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Shakes, Shivers & Tremors; Understanding Parkinsons

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11 September 2025

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3 minute read

Shakes, Shivers & Tremors; Understanding Parkinsons

By Dr. Hasnur Zaman Bin Hashim

When people think of Parkinson’s disease, they often picture trembling hands. But for many, the early signs involve more than just movement—constipation, trouble sleeping, or even a fading sense of smell can appear before the shaking begins. Subtle at first, these symptoms often go unnoticed until the disease has progressed. To shed light on this complex condition, we spoke with Dr. Hasnur Zaman Hashim, Consultant Internal Medicine and Neurologist at Columbia Asia Hospital – Klang, about what Parkinson’s really is, how to recognize it early, and why timely treatment matters.

What Is Parkinson’s Disease? How Does It Affect the Brain?

“Parkinson’s disease, simply put, is caused by a lack of dopamine in the brain. Dopamine is a neurotransmitter— a chemical messenger that transmits signals between nerve cells in the brain. It plays a crucial role not only in regulating movement but also in influencing emotions and the body’s perception of its surroundings. A patient with low dopamine levels will experience both motor symptoms (related to movement) and non-motor symptoms, such as depression and anxiety.”

What Are the Main Signs and Early Warning Signs to Look Out for?

Parkinson's disease symptoms include trembling, constipation, and loss of sense of smell.

“Normally, motor symptoms of Parkinson’s disease are easily noticed by the patient. These symptoms include tremors (shaking), body rigidity, slowed movements that can be observed during activities like walking or responding to questions, and instability, which makes the patient prone to falls. However, non-motor symptoms can appear earlier, often going unnoticed because the characteristic motor symptoms have not yet developed. Examples of non motor symptoms include anxiety, a reduced sense of smell, depression, and constipation. Many people may not realize they have Parkinson’s disease at this stage due to the absence of noticeable motor symptoms.”

What Causes Parkinson’s Disease, and What Are the Risk Factors? Can This Disease Be Prevented if Someone Has the Risks?

“Actually, up until now, we still do not know the exact cause of idiopathic Parkinson’s disease. That is why it is called ‘idiopathic,’ meaning the cause remains unknown. However, there are forms of Parkinson’s disease with a high incidence rate within families, especially when it begins at a young age. This type of Parkinson’s disease is believed to be related to genetic predisposition. Unfortunately, Parkinson’s disease cannot be prevented as of now.”

How Is Parkinson’s Disease Diagnosed, and Why Is It Important to Catch It Early?

“Parkinson’s disease is diagnosed through a patient’s medical history and an examination for characteristic features of the disease.Certain investigations are done to rule out other causes of parkinsonism (conditions that resemble Parkinson’s disease), such as stroke, hypothyroidism, and Wilson’s disease. Early diagnosis is crucial, as patients with Parkinson’s disease can maintain a good quality of life if started on medication promptly. Unfortunately, the condition is often misdiagnosed by non neurologists. I have a patient who consulted multiple doctor and underwent endoscopic procedures for constipation over many years, only to later discover that Parkinson’s disease was the underlying cause. He suffered from constipation for years because the symptoms of Parkinson’s disease were not properly recognized.”

What Treatments Are Available, and How Can They Help Improve Life for People With Parkinson’s?

“There are plenty of medications available for Parkinson’s disease, primarily to ensure the availability of dopamine in the body. Examples include L-dopamine and dopamine agonists, which help ensure a sufficient dopamine supply. Other medications are also available to improve symptoms; for instance, to reduce tremors. Nowadays, there are various medication options even for late-stage Parkinson’s disease, and in certain cases, surgical interventions can also be offered. That is why patients with Parkinson’s disease are expected to have a good quality of life with the right choice of treatment.”

How Can People With Parkinson’s Manage Their Daily Symptoms and Stay As Active as Possible? Are There Any Devices That They Can Use?

“With the right medications, patients can stay active and function like others. Some studies suggest that staying active and engaging in activities like exercise, dancing, and yoga may help slow the progression of Parkinson’s disease. Devices such as canes, walking frames, and medication reminders are sometimes used to support patients, especially as the disease becomes more severe.”

What New Research Is Being Done on Parkinson’s Disease, and Could Better Treatments or a Cure Be on the Way?

“Nowadays, scientists are working to find a cure for Parkinson’s disease. However, like other neurodegenerative diseases, even preventing its progression remains far from reality. Nevertheless, the medications available to manage symptoms are highly effective, and with treatment, patients’ quality of life can significantly improve.”

Can You Share Some Cases Which You Have Personally Seen i.e. the Worst Case/ the Best Outcome.

“Recently, I saw a patient who had been suffering from Parkinson’s disease for five years. His life was miserable, as he had been diagnosed with anxiety and chronic constipation by doctors. What was missed, however, was that he had never been properly diagnosed with Parkinson’s disease. As a result, he did not have a good quality of life for five years because the right medication was not started.”

How Can Caregivers Best Support Someone With Parkinson’s, and What Advice Do You Have for Them?

“Caregivers play a crucial role in supporting Parkinson’s patients, not only due to mobility issues but also because, as mentioned, these patients experience non motor symptoms such as depression. Both motor and non motor symptoms require continuous physical and emotional support. My advice to caregivers is to educate themselves about Parkinson’s disease and gather as much information as possible to provide better care.”

While Parkinson’s disease remains a challenge with no known cure, understanding its signs and seeking early treatment can make a significant difference. For those affected—whether patients, caregivers, or loved ones knowledge is power. The more we recognize and support those living with this condition, the better we can help them maintain their quality of life.

This article first appeared in HealthToday, 16 July 2025.

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11 September 2025

•

3 minute read

Shakes, Shivers & Tremors; Understanding Parkinsons

By Dr. Hasnur Zaman Bin Hashim

Dr. Hasnur Zaman Bin Hashim

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