While Parkinson’s disease symptoms may start as early as in middle age, many “early warning signs” can crop up years before the classic motor issues like tremors. Having one or more of these early symptoms does not mean you have PD, but they should be discussed with your doctor.
Many of these early symptoms are non-movement related, such as loss of smell, constipation, sleep problems, and depression.
Muscle stiffness or rigidity is a sign that your muscles are too tight and cannot stretch. You may feel it in your arms, legs, back, and even smaller facial muscles. Rigidity can lead to a stooped posture or balance problems, increasing your risk of falls.
While tremors are PD’s most widely known motor symptom, rigidity is also vital to watch for. Rigidity affects arm swinging and daily tasks like buttoning a shirt or tying laces.
Increasing movement throughout the day can help improve flexibility and relieve stiffness. Stretches that lengthen and relax the muscles can help with rigidity, and a physical therapist at The Mighty with experience in Parkinson’s disease can provide them.
Unstable Posture or Walking Gait
People without Parkinson’s disease walk in a “natural” way, with their feet landing on the heel each time they take a step. They also don’t need to think about swinging their arms. With Parkinson’s, these automatic movements start to break down.
For example, when a person with PD tries to rise from a chair, they may try to stand up too fast for their balance and topple backward into the seat. This is called the rocket sign.
A neurologist trained in movement disorders can evaluate your signs and symptoms over time to diagnose Parkinson’s disease. They can also help rule out other conditions that cause similar symptoms, including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and vascular Parkinsonism (VP). The onset of a new condition often happens suddenly.
Tremor (shaking) is one of the most recognized signs of Parkinson’s. It usually starts in the hands but can affect any body part, including your head, arms, legs, and trunk. You may have tremors at rest or while moving your muscles, such as kinetic or postural tremors.
You might also experience a tremor when you are trying to perform a task, such as writing or using a toothbrush. Sometimes, a tremor might disappear when you stop trying to do the task or hold your hand in a specific position, such as with a sedentary tremor.
Your doctor will diagnose essential tremor (ET) based on your symptoms and a neurological exam. They will check to ensure your tremors aren’t caused by thyroid disease, too much caffeine, or medications.
When Parkinson’s disease progresses, you may notice that your movement slows. This is called bradykinesia, making it difficult to perform tasks like buttoning a shirt or cutting food. You might drag your feet or shuffle your steps as you walk.
Tremors and slowed movements are motor symptoms, but Parkinson’s also causes non-motor symptoms. These include sleep problems, constipation, loss of sense of smell, and depression.
The clumping of proteins in the brain that occurs with PD (alpha-synuclein) also affects other body parts. For example, it can lead to the stiff muscles that characterize PD and a decline in memory and thinking skills. It can also cause cognitive changes. This is a condition called progressive supranuclear palsy (PSP). It has similar symptoms to PD, but the symptoms happen more slowly.
Loss of Automatic Movements
The primary symptoms of Parkinson’s disease include tremors (trembling in the hands, arms, legs, and face) or stiffness in the muscles; rigidity; bradykinesia, or slow movement; and freezing of gait. Other symptoms that may not be movement-related are constipation, loss of the sense of smell (anosmia), and sleep problems.
The condition occurs when dopamine-producing nerve cells deteriorate or perish. Scientists don’t know why these neurons are affected.
Medications can ease many of the PD symptoms. They work by stimulating the remaining substantia nigra cells to make more dopamine or by inhibiting some of the acetylcholine that is produced in the basal ganglia. Side effects vary by medicine and patient. Your healthcare provider can assist in selecting the appropriate medications and dosages to alleviate your symptoms.
People with PD often develop voice and speech problems. This is because nerve cells that send messages from the lower brain to the muscles responsible for lip, tongue, throat, and vocal cord movement are lost. The result is a soft, monotonous, or hoarse voice with imprecise articulation.
Although it is expected to experience some changes in writing as you age, handwriting that gets smaller and cramped is a classic sign of Parkinson’s disease. It is called micrographia.
It is essential to talk with a doctor if you notice changes in your voice or speech. The sooner you have a baseline evaluation, the more likely your symptoms will be monitored and treated to slow down the progression of PD.
Although nonverbal cues make up a large part of communication, it can be difficult for people with Parkinson’s to express their emotions. Combined with changes in speech volume and difficulty forming words, facial masking can lead to poor interpersonal relationships.
Facial masking, or hypomimia, is a loss of facial expressions and movement. This symptom occurs as the nerve cells that produce dopamine become damaged or deteriorate. The loss of these chemical messengers can cause various symptoms, including bradykinesia and muscle rigidity.
Communicating with someone whose face does not react can be challenging for loved ones. In some cases, however, medication and therapy can help improve facial movement and reduce the severity of this symptom.