What Are The Early Signs of Parkinson’s?
Early detection can help manage symptoms sooner
Early detection can help manage symptoms sooner
Key Takeaways
- Symptoms develop gradually and vary.
- Early signs include tremor, sleep changes and loss of smell.
- Non-motor symptoms may appear years earlier.
- Early care helps manage symptoms.
Parkinson’s disease is a progressive neurological disorder that affects how the body moves. It affects 1 million people in the United States, with cases expected to rise.
Parkinson’s develops when dopamine-producing nerve cells, which are critical for controlling movement, become damaged or die.
Symptoms develop gradually and worsen over time. In the early stages, signs are less noticeable and easy to miss. Recognizing these early changes can help you seek care sooner and better manage symptoms.
“Parkinson’s does not affect everyone the same way. Symptoms can vary from person to person, and the disease may progress at different rates,” says Melissa Houser, MD, a neurologist at Scripps Clinic Torrey Pines. “In fact, the first signs of Parkinson’s may be vague or associated with other conditions, making it difficult to know if they are caused by the disease or something else.”
What causes Parkinson’s disease?
The exact cause of this movement disorder is not fully known. Experts believe it results from a combination of genetics, lifestyle and environmental factors.
The disease is associated with the loss of dopamine-producing neurons in the substantia nigra, a key part of the brain’s movement control system.
Age is the strongest risk factor. Most people are diagnosed after age 60. However, about 2% to 10% are early-onset and develop it before age 50.
Early signs of Parkinson’s disease
According to the Parkinson’s Foundation, the following may be early warning signs of Parkinson’s disease. If you or a loved one often notice more than one of these symptoms, make an appointment with your doctor.
Tremor: A slight trembling or shaking in your hand or fingers while you’re at rest is one of the most common early signs. It may begin on one side of the body.
Loss of smell: A loss of sense of smell can occur early. You may notice difficulty detecting certain foods or scents, such as bananas, dill pickles or licorice.
Handwriting changes: Handwriting may become smaller, tighter or more crowded over time. This change is called micrographia, a common early motor symptom. While handwriting can change with age, a noticeable change may be worth evaluating.
Sleeping problems: Changes during sleep, like sudden movements, kicking or acting out dreams, may be signs of REM sleep behavior disorder. This condition is closely linked to Parkinson’s disease and related disorders and may occur years before movement symptoms appear.
Soft or hoarse voice: People with early signs of Parkinson’s may be told they are speaking more softly. They may sound hoarse or monotone. If these changes continue and are not due to an illness, have them checked.
Facial masking: Reduced facial expressions, sometimes called facial masking, is another early sign. It can make a person look angry, serious or sad, even when they do not feel that way.
Dizziness or fainting: Feeling lightheaded or faint, especially when standing, may be due to orthostatic hypotension. This is a drop in blood pressure that can occur with Parkinson’s.
However, dizziness can also be caused by dehydration or by some medicines. If symptoms continue, they should be checked.
Problems with movement or walking: Early movement symptoms may include stiffness or rigidity in the arms or legs. They may also include trouble with coordination or changes in walking. You may notice less arm swinging, smaller steps or balance problems. Often, other people notice these changes first.
Constipation: Ongoing constipation can happen early due to changes in the autonomic nervous system. In some cases, it can appear years before movement symptoms.
Mood changes: Depression, anxiety or low motivation can be early non-motor symptoms. These changes are linked to shifts in brain chemistry and may appear before physical symptoms.
“Remember, having any of these signs doesn’t necessarily mean you have Parkinson’s,” says Dr. Houser. “Temporary symptoms are usually nothing to worry about, but if they persist, talk about them with your doctor.”
Understanding early stages of Parkinson’s disease
Parkinson’s disease progresses in stages, though symptoms and progression vary from person to person.
Stage 1: Symptoms are mild and may affect only one side of the body. Daily activities are not significantly impacted. Many of the early signs listed above appear in this stage.
Stage 2: Symptoms start to affect both sides of the body. Daily tasks may take longer. Changes in posture and walking become more noticeable, although the person can still live independently.
Parkinson’s continues to progress beyond these early stages. Symptoms become more pronounced over time and may affect balance, mobility and independence.
Even before stage 1, some people experience prodromal Parkinson’s disease. In this stage, non-motor symptoms can appear years before movement problems.
When should you see a doctor?
Occasional symptoms like poor sleep or mild stiffness are common. However, seek medical advice if symptoms persist, worsen or occur together.
Patterns matter. For example, a tremor combined with changes in movement or sleep may warrant evaluation. Early assessment can help identify the cause and allow for earlier treatment and symptom management.
If Parkinson’s is suspected, your doctor may refer you to a neurologist or movement disorder specialist for further testing.
How is Parkinson’s disease diagnosed?
There is no single test to diagnose Parkinson’s disease. Diagnosis is based on a clinical evaluation, including medical history, symptoms and a neurological exam.
Doctors assess movement, coordination, balance and reflexes, looking for key signs, such as tremor, rigidity and slowed movement.
Imaging tests may be used to rule out other conditions, but they do not confirm Parkinson's.
Treatment options for Parkinson’s disease
While there is no cure, treatment can help manage symptoms and improve quality of life. Care is individualized based on each person's needs and stage of the disease.
Treatment plans often include one or more of these following:
Medications: Typically, the first line of treatment, these help increase or mimic dopamine to reduce symptoms, such as tremors, stiffness and slowed movement. Over time, medications may need to be adjusted as symptoms change.
Exercise and therapy: Regular exercise, along with physical, occupational and speech therapy, can help maintain mobility and independence. These therapies also support communication and everyday functioning.
Advanced treatments
If symptoms are not well controlled with medication, other treatment options may be considered.
Deep brain stimulation (DBS) is a surgical treatment that uses implanted electrodes to regulate abnormal brain activity. It can help improve tremor, stiffness, slowed movement and motor fluctuations.
Other advanced treatments include continuous medication delivery, such as pump-based therapies. They may reduce “on-off” fluctuations, when symptoms suddenly improve and then return. This can keep symptoms more consistent and easier to manage during the day.
Comprehensive care
Managing Parkinson’s disease requires a personalized, team-based approach that evolves as symptoms change over time.
Scripps provides comprehensive care, including access to neurologists and movement disorder specialists, advanced treatments, such as deep brain stimulation, and specialized rehabilitation programs to support long-term function and independence.
“Parkinson’s disease varies from person to person, so we develop personalized treatment plans to address each individual’s symptoms and lifestyle,” says Dr. Houser. “Many patients are able to successfully manage their symptoms and continue their usual activities.”