Early Signs of Parkinson’s Disease

Early signs of Parkinson's disease

The distinctive characteristics of Parkinson’s disease are tremors and slow, rigid movements. Usually, small changes in a person’s movement and behaviour can indicate the start of Parkinson’s disease before diagnosis. 

Parkinson’s disease is a disorder of the nervous system that usually affects people aged 65 and over. Symptoms can develop slowly over several years and may be subtle at first, so symptoms can be easily missed.

If you notice symptoms of Parkinson’s disease, you should consider contacting a specialist for more information. Early treatment can help to improve the condition in the long-term. 

In this blog post, we will cover the 13 early signs of Parkinson’s disease. 

  1. You May Start Getting Tremors

A tremor is an uncontrollable movement that affects a part of the body, such as the hands. Having a tremor is a common feature of Parkinson’s, but it doesn’t necessarily mean you have Parkinson’s.

 It can also be a symptom of other conditions. For example, a common type of tremor is an ‘essential tremor’, which is a trembling of the hands, head, legs, body or voice, most noticeable when you are moving. 

Sometimes essential or dystonic tremor (which you can get if you have dystonia, a range of movement disorders that cause muscle spasms and contractions) can be difficult to tell apart from a Parkinson’s tremor. 

What is Parkinson’s tremor? 

A tremor caused by Parkinson’s can appear in two ways: 

A resting tremor 

This may happen when your body is relaxed. The most common type of tremor in Parkinson’s is known as a ‘pill-rolling’ tremor. This is because it can look like you are trying to roll a pill between your thumb and index finger. This Parkinson’s tremor is more likely to happen when you’re resting. 

An action tremor 

This type of tremor can occur when you’re active. There is a clinical assessment that can be carried out by a specialist to see whether you have Parkinson’s tremor. There are additional tests that can be done such as a DaTSCAN that can also determine whether you have a Parkison’s Tremor.

  1.  You May Have Difficulty walking

There may be subtle changes in your walking pattern that could be an early indication of Parkinson’s disease. 

You may find that you are walking slowly, or dragging your feet as your walk. You may also find that you are walking at an irregular pace, such as walking faster or slowly all of a sudden or even changing the length of your stride. You may also find that you may have difficulty turning which can lead to a freezing episode or even a fall. 

Freezing episodes are short and sudden movements that occur when walking, turning or when manoeuvring through small spaces. Freezing can last up to several minutes or a few short seconds. Freezing limits mobility and increases the risk of falling often resulting in reduced socialisation and quality of life.  

  1.  You May Have Cramped or Small Handwriting

Parkinson’s disease can cause a symptom called Micrographia. This is a disorder that causes difficulties using your hands to write with or catching a ball. 

A neurologist can confirm the diagnosis by assessing the size of your handwriting in a writing test. The size, speed, fluency and duration of writing is analysed to provide an accurate measurement of writing characteristics.

What Are The Causes of Micrographia?

The basal ganglia, a structural network containing nerve cells located deep in the brain, regulates motor skills such as the movement and coordination of the arms and legs. Damage to the basal ganglia affects most motor functions, including writing.

Research has shown that there is a correlation between micrographia and bradykinesia, which is another symptom of Parkinson’s disease. Bradykinesia, or slow movement, can affect the movement of your arms or fingers leading to difficulty in writing. Tremors can also lead to micrographia. 

  1. Loss of smell

The ability to lose the sense of smell is called Hyposmia. This is a relatively common symptom of Parkinson’s disease and it usually affects 70 to 90% of people with Parkinson’s disease. 

Losing the sense of smell is one of the most noticeable symptoms of Parkinson’s disease. It can appear years before the disease can affect a person’s movement. 

People with hyposmia may experience:

  • A dulled sense of smell
  • A difficulty identifying different odours
  • A difficulty detecting different odours
  • Difficulty with telling the difference between odours. 

You’ll find that smell identification tests are used to diagnose hyposmia, but the accuracy of these tests can vary. 

However, hyposmia doesn’t automatically mean that you have Parkinson’s disease. It is also a symptom of other medical conditions like Alzheimer’s disease and Huntingdon’s disease.

  1. Bradykinesia

As mentioned, Bradykinesia is a term that means slowness or absence of movement.

In Parkinson’s, the slowness can occur in different forms: 

  • A reduction of automatic movements, such as swinging your arms when you walk or blinking.  
  • Difficulty initiating movements, such as getting out of bed or a chair. 
  • Slowness in physical actions.
  • A decrease in facial expressions or abnormal stillness. 

The above can result in a difficulty in performing day-to-day functions, such as brushing your teeth, tying your shoelace or cutting your food. 

Often, Bradykinesia can be frustrating as it can be unpredictable. You may find that one movement can be easily performed, and suddenly you may require help for the same movement. 

Those who have this symptom may misinterpret it as a weakness of the muscle. However, this doesn’t affect muscle strength at all.  

  1. You May Experience Problems With Your Sleep

During the early stages of Parkinson’s, you may experience some problems with your sleep.

Parkinson’s disease can severely affect the ability to sleep. Some of the sleep-related problems include: 

  • Sleep apnea
  • Insomnia
  • Daytime exhaustion
  • Uncontrolled movements while sleeping
  • Narcolepsy
  • Nightmares

  1. You Can Have Poor balance

Parkinson’s disease specifically targets nerve cells called basal ganglia, which reside deep within the brain. Basal ganglia nerves control balance and flexibility, so any damage to these nerves can impair balance.

To assess balance, specialists use the ‘pull test’ which involves the specialist pulling gently on your shoulders back until you lose your balance. They then record how long it takes to regain your balance. 

Healthy individuals can regain their balance after one or two steps, while an individual with Parkinson’s disease may take additional smaller steps to fully regain their balance. 

  1. Facial masking

Facial masking is the reduced ability to make facial expressions. Facial masking is related to bradykinesia, where the facial muscles move more slowly or rigidly than usual. 

People who have facial masking may appear emotionless or expressionless, however, their ability to feel emotions is not lost, only impaired. You may also find that facial masking can cause slow blinking. 

Due to facial masking, it can be difficult to communicate with others because the changes in the facial expressions are less noticeable than usual. 

  1. Changes In Your Voice

There may be changes in volume and the quality of your voice, which can be an early sign of Parkinson’s disease.

Some changes you may notice is the voice is a softer tone. You may also notice that the voice starts off in the normal volume and gradually becomes softer or fades away altogether. 

In other cases, the voice may lose the variety in volume and tone causing it to sound monotonous.

  1. Changes In The Posture

Many people experience changes in their posture. Some may find that the changes are subtle, such as developing a slight stoop, but others may find that changes are very pronounced, forcing them to be in extremely painful positions. 

Control of posture depends on the brainstem, a part of the brain that can be affected in the later stages of Parkinson’s. When the brainstem is no longer able to do this, posture and balance will need to be controlled consciously. So often Parkinson’s disease can cause you to need to concentrate a little harder than usual on your posture. 

  1.  Constipation

Another early sign of Parkinson’s disease is constipation. Although constipation is a common problem that has a wide range of causes, it is one of the most common non-motor symptoms associated with Parkinson’s disease. 

The ways in which Parkinson’s disease can increase the risk of constipation include: 

  • A lack of dopamine in the brain – this impairs control of muscle movement throughout the body causing the muscles in the bowel to become slow and rigid. 
  • Uncoordinated bowel motions – causing the muscles in the bowel to become weak and unable to contract, or the muscles may clench instead of relaxing when passing a motion.
  • Problems with eating – a diet that consists of insoluble fibre can add bulk to your bowel motions which help to prevent constipation. 
  • Problems with drinking – water helps to aid the dietary fibre in your bowel movements. Difficulty in swallowing can discourage a person from drinking enough fluids to help. y
  • A sedentary lifestyle – the lack of exercise can slow the passage of food through your intestines. As Parkinson’s disease reduces muscle control, exercising becomes less common. 
  • The medications – different medications can cause constipation and medications used to treat Parkinson’s disease (anticholinergic medications that are used to block involuntary movements of the muscles) can slow the movement of bowels and can also cause a decrease in appetite.

  1. Psychological symptoms

Parkinson’s disease can severely affect a person’s psychological well-being as the disease lowers the body’s natural levels of dopamine, causing changes in your mood and behaviour. 

Psychological symptoms associated with Parkinson’s disease include:

  • Depression
  • Anxiety
  • Psychosis
  • Dementia
  • Confusion
  • Difficulty staying organised
  • Reduced ability to solve problems 

  1. Weight loss

People with Parkinson’s disease may experience weight loss.

Tremors and other motor symptoms associated with Parkinson’s may increase the body’s natural energy requirements. Non-motor symptoms, such as loss of smell, depression, or digestive issues, might cause people to lose their appetite or change their eating habits which can result in weight loss.

Parkinson’s disease is difficult to diagnose as symptoms vary from individual to individual, especially in the early stages as symptoms can be subtle and sporadic. 

However, knowing what the symptoms are may encourage you to speak to a specialist before symptoms progress.

To summarise, the early symptoms of Parkinson’s disease are:

  • Tremors
  • Difficulty walking
  • Changes in your handwriting, such as cramped or small handwriting
  • The loss of smell
  • Sleep problems
  • Poor balance
  • Bradykinesia
  • Facial masking
  • Changes in the voice
  • Changes in posture
  • Constipation
  • Psychological symptoms
  • Weight loss

Displaying these symptoms doesn’t necessarily mean that you have Parkinson’s disease. If you are unsure or experiencing some of the symptoms in this blog post, speak to one of our consultants by booking an appointment. Early diagnosis will lead to earlier treatment, which can improve your overall quality of life.