Shake and Freeze Day: Raising Awareness for Parkinson's Disease

Every year Shake and Freeze Day (also known as “Shorts Day”) is observed on December 21st—the first day of winter and the shortest day of the year. Shakeandfreeze.com describes how on this day participants wear shorts (even in cold weather) as a symbolic gesture of “shaking” and “freezing” to draw attention to the two hallmark symptoms of Parkinson’s: tremor (shaking) and freezing of gait (temporary inability to move). The date also marks the death anniversary of James Parkinson—the physician who first described the disease later named after him. The campaign is a mix of raising awareness and fundraising toward research and support organizations dedicated to Parkinson’s Disease. The National Institute of Neurological Disorders and Stroke (NIH), Mayo Clinic, Cleveland Clinic, and the Michael J. Fox Foundation provide the following, detailed information about Parkinson's Disease.

What is Parkinson’s Disease?

Parkinson’s disease (PD) is a progressive movement disorder of the nervous system. It causes nerve cells in parts of the brain to weaken, become damaged, and die leading to tremors, stiffness, impaired balance, and movement difficulties. The condition arises because of loss of neurons in a region near the base of the brain called the substantia nigra. Neurons there normally produce the neurotransmitter dopamine, which is critical for smooth, coordinated movement. By the time symptoms appear, many dopamine-producing neurons have already been lost. The damaged brain cells in people with PD often contain abnormal clumps of protein, known as Lewy bodies, which include the protein alpha-synuclein. The accumulation of these materials is believed to play a role in neuron death.

Symptoms of Parkinson’s Disease:

Symptoms vary widely among individuals and often begin gradually.

Motor (Movement-Related) Symptoms:

• Tremor: Shaking of muscles while they're at rest, including a “pill-rolling” motion in the hands.

• Slowness of movement (bradykinesia): Difficulty initiating and carrying out movement, including slow walking and reduced ability to perform tasks.

• Muscle rigidity or stiffness: Resistance in the muscles that leads to short, jerky movements.

• Impaired posture and balance: Stooped posture, shuffling gait, difficulty turning, reduced arm swinging with walking, and increased risk of falls are common.

• Reduced facial movement: Less facial emotion (“masked face”), a soft voice (hypophonia), monotone, slurred speech, and difficulty with chewing or swallowing (dysphagia) can occur.

Non-Motor symptoms:

• Sleep disturbances: Restless sleep, nightmares, and daytime drowsiness are common.

• Autonomic nervous system disturbances: Constipation, urinary incontinence, and orthostatic hypotension (low blood pressure with standing) can occur.

• Cognitive and mood changes: Disorders such as depression, anxiety, and memory issues are common, especially as the disease progresses.

Stages of Parkinson’s Disease:

While there’s no universally accepted “stage 1–5” classification in all cases, a commonly referenced progression suggests:

• Early stage: Mild symptoms, often on one side of the body, may go unnoticed for months or years.

• Mid-stage: Symptoms worsen gradually until tremor, rigidity, slowness, and balance problems make activities of daily living difficult.

• Advanced stage: Greater difficulty walking, increased risk for falls, impaired speech and/or swallowing, cognitive decline or dementia, and non-motor complications are experienced.

Some specialized clinics, such as early-onset centers, treat cases where PD begins under age 55. The disease course and care needs can differ with each patient.

Causes and Risk Factors:

• The exact cause of Parkinson's Disease remains unknown, but research suggests a combination of genetic and environmental factors contributes to PD.

• Abnormal accumulation of proteins (alpha-synuclein) forming Lewy bodies inside neurons is a hallmark of PD, though why this happens is not fully understood.

• The death or dysfunction of dopamine-producing neurons in the substantia nigra reduces the brain’s ability to coordinate smooth movement.

• Older age leads to an increased risk of developing PD.

• Having close relatives with PD increases the risk, but this accounts for only a fraction of diagnosed cases.

• Men are more likely than women to develop Parkinson’s.

• Prolonged exposures to certain toxins, pesticides, or other environmental factors may increase risk.

Diagnosis:

• There is no definitive lab test for Parkinson’s Disease. Diagnosis is based on a careful history and neurological examination to evaluate movement, balance, gait, reflexes, and other symptoms.

• Blood tests, genetic testing, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) scans are done to rule out other possible causes of symptoms.

• A good response to dopamine-boosting therapy (e.g., levodopa) is often used to support the diagnosis of PD rather than other “parkinsonism” conditions.

Treatment and Management:

While there is currently no cure for Parkinson’s, several approaches can help manage symptoms and improve quality of life.

• Medications

o Levodopa, often combined with other drugs, remains the most effective treatment by boosting dopamine levels in the brain.

o Other medications include dopamine metabolism blockers or inhibitors, and adenosine blockers to enhance or prolong the effects of dopamine-based therapy.

• Surgical treatment

o For some individuals, deep brain stimulation (DBS)—an implanted device delivering a mild electrical current to targeted brain regions—may help when medications are no longer effective. This is often considered in advanced stages or when tremors are difficult to control.

• Supportive therapies, lifestyle & holistic care

o Physical therapy, occupational therapy, and speech therapy can help maintain mobility, manage daily tasks, and address speech/swallowing issues.

o Complementary therapies, such as gentle exercise, stretching, posture training, and balance exercises (tai chi or yoga), may help with flexibility, stability, muscle tension, and fall prevention.

o Mental health and social support are important to manage depression, anxiety, and cognitive changes.

• Daily-living adjustments and safety measures

o Use of assistive devices (walkers and canes), home modifications (removing tripping hazards and improving lighting), and adaptive strategies (using handrails and adjusting walking technique) help maintain independence and prevent falls.

Shake and Freeze Day brings public attention to the real challenges faced by people living with Parkinson’s, not only the visible “shaking” and “freezing” but also the invisible stiffness and non-motor symptoms. Parkinson’s disease is complex, progressive, and variable—no two people will experience it the same way. It is life-changing, but thanks to advances in research, care strategies, medications, and community awareness efforts like Shake and Freeze Day there is hope. For caregivers, patients, and allies alike, days like December 21st offer an opportunity to stand together to “shake” off stigma, “freeze” out indifference, and step forward in support, compassion, and the pursuit of a cure.

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