10 Early Signs of Parkinson's Disease to Be Aware Of

Parkinson's disease is a condition where symptoms develop slowly over many years. The initial signs can be subtle and are sometimes mistaken for normal effects of aging. Recognizing these early indicators is an important step in seeking a proper evaluation. While some of these signs can be caused by other conditions, understanding them in the context of Parkinson's is key to awareness.

Tremor or Shaking

One of the most recognizable signs of Parkinson's disease is a tremor, or shaking. This often begins in a limb, typically a hand or fingers, and is known as a resting tremor because it occurs when the muscle is relaxed. You might notice a slight shaking or trembling in a finger, thumb, hand, or chin. A characteristic tremor associated with this condition is the 'pill-rolling' tremor, where the thumb and forefinger rub back and forth.

It is important to note that not everyone with Parkinson's experiences a tremor, and not all tremors are a sign of the disease. Stress, exercise, injury, or certain medications can also cause shaking. However, if you notice a persistent, slight tremor in one of your limbs while you are at rest, it may be worth discussing with a healthcare provider.

Small Handwriting (Micrographia)

A change in handwriting, known as micrographia, is another common early sign. You may notice that your handwriting has become much smaller than it was in the past, or that the letters and words are crowded together. This change is often gradual and happens because of difficulties with automatic, routine movements.

This symptom is related to the same motor control issues that cause other movement-related signs of Parkinson's. The brain's ability to control fine motor skills can be impacted, making it difficult to produce the larger, more fluid movements required for normal handwriting. A person may start writing a sentence with their usual letter size and find that it gets progressively smaller as they continue.

Loss of Smell

A reduced ability to smell certain substances, a condition called hyposmia or anosmia, can be an early indicator of Parkinson's. A person might have difficulty smelling specific foods like bananas, dill pickles, or licorice. This symptom can appear months or even years before the motor symptoms, such as tremors and stiffness, become apparent.

The loss of smell is thought to be caused by the buildup of alpha-synuclein proteins, a hallmark of Parkinson's, in the parts of the brain that control olfaction. While colds, flu, or a stuffy nose can temporarily affect your sense of smell, a persistent and unexplained loss should be noted.

Trouble Sleeping

Significant changes in sleep patterns can also be an early warning sign. While it is common for many people to experience occasional sleep problems, those with early Parkinson's may experience more specific issues. These can include vivid dreams, sudden movements, or even acting out dreams while asleep, a condition known as REM sleep behavior disorder (RBD).

Other sleep-related issues can include insomnia, difficulty staying asleep, or restless legs syndrome. People may find themselves thrashing, kicking, or punching in their sleep. These movements can be intense and are a departure from normal sleep patterns. Such disturbances often precede the onset of motor symptoms by several years.

Stiffness and Slow Movement

Stiffness of the limbs, neck, or trunk is a core symptom of Parkinson's. This stiffness, known as rigidity, can cause discomfort and limit the range of motion. It might be mistaken for arthritis or simple soreness, but it does not go away with movement. For example, you might notice that your arm does not swing as freely when you walk, or you might feel a persistent stiffness in your shoulders or hips.

This rigidity is often accompanied by a general slowing of movement, called bradykinesia. Everyday tasks that were once simple, such as buttoning a shirt, cutting food, or getting out of a chair, may take longer to complete. This slowness can affect walking, leading to a slow, shuffling gait with short steps.

Voice Changes

Your voice may undergo changes in the early stages of Parkinson's. A common change is the voice becoming very soft, almost a whisper, which is known as hypophonia. Others may not hear you clearly, and you might not even be aware of the change yourself until someone points it out. Your speech may also become more monotone, losing its usual inflection and emotion.

In addition to being softer, the voice might sound hoarse or breathy. Some people may hesitate before speaking or slur their words. These changes are due to the impact of the disease on the muscles that control speech and the voice box. If friends or family mention that your voice sounds different or that you seem to speak less, it could be a subtle sign.

Masked Face

Facial expression is controlled by many small muscles in the face that allow us to convey a wide range of emotions. In Parkinson's disease, these muscles can become stiff and slow to move, leading to a condition called hypomimia, or 'masked face'. This can result in a serious, depressed, or angry look, even when the person is not feeling that way.

This reduction in facial expression is often unconscious. A person might smile less often or have a blank, staring expression. The rate of blinking may also decrease. Family and friends are often the first to notice this change, as it can affect nonverbal communication and social interaction.

Stooping or Hunching Over

Changes in posture are a frequent sign of developing Parkinson's. A person might start to stoop, hunch, or lean forward. This change can be so gradual that the individual does not notice it themselves. It is caused by a combination of rigidity in the muscles of the trunk and changes in the brain's ability to control posture and balance.

This stooped posture can contribute to balance problems and an increased risk of falls as the condition progresses. You might notice it when looking at your reflection in a window or when a loved one points it out. While poor posture can have many causes, a persistent, involuntary stoop that you cannot easily correct could be an indicator.

Constipation

Problems with the digestive system, particularly constipation, are a very common non-motor symptom of Parkinson's disease and can appear long before motor issues develop. This involves infrequent bowel movements or difficulty passing stool. It occurs because the autonomic nervous system, which controls automatic bodily functions like digestion, is affected.

The disease can slow down the entire digestive tract, making the movement of food and waste through the system less efficient. While diet, hydration, and activity levels can all cause constipation, chronic and persistent issues that do not resolve with typical remedies could be an early clue, especially when seen with other potential signs.

Dizziness or Fainting

Feeling dizzy, lightheaded, or even fainting when you stand up from a sitting or lying position can be an early sign of Parkinson's. This is a symptom of orthostatic hypotension, which is a significant drop in blood pressure upon standing. It is caused by the impairment of the autonomic nervous system's ability to regulate blood pressure.

Many things can cause occasional dizziness, such as dehydration or getting up too quickly. However, if this becomes a frequent occurrence and is accompanied by other symptoms, it warrants attention. It can lead to unsteadiness and an increased risk of falling.