Written by Katie E. Golden, MD | Reviewed by Patricia Pinto-Garcia, MD, MPH Updated on October 2, 2023
Key takeaways:
The early signs of Parkinson’s disease can be subtle. They include loss of smell, constipation, trouble sleeping, and change in bladder habits.
Many of the early symptoms of Parkinson’s start years before the more noticeable symptoms. Tremors, difficulty walking, and muscle rigidity usually develop later in the disease.
Some people are more likely to develop Parkinson’s disease based on their genes and their environment. But it tends to affect people older than 65 years of age.
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Parkinson’s disease is a condition that affects the brain and nervous system. Some of the most recognizable symptoms include tremors, slow and rigid movements, and difficulty walking. But these symptoms tend to develop in the later stages of the disease.
Parkinson’s disease is a progressive disorder, meaning that it steadily gets worse over time. This also means that the earliest symptoms can be subtle. And so many people are not diagnosed with the condition until the later stages of the disease.
If you’re worried that you or someone you know has Parkinson’s disease, you’re not alone. It can be hard to know if someone’s symptoms are truly Parkinson’s or if they’re something else. But it helps to know some of the early symptoms. That way, you can know when it’s time to see a provider. The earlier someone is diagnosed with Parkinson’s, the earlier they can start treatment to help slow down the disease.
11 EARLY SIGNS AND SYMPTOMS OF PARKINSON’S DISEASE
Early symptoms of Parkinson’s disease aren’t always easy to notice. They are usually more vague symptoms that start before the more obvious ones that affect someone’s movement.
The following list starts with some of the earliest symptoms, then walks through a typical progression of some of the later symptoms. These later symptoms are included because the condition can develop differently from person to person. Also, some people may start to notice very subtle changes that are the first signs of the later symptoms, so it helps to know what those are.
It’s also helpful to remember that if someone develops the symptoms listed below, it does not necessarily mean they have Parkinson’s. Some of these are very common symptoms of other conditions, with much more likely causes.
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Loss of smell
Experts believe that loss of smell may be one of the earliest signs of Parkinson’s. And it can start years before any of the more recognizable movement symptoms start. At the time of diagnosis, the majority of people with Parkinson’s report a noticeable loss of smell.
Constipation
Constipation is a very common issue for many Americans — and for many different reasons. But one of the early symptoms of Parkinson’s is difficulty moving your bowels or needing to strain to pass a bowel movement. This is because of the way Parkinson’s affects the nervous system, which is an important part of digestion.
Bladder problems
Like constipation, changes in bladder function are common problems among adults. And the nervous system plays an important role in bladder function too. People with Parkinson’s often feel like they have an overactive bladder. They may have to get up frequently to pee, or they may experience urinary urgency (suddenly needing to pee).
Trouble sleeping
Parkinson’s can disrupt someone’s sleep for a few different reasons. This can be due to:
The bladder problems described above, causing someone to use the bathroom more frequently
Sudden movements — like jerking — when a person is in deep sleep
Pain or restlessness in their legs that improves if they move around
These sleep disruptions may also lead to increased daytime sleepiness or more frequent naps in the middle of the day.
Dizziness
A condition called orthostatic hypotension can cause dizziness when someone changes position. It is relatively common in early Parkinson’s disease. This is related to the way Parkinson’s affects the nerves that control blood pressure. When someone with orthostatic hypotension stands up, their blood pressure drops temporarily. This can cause them to feel dizzy or potentially even pass out.
Slow movements
One of the first movement symptoms in Parkinson’s is a general slowness. This is called “bradykinesia.” This may be difficult for someone to describe when it first starts. It may just feel like weakness or tiredness. Or someone may notice it just becomes harder to initiate movement.
In the arms, someone may first notice it is hard to coordinate movement in the hands. They may have difficulty with:
Buttoning shirts or zippering jackets
Tying shoelaces
Typing on a phone or computer
Writing by hand, including handwriting that may start to appear smaller
In the legs, someone may notice:
Difficulty getting out of a chair
A shorter stride when walking
A feeling of unsteadiness
Stiffness and rigidity
Muscle and joint stiffness can also be early movement signs of Parkinson’s. Some people may experience this as inflexibility. Or it may even feel like muscle cramps or tightness. But this will become more noticeable with time. This may be particularly apparent when someone is walking.
For example, it can lead to:
Decreased arm swing when walking
A “shuffling gait,” meaning it is hard to lift their feet off the ground or take full steps
A stooped-over appearance when walking
Later in Parkinson’s, the change in posture will become more apparent. It can look like stooping, slouching, or leaning when standing. This may also lead to trouble balancing and increased falls.
Tremor
Shaking is one of the hallmark movement symptoms of Parkinson’s. This shaking can be in the:
Hand
Arm
Foot
Leg
The classic Parkinson’s tremor is described as a “pill rolling” tremor in the hand. It is a small, circular tremor that looks like someone is drawing small circles with their hand. It’s usually more noticeable when someone is at rest, and it gets better with movement.
Most Parkinson’s tremors start on just one side of the body, but over time it can affect both sides. And not everyone with Parkinson’s will develop the classic pill rolling tremor. Most people with the condition have some type of tremor, but it can look different from person to person.
Changes in voice
Parkinson’s disease affects many different muscles in the body, including ones that help you speak. Someone with Parkinson’s may start to speak in a softer or lower voice. They may also mumble, stutter, or have trouble articulating their words.
Masked face or inability to make facial expressions
Parkinson’s also affects the muscles in the face. This can make it harder for people to form facial expressions, sometimes referred to as “masked face.” It describes the way some people with Parkinson’s have a harder time expressing joy or laughter. They may look like they are upset, mad, or serious even when they’re in a good mood.
Depression and anxiety
Changes in mood can happen in both early or late stages of Parkinson’s. Depression in particular can be underdiagnosed and undertreated in people with the condition. But about a third of people with Parkinson’s experience depression.
Other common mental health symptoms include:
Decreased interest in activities
Decreased motivation
Low mood
Anxiety
Difficulty concentrating
Difficulty with planning
In the later stages of the condition, people can also develop hallucinations and delusions. Others can start to develop dementia, but memory changes tend to come later in the disease.
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