"I was surprised and I think it's because that people think that no one under fifty is coming in with a neurological issue," Milstein said.
But Andrea's symptoms started in her early forties, typical for the ten percent of Parkinson's patients who are young. Like many Parkinson's sufferers, young patients have the slow movements and stiffness that all patients feel. But they usually are missing one typical symptom.
It's the type of tremor that older Parkinson's patients have, and most doctors look for it. One of the reasons that young onset patients are not diagnosed is that they generally do not have the tremor, at least at first.
A few years later, Andrea noticed tremulousness in her left hand. Left leg and hand, symptoms generally stick to one side of the body. Her father had Parkinson's late in life.
"Young patients have more of a genetic predisposition, and if you dig hard enough you can find an uncle or their father had a little of a tremor," said Dr. Michele Tagliata of Mount Sinai Medical Center.
The medications are just a bit different for younger patients, and they've helped Milstein back to a relatively normal life, even knowing that the illness always progresses.
"My husband is an optimist and his optimism is very contagious. There seem to be a lot more cures than there were 20 years ago and many options out there," she said.
Dr. Taliata is optimistic as well, saying that there is a great deal of research going on looking for new treatments for Parkinson's, including deep brain stimulation, surgery, stem cell work and gene therapy. The goal is to find better ways to manage both young and older onset Parkinson's.