Parkinson’s Disease: Signs, Treatment, and Guidelines for Care in Canada

This post includes excerpts from the Canadian Guideline for Parkinson Disease, 2nd Edition, published in the Canadian Medical Association Journal on September 9, 2019. Authorship, citations, and additional resources are listed at the end of this article.

Parkinson’s disease is one of those conditions that most people have heard of, but few fully understand until it touches their lives or the lives of someone they love. It’s more than just tremors. It affects movement, mood, sleep, thinking, and the rhythms of everyday life. If you or a loved one has recently been diagnosed, or if you’re simply looking to better understand what Parkinson’s care looks like in Canada, this post is for you.

What Is Parkinson’s Disease?

Parkinson’s disease is a progressive neurological condition, meaning it develops gradually over time and affects the nervous system. While it’s most commonly associated with physical symptoms like shaking or stiffness, it can also influence mood, sleep, cognition, and overall quality of life in ways that aren’t always visible from the outside.

The information in this post is drawn from the Canadian Guideline for Parkinson Disease (2nd Edition), published in the Canadian Medical Association Journal in 2019. Parkinson Canada contributed to this guideline, which outlines best practices for diagnosis, treatment, and long-term management across Canada. Our goal here is to make that guidance accessible and easy to understand.

Recognizing the Early Signs

Healthcare providers may suspect Parkinson’s disease when a person develops a combination of the following symptoms:

  • Tremors: Shaking, often in the hands or fingers, that may be most noticeable at rest

  • Muscle stiffness: A sense of rigidity or reduced flexibility in the limbs or trunk

  • Slowed movement (bradykinesia): Everyday tasks that once felt automatic start to take more time and effort

  • Balance difficulties: A greater risk of stumbling or falling

  • Difficulty when walking: Shorter steps, shuffling, or reduced arm swing

Diagnosis is primarily a clinical process, meaning doctors rely on a person’s medical history and physical examination rather than imaging. CT scans and MRIs are not routinely used to confirm Parkinson’s disease. In younger individuals, genetic testing may be considered in specific circumstances, and referral to a movement disorders specialist may be recommended.

At present, no therapies have been proven to stop or reverse the underlying neurodegeneration associated with Parkinson’s disease. However, many approaches are available to manage symptoms and support quality of life.

The Importance of Good Communication in Parkinson’s Care

Something that might not come to mind right away when thinking about a neurological condition is communication, but the Canadian guideline highlights it as a cornerstone of good care.

eople living with Parkinson’s disease should actively participate in decisions about their own treatment. Healthcare providers should share information clearly and consistently, both in conversation and in writing whenever possible. Family members and caregivers should also be included in care discussions and connected with available supports early on, since Parkinson’s affects not only the individual but everyone in their circle of care.

In practice, this means:

  • Patients take part in discussions about their treatment options rather than simply receiving instructions.
  • Healthcare providers reinforce what is discussed during appointments by providing written information.
  • Families and caregivers receive information about the condition and the supports available to them.

Invisible Non-Motor Symptoms

Visual ques such has the shaking of hands and difficulty walking are indicators that people associate with Parkinson’s Disease. These traits are known as movement disorders, and they are only part of the symptoms that Parkinson’s patients experience. Infact, the symptoms that are not visible, non-motor symptoms, may begin years before the motor symptoms begin.

Depression
Depression commonly occurs in people with Parkinson’s and can affect mood, motivation, and energy levels.It’s not simply a reaction to receiving a difficult diagnosis; it can be a direct feature of the disease itself. Support may include counselling, medication, or a combination of both, and it’s just as important to address as any physical symptom.

Low Blood Pressure When Standing (Orthostatic Hypotension)
Some Parkinson’s patients experience dizziness or lightheadedness when standing up. A temporary drop in blood pressure causes these symptoms. Because blood pressure drops can lead to fainting, healthcare providers should monitor them. Medications and practical lifestyle adjustments can help manage low blood pressure, including:

  • Avoiding large meals

  • Limiting alcohol

  • Increasing fluid and salt intake as recommended by a healthcare provider

  • Rising slowly from sitting or lying positions

  • Slightly elevating the head of the bed during sleep

Drooling (Sialorrhea)
Reduced swallowing frequency can lead to saliva pooling in the mouth, which can be both uncomfortable and socially difficult. Botulinum toxin A injections into the salivary glands are one option that may help reduce symptoms.

Sleep Disturbances
Sleep problems are very common in Parkinson’s and can take different forms: insomnia, excessive daytime sleepiness, or a condition called REM sleep behaviour disorder (RBD), where a person physically acts out their dreams during sleep. RBD can actually appear before a Parkinson’s diagnosis in some cases. Treatment options vary by symptom but may include melatonin or clonazepam under clinical guidance.

Cognitive Changes
Some individuals experience changes in memory, attention, or thinking abilities as Parkinson’s progresses. In turn,  a patient’s healthcare team may prescribe medications such as rivastigmine or donepezil, often alongside other management strategies.

Treatment Options: What Can Help

While there is currently no cure for Parkinson’s disease, treatments can significantly reduce symptoms and improve quality of life. Here’s a broad overview of the approaches available.

Medication

Healthcare providers introduce Levodopa when clinically appropriate because it remains the most effective medication for managing motor symptoms. Levodopa works by replenishing dopamine, which is the chemical within the brain that Parkinson’s lowers over time.

Physical Activity and Rehabilitation
Healthcare providers strongly encourage regular physical activity throughout the course of Parkinson’s disease. Exercise helps maintain mobility, strength, balance, and overall function. Many people also benefit from working with physiotherapists and occupational therapists, especially those with experience in Parkinson’s care. These professionals can help people adapt their routines and environment to stay as independent and active as possible.

Advanced Therapies
When standard medications no longer control symptoms effectively, healthcare providers may consider more advanced treatment options. These include deep brain stimulation (DBS), a surgical procedure that uses electrical impulses to regulate abnormal brain activity, as well as medication infusion therapies that deliver treatment continuously throughout the day.

Planning for the Long Term

Parkinson’s disease is a lifelong condition, and care needs evolve over time. The Canadian guideline highlights that healthcare providers can introduce supportive and palliative care at any stage of the disease, not only in the late stages. This kind of care focuses on comfort, quality of life, and making sure that a person’s values and wishes are guiding their care.

Additional Information and Support

Healthcare providers based this post on the Canadian Guideline for Parkinson Disease, 2nd Edition, published in the Canadian Medical Association Journal on September 9, 2019.

Citations

¹CMAJ 2019 September 9;191:E989-1004. doi: 10.1503/cmaj.181504, Canadian Medical Association Journal, VOLUME 191 | ISSUE 36

²David Grimes MD, Megan Fitzpatrick MSc, Joyce Gordon BSc, Janis Miyasaki MD, Edward A. Fon MD, Michael Schlossmacher MD, Oksana Suchowersky MD, Alexander Rajput MD, Anne Louise Lafontaine MD, Tiago Mestre MD, Silke Appel-Cresswell MD, Suneil K. Kalia PhD, Kerrie Schoffer MD, Mateusz Zurowski MD, Ronald B. Postuma MD MSc, Sean Udow MD, Susan Fox PhD, Pauline Barbeau MSc, Brian Hutton PhD

³CMAJ 2019 September 9;191:E989-1004. doi: 10.1503/cmaj.181504, page 3 visual summary