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Early Signs and Symptoms of Parkinson’s Disease

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Updated March 31, 2014

Early Signs and Symptoms of Parkinson’s Disease

A change to smaller, cramped handwriting can be an early sign of Parkinson's disease.

© 2001-2008 HAAP Media

If you are wondering if you or a loved may have Parkinson’s disease (PD), here are some signs that doctors look for in the early stages:

Symptoms That Usually Start on One Side of the Body

The following symptoms typically appear on only one side of the body in early PD. Later, they appear on both sides, but at the beginning of the disorder the signs are unilateral -- meaning one-sided.
  • Resting Tremor
    Resting Tremor is a slight shakiness in the hand when the hand is at rest. The shakiness or trembling goes away when you move the hand to do something. For example, the shakiness stops when you pick up a book or a cup and so forth. The tremor may extend to the leg or foot on the same side and sometime to the lips and jaw. You might even feel an internal tremor as if the trembling is deep within your body.
  • Rigidity
    Rigidity, or muscle stiffness typically occurs in the limbs but full body rigidity is possible as well. Cog-wheel rigidity refers to a body motion (typically the arm) that resembles cogs in a wheel -- it's very jerky and similar to a spring-like action. The stiffness can affect all kinds of daily activities like buttoning up a shirt or turning over in bed.

Other Early Signs of Parkinson's Disease

  • Bradykinesia
    You might notice slow movements, otherwise known as bradykinesia. Does it take you longer to do things than it used to? Is dressing more of a chore? Do you sometimes feel like you were walking through water? Have you lost the swing in your arm when you walk?
  • Postural instability
    You might have problems with balance. You have trouble walking a straight line. You stumble often. You sometimes lean too far forward when you walk.
  • Generalized fatigue
    Parkinson's can cause fatigue that persists for greater than two weeks. Do you feel persistently worn-out and tired, despite lots of sleep?
  • Gastrointestinal problems (like constipation). Have your bowel habits changed? Do you feel constipated and has this been going on for weeks or longer?
  • "Facial mask"
    You might notice lack of emotional expressions on your face. This is sometimes called "masked facies". Loss of dopamine leads to less control over the facial muscles and loss of eye blinks, so when you feel an emotion it may not necessarily be revealed through your facial expression. Have your family members or friends or acquaintances begun to say to you that you appear to be staring or that you rarely smile?
  • Slurred speech
    Your friends and family may also notice that your voice is softer and does not express as much emotion as it used to. Do your friends and family repeatedly say that can’t hear you? Do you stumble over words more frequently than you used to?
  • Personality change
    Friends and family sometimes say your personality has changed. You are a bit more rigid, less flexible, more withdrawn.
  • Micrographia or small, cramped handwriting
    Have you noticed that it is more difficult for you to write or sign your name? Do you start out OK but then notice that the letters become smaller and closer together?
  • Anosmia
    Anosmia is a loss of the sense of smell. This is a subtle sign that many people notice only because it affects their appetites. Do you still feel that relish and anticipation when you smell the food cooking? Does food taste as good as it once did?
  • Anxiety or depression
    Anxiety of early PD is usually experienced as free-floating and vague feelings of uneasiness and fear. Sometimes you might even experience a full-blown panic attack when for no apparent reason. Your heart starts racing, your breathing becomes labored and you start to imagine all kinds of horrible things. The attack lasts only a few minutes but it is unforgettable. Depression, on the other hand, manifests itself as a day-to-day loss of interest in normal activities, and an inability to experience the same sense of pleasure in the things you used to love to do.
  • Executive dysfunction
    Do you get distracted easily? Are you more impulsive than you used to be? Do have trouble making decisions?
  • Sleep disturbances
    Do you have problems during the day with an intense sleepiness? Do you take more naps during the day than you used to? Does your bed partner tell you that you have bad dreams at night and that you sometimes "act out" those dreams during the night? Without waking up you seem to be seeing things and reacting to them as if they were real. Then you awaken and remember a dream where you were being attacked by someone or some animal? These latter symptoms may be related to REM behavior disorder, an early sign of PD.
  • Midlife obesity
    Did you gain an unusual amount of weight in your 40s and 50s?

As you read through these early signs of PD, do not jump to any conclusions about your particular case. You cannot decide that you have or don't have PD or any other illness simply by reading an article or two about the disorder. You need to be evaluated by a specialist, in this case a neurologist, who specializes in PD in order to know for sure if you have the disease. Keep in mind also that everyone is different. You need not have all of these signs to be diagnosed with PD. Some persons with PD never develop one or another of these signs. On average, however, most people who end up getting PD reported several of these signs before receiving the actual diagnosis.

Sources:

Hawkes CH, The prodromal phase of sporadic Parkinson's disease: does it exist and if so how long is it? Mov Disord. 2008 Oct 15;23(13):1799-807.

Stewart A Factor, DO and William J Weiner, MD. (eds). Parkinson’s Disease: Diagnosis and Clinical Management: Second Edition Edited by 2008 Demos Medical Publishing.

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