Early Signs of Parkinson’s Disease

Parkinson’s disease (PD) is a neurodegenerative disease that destroys dopamine-producing nerve cells (neurons) in an area of the brain called the substantia nigra in the brain stem. Specific symptoms may be early signs of PD.

While there is currently no cure for PD, early identification and treatment may slow progression and decrease symptoms of PD. Knowing how to recognize early signs of PD will indicate when to see a healthcare provider. Having a good quality of life while living with PD is possible.

Causes of Parkinson’s disease

Parkinson's disease affects about one million people in the U.S. and about 10 million worldwide, with most cases in people over 65. Although 5% to 10% of patients are “early onset,” PD at 50 or younger, age is the most significant risk factor for PD. About 1% of people over 60 have PD.

The cause of PD has yet to be fully understood.

Genetics alone cause 10% to 15% of PD cases, so PD does not run in most families.

Scientists believe that a combination of genetics, environmental factors, and lifestyle influences causes most cases of PD. There is no cure yet for PD. However, research on PD is ongoing, and encouraging results are being produced.

Categories of PD symptoms

PD symptoms are divided into two categories: motor symptoms and non-motor symptoms.

• Motor symptoms. These involve rest tremors, stiffness, voice changes, problems with balance and gait (walking), and an expressionless face.
• Non-motor symptoms. These do not affect movement, such as mood disorders (like depression), urinary frequency, sleep difficulties, cognitive (thinking) disorders, and constipation. Non-motor symptoms usually present first and can begin years to decades before other PD symptoms.

Why do non-motor symptoms usually appear first?

Lewy bodies (abnormal clumping of the alpha-synuclein protein) start to build up in the lower brain stem, where non-motor functions are controlled. With time, the Lewy bodies travel up the brain stem to the midbrain, where motor function is controlled. Once this happens, the motor symptoms start to show.

It is important to recognize the possible early symptoms of PD so treatments can start as early as possible.

Main symptoms of PD

According to the National Institute on Aging, PD has four primary motor symptoms:

1. A tremor in hands, arms, legs, jaw, or head;
2. Muscle stiffness, where muscle remains contracted for a long time;
3. Slowness of movement, known as bradykinesia;
4. Impaired balance and coordination, sometimes leading to falls;

These symptoms are the most common in people with PD. However, they are not the only symptoms nor the symptoms that first appear in PD.

PD symptoms usually begin gradually, with non-motor symptoms, and worsen over time.

These early warning signs of PD may first be noticed by a partner, family member, or friend. They may see someone moving differently or notice their voice is changed. It is essential to listen to trusted people for clues about health and see a healthcare provider (HCP) for a checkup and advice.

1. Loss of smell. The inability to smell dill pickles or bananas (in the absence of cold or flu symptoms) may be related to PD.
2. Constipation. Trouble moving your bowels daily without straining. Constipation may feel as though only a small amount of food makes you feel full. Persistent constipation may be a PD sign.
3. Trouble sleeping. Thrashing or moving a lot during deep sleep may be a sign of PD. Your partner may notice this first. These sudden movements can be caused by PD.
4. Tremor. A tremor is the shaking or quivering of a finger, hand, or chin. A tremor at rest is a potential early sign of PD.
5. Small handwriting. Noticeable smaller handwriting than before or more crowded in appearance may be a PD early sign called micrographia.
6. Trouble moving or walking. Feeling stiffness in your body, arms, and legs that does not go away when you start walking — or feeling like your feet are stuck to the floor. This may lead to falling. Again, these may be signs of PD that need to be investigated.
7. A soft or low voice. A change in voice or sounding hoarse or quieter than before could signal PD. Sometimes others think they are losing their hearing because the person’s voice becomes so soft.
8. Masked face. Facial masking is when a person looks serious, depressed, or angry when they are not. This needs to be checked by an HCP.
9. Dizziness or fainting. Feeling dizzy or faint on standing may be due to blood pressure fluctuations caused by PD. Either way, this symptom needs to be brought up with an HCP.
10. Stooping over or hunching. If a person is no longer standing up straight or is being told they are slouching may be a sign of PD.

These symptoms, taken together as two or more, must be checked out by an HCP. However, some can be signs of other things, so it is important to get examined and diagnosed as soon as possible.

What if someone has symptoms from the list?

A single symptom from this list does not mean PD is present. However, it is still a good idea to discuss it with your HCP to see why it has appeared. Many people have one or two of these symptoms. However, if there are two or more checked off or if there is a concern, see an HCP for the next steps. If PD is suspected, a referral will be made to a specialist called a neurologist. A neurologist specializes in disorders of the brain and will be able to diagnose and treat PD. Treatments for PD can help maintain a good to the excellent quality of life.

Early diagnosis and treatment of PD

Diagnosis of PD does not mean the end of life. On the contrary, people with PD can lead long and productive lives. The earlier a diagnosis is made, the sooner a treatment plan can be made. PD treatment may improve symptoms or delay progression.

Types of PD treatment

Treatment for PD is available in prescription medication, surgery, physical, occupational, and speech therapy. A neurologist will recommend treatment for each PD case, as cases can vary widely.

A neurologist will also work to adjust the treatment plan as needed to find the best balance for each person.

Proper nutrition, diet, and exercise are highly recommended and may play a role in PD treatment.

Complementary therapies such as tai chi, acupuncture, dance, and massage may be helpful for PD symptoms. People with PD may try several complementary therapies and stick with the ones that provide the most relief.

NOTE: All treatments, even over-the-counter and complementary therapies, should be discussed with your healthcare provider.