In this episode of The 518 Thrives Healthcast, Dr. Disha Spath, internal medicine physician and founder of Thrive Direct Primary Care, sits down with Dr. Kathrin LaFaver, a neurologist with expertise in movement disorders and Parkinson’s care.
Parkinson’s disease affects millions of families, but it is still widely misunderstood. Many people think Parkinson’s is only about tremors, but it can also affect movement, handwriting, smell, digestion, mood, sleep, blood pressure, and quality of life.
If you or someone you love has noticed a new tremor, slower movement, smaller handwriting, loss of smell, constipation, or changes in walking or balance, this episode gives a clear and practical explanation of what may be happening and when to seek medical guidance.
What Is Parkinson’s Disease?
Parkinson’s disease is a neurological condition that affects the brain cells that produce dopamine.
Dopamine is often associated with mood, motivation, and reward, but it also plays a major role in smooth movement. When dopamine-producing neurons are lost or damaged, movement can become slower, stiffer, and harder to control.
Dr. LaFaver explains that Parkinson’s disease can affect more than just movement. It can also involve mood changes, sleep changes, constipation, low blood pressure, bladder issues, and other symptoms connected to the autonomic nervous system.
The exact cause of Parkinson’s is still not fully understood. Some cases are genetic, but many are related to aging, environmental exposures, or a combination of factors.
Early Signs of Parkinson’s Disease
One of the key points in this episode is that Parkinson’s disease can start subtly.
Dr. Spath introduces a fictional patient named Tom, a 58-year-old man from the Capital Region whose wife starts noticing small changes. His hand trembles slightly at rest, he moves more slowly, his handwriting becomes smaller, he feels more tired, and he loses his sense of smell.
These are the types of early signs that can raise concern for Parkinson’s disease.
Common early signs discussed in this episode include:
- Resting tremor, often starting on one side of the body
- Smaller handwriting
- Slower movement
- Stiffness
- Shuffling gait
- Stooped posture
- Fatigue
- Loss of smell
- Constipation
- Restless sleep or acting out dreams
- Anxiety or depression that appears later in life
Dr. LaFaver also explains that Parkinson’s can sometimes be obvious to a trained neurologist because certain movement patterns are very recognizable.
Parkinson’s Tremor vs Essential Tremor
Not every tremor is Parkinson’s disease.
Dr. LaFaver explains that one of the main conditions doctors often compare Parkinson’s against is essential tremor.
With essential tremor, the tremor is usually more noticeable when someone is using their hands, such as while eating, drinking, or writing. The handwriting may look shaky or jagged.
With Parkinson’s disease, tremor is often more noticeable when the person is at rest. Parkinson’s can also cause handwriting to become smaller, a change called micrographia.
This distinction matters because different types of tremor may need different evaluation and treatment.
Parkinson’s Myths: Should Treatment Be Delayed?
One of the biggest myths Dr. LaFaver hears is that Parkinson’s treatment should be delayed because medication will only work for a limited number of years and then stop working.
She explains that this is not correct.
Treatment decisions should be based on how symptoms are affecting a person’s daily life. Some people with very mild symptoms may choose to wait before starting medication. But if symptoms are interfering with work, movement, safety, or quality of life, there is no reason to automatically delay treatment.
The goal of Parkinson’s treatment is to help patients maintain the best quality of life possible at every stage.
How Parkinson’s Disease Is Diagnosed
Parkinson’s disease is usually diagnosed through a combination of medical history and neurologic examination.
A neurologist may ask about:
- Tremor
- Walking changes
- Balance issues
- Handwriting changes
- Loss of smell
- Constipation
- Sleep changes
- Mood changes
- Stiffness or slowness
A physical exam may show movement changes that point toward Parkinson’s disease.
Dr. LaFaver also discusses additional testing that may be used when the diagnosis is less clear, including dopamine transporter scans and skin biopsy testing for abnormal alpha-synuclein proteins.
These tests are not always necessary, but they can be useful in certain cases, especially when symptoms are atypical or a person does not respond as expected to treatment.
Parkinson’s Disease Treatment Options
The main medication used for Parkinson’s disease is still carbidopa-levodopa.
Levodopa helps replace or support dopamine activity in the brain. It has been used for many years and remains one of the most effective medications for Parkinson’s movement symptoms.
Dr. LaFaver explains that levodopa can help with:
- Slowness
- Shuffling gait
- Tremor
- Stiffness
- Movement difficulty
However, medication may not improve every symptom. For example, loss of smell and handwriting changes may not fully respond to medication.
Possible side effects can include nausea, dizziness, lightheadedness, and blood pressure changes. These should always be discussed with a physician.
Exercise, Physical Therapy, and Speech Therapy for Parkinson’s Disease
Exercise is one of the most important parts of Parkinson’s care.
Dr. LaFaver explains that regular exercise can improve quality of life, help with symptom management, and may even slow disease progression.
A helpful exercise plan may include:
- Aerobic exercise
- Strength training
- Balance training
- Physical therapy
- Speech therapy
The episode also discusses Parkinson’s-specific therapy programs sometimes called “big and loud” therapy. These programs help people with Parkinson’s make their movements bigger and their voices stronger, because the brain may incorrectly perceive movement and speech volume.
For example, someone with Parkinson’s may feel like they are speaking normally, while family members notice their voice has become quieter.
Can Parkinson’s Disease Be Prevented?
There is no guaranteed way to prevent Parkinson’s disease, but lifestyle habits that support heart health and brain health may help reduce risk.
Dr. LaFaver shares that what is good for the heart is often good for the brain.
Helpful habits discussed include:
- Regular exercise
- Mediterranean-style eating
- Whole foods
- Limiting ultra-processed foods
- Washing fruits and vegetables well
- Reducing pesticide exposure when possible
- Avoiding excessive alcohol
- Supporting long-term brain health
The episode also explores the possible link between Parkinson’s disease and environmental exposures, including pesticides, paraquat, dry cleaning chemicals, and other toxins.
Parkinson’s Disease and Environmental Toxins
Dr. LaFaver discusses growing awareness around the role of environmental toxins in Parkinson’s disease.
While not every case has a clear cause, certain chemical and pesticide exposures may increase risk. The episode mentions paraquat, dry cleaning chemicals, Agent Orange exposure, agricultural exposure, and possible regional clusters.
This is especially relevant for communities in Upstate New York and the Capital Region, where agriculture, industrial history, and environmental exposures are part of the broader health conversation.
Breakthroughs in Parkinson’s Disease Treatment
Parkinson’s disease treatment continues to evolve.
Some newer and developing treatment options discussed in this episode include:
- Levodopa pumps
- Improved medication delivery systems
- Deep brain stimulation
- Stem cell therapy research
- Wearable devices for tremor management
- Research into dopamine-producing cell restoration
Dr. LaFaver explains that while Parkinson’s does not currently have a cure, there are more treatment options now than ever before, especially for people in more advanced stages of the disease.
Local Parkinson’s Support in the Capital Region
For people living with Parkinson’s, Dr. LaFaver emphasizes the importance of building a care team.
A support team may include:
- Neurologist
- Primary care physician
- Physical therapist
- Speech therapist
- Family members
- Caregivers
- Exercise programs
- Local support groups
The episode mentions HelpForPD.org, a Capital Region resource that shares information about support groups, exercise classes, educational events, and local Parkinson’s resources.
The YMCA is also mentioned as offering strong group exercise support for people with Parkinson’s, including free membership opportunities for people with Parkinson’s and their families at a local YMCA location.
Key Topics Covered in This Episode
- What Parkinson’s disease is
- Early symptoms of Parkinson’s disease
- Resting tremor vs essential tremor
- Loss of smell and constipation as early warning signs
- REM sleep behavior disorder and Parkinson’s
- Mood changes, anxiety, and depression in Parkinson’s
- How neurologists diagnose Parkinson’s disease
- Dopamine transporter scans and skin biopsy testing
- Levodopa and Parkinson’s medication
- Why Parkinson’s treatment does not always need to be delayed
- Exercise and Parkinson’s disease
- Physical therapy and speech therapy for Parkinson’s
- Parkinson’s prevention and brain health
- Environmental toxins and pesticide exposure
- Deep brain stimulation and stem cell research
- Parkinson’s support groups in the Capital Region
Resources Mentioned
- Dr. Kathrin LaFaver on LinkedIn
- Michael J. Fox Foundation
- Parkinson’s Foundation
- The Parkinson’s Plan by Dr. Ray Dorsey and Dr. Michael Okun
- HelpForPD.org
- Thrive Direct Primary Care
- Follow: @518ThriveHealth
This Episode is Sponsored By…
Experience healthcare the way it was meant to be: personal, accessible, and focused on prevention. Thrive Direct Primary Care offers longer visits, same-week or next-day appointments, direct access to your doctor by phone or text, transparent monthly pricing, and a focus on early detection and real relationships.
Visit www.ThriveConciergeCare.com or follow @518ThriveHealth to learn more.
Key Takeaways
- Parkinson’s disease is more than just a tremor.
- Early signs can include smaller handwriting, slower movement, loss of smell, constipation, and sleep changes.
- Treatment does not always need to be delayed if symptoms are affecting daily life.
- Levodopa remains one of the most effective medications for Parkinson’s movement symptoms.
- Exercise may be one of the most powerful tools for managing Parkinson’s disease.
- Environmental toxins and pesticide exposure may play a role in Parkinson’s risk.
- People with Parkinson’s benefit from a care team, support groups, and local resources.
Frequently Asked Questions About Parkinson’s Disease
What are the first signs of Parkinson’s disease?
Early signs may include a resting tremor, smaller handwriting, slower movement, stiffness, loss of smell, constipation, fatigue, mood changes, and changes in sleep.
Does Parkinson’s disease always cause tremors?
No. Tremor is common, but not everyone with Parkinson’s has a noticeable tremor. Some people first notice slowness, stiffness, balance changes, or smaller handwriting.
How is Parkinson’s disease diagnosed?
Parkinson’s disease is usually diagnosed through a medical history and neurologic exam. In some cases, doctors may use imaging or specialized tests if the diagnosis is unclear.
What is the difference between Parkinson’s tremor and essential tremor?
Essential tremor is often more noticeable during movement, such as eating, drinking, or writing. Parkinson’s tremor is often more noticeable when the body is at rest.
Can Parkinson’s disease be prevented?
There is no guaranteed way to prevent Parkinson’s disease. However, regular exercise, a healthy diet, reducing toxin exposure, and supporting heart and brain health may help reduce overall risk.
Does exercise help Parkinson’s disease?
Yes. Exercise can improve quality of life, help manage symptoms, support balance and strength, and may possibly slow progression.
When should Parkinson’s treatment start?
Treatment depends on how symptoms affect daily life. If symptoms are interfering with function, safety, work, or quality of life, treatment may be helpful and should be discussed with a neurologist.
About Thrive Direct Primary Care
Thrive Direct Primary Care is a membership-based primary care practice founded by Dr. Disha Spath, MD, FACP — a board-certified internal medicine physician with over 14 years of experience. Thrive celebrated its grand opening in April 2026 in Latham, NY.
Thrive is currently accepting new members.
📍 711 Troy Schenectady Road, Suite 207, Latham, NY 12118 📞 (518) 490-5990 🌐 www.thriveconciergecare.com
Schedule a complimentary Meet & Greet to learn if Thrive is the right fit for you and your family.
About The 518 Thrives Healthcast
The 518 Thrives Healthcast is a podcast dedicated to bringing evidence-based, locally relevant health information to families across New York’s Capital Region — the 518. Each episode features conversations with trusted local experts on topics that matter to our community.
New episodes drop regularly. Subscribe wherever you listen to podcasts.
Medical Disclaimer: This podcast is for educational and informational purposes only and does not constitute medical advice. The scenarios discussed are not based on real individuals. Always consult a qualified healthcare provider for personal medical guidance.
Music Credit
Justin Varnes Quartet: Evolution of the Pack
