetic predisposition and environmental exposure plays a role. People with a family history of Parkinson’s may be at higher risk, as may exposure to certain toxins or pesticides over time.Men are slightly more likely to develop the condition than women, although the reasons are still being studied.Despite these risk factors, many patients like Mr Bipin develop Parkinson’s without any clear warning or identifiable cause.
The Invisible Burden: Caregiving and Social Stigma
Beyond the physical symptoms is a deeper, often unspoken challenge: social and emotional isolation.Patients may gradually withdraw from social interaction, not because they want to, but because the disease makes communication and movement difficult. Slow speech, reduced facial expression, and physical limitations may be misinterpreted as disinterest or detachment.“Patients withdraw, and families sometimes don’t understand why,” Dr. Syed said.Where awareness is limited, this can lead to stigma, misunderstanding and delayed care. At the same time, it can add emotional and physical toll on families taking on caregiver roles, managing medications, daily routines, and emotional needs.
Daily challenges
Parkinson’s affects even simple daily activities. There may be difficulty getting up from a chair, turning while walking, going to the bathroom or swallowing food.“A misconception is that patients should try to move quickly. This can actually increase the risk of falling,” warns Dr Syed.He emphasizes adaptation to the environment, from using assistive devices to changing dietary habits. Soft or semi-solid foods can help those who have trouble swallowing, while fiber-rich foods can reduce constipation, a common problem.Physiotherapy and rehabilitation, he adds, are essential to maintaining mobility and independence.
“The Million Dollar Question”: Can Parkinson’s disease be cured? ?
Dr. Syed addressed one of the most frequently asked concerns, which he referred to as the “million dollar question” asked by patients and families about whether there is a permanent cure for Parkinson’s disease. He explained that it is a progressive, degenerative disorder that worsens over time and currently has no specific cure, although treatment can help manage symptoms and improve quality of life.“The million dollar question is, Doctor, can I have a permanent cure? We all know that Parkinson’s disease is a progressive disorder, a degenerative disorder, and patients continue to deteriorate over the years. Parkinson’s has a regressive process. But the million dollar question is: Can I have a permanent cure? Unfortunately, at this point in time for Parkinson’s disease, there is no cure.“Although there is currently no cure, a combination of medications, physical therapy, lifestyle adjustments, and in some cases, surgical treatment can help manage symptoms and improve quality of life.
Why this conversation is important now
On World Parkinson’s Day, the focus is not just on the disease, but on awareness, early detection and support measures.According to a study titled Neuropalliative care for Parkinson’s disease in IndiaThe prevalence of Parkinson’s disease (PD) in India is about 10% of the global burden, making it a significant public health concern.Experts at the 6th International Annual Symposium-2026 in Kerala said that India is expected to see an increase in Parkinson’s cases in the coming years, which could be an increasing burden on families and caregivers. Yet awareness of early symptoms and non-motor symptoms remains low.The need is not just for better treatment, but for earlier recognition, reduced stigma, and stronger support networks, so that patients don’t have to navigate the situation in silence.
Looking ahead
Although there is no cure yet, ongoing research offers cautious optimism. Stem cell research is exploring new drug delivery systems and emerging therapies, particularly with induced pluripotent stem cells and human pluripotent stem cells.For now, doctors emphasize a holistic approach combining medication, mental health support, physiotherapy and family involvement.“Parkinson’s is not just about tremors or movement. It affects the entire life of the patient and family,” said Dr. Syed.Parkinson’s disease is increasingly recognized as a condition that begins long before visible symptoms such as tremors appear. Evidence shows that more than half of the brain’s dopamine-producing neurons may already be lost at the time of clinical diagnosis, indicating how silently the disease progresses in its early stages.This makes early recognition of non-motor symptoms such as sleep disturbances, loss of smell, mood swings and constipation especially important. Greater awareness among families and caregivers can help ensure earlier treatment, timely diagnosis, and better symptom management.At the same time, experts emphasize that medical care alone is not enough. Social acceptance and understanding play an important role, as patients often experience isolation due to slow speech, reduced facial expression and movement difficulties that are often misunderstood. Reducing stigma can go a long way to improving mental well-being and quality of life.
