Parkinson’s disease is a progressive neurological condition that affects how the brain controls movement. Although it’s commonly diagnosed in people over 65, early changes can appear long before a formal diagnosis. These early signs are often subtle, consisting of small shifts in movement, behaviour, or day-to-day function, and can easily be overlooked.
Parkinson’s symptoms generally fall into two categories:
- Motor symptoms which involve changes in physical movement, such as tremors, stiffness or slowed mobility.
- Non-motor symptoms which affect areas beyond movement and may include changes in sleep, mood, digestion, or sense of smell. Both types can emerge in the early stages and may provide important clues that the nervous system is changing.
If you begin to notice any of these early indicators in yourself or someone close to you, seeking advice from a specialist can be valuable. Identifying Parkinson’s disease early allows for timely treatment and better long-term management.
In this article, we explore 13 early symptoms that may signal the onset of Parkinson’s disease.
Motor Related Symptoms
Motor symptoms are the hallmark of Parkinson’s disease. These changes affect how the body moves and may be among the earliest signs that something is altering the brain’s control of muscle activity. Below are the most common motor related symptoms:
1.Tremors
One of the most recognised symptoms of Parkinson’s is a tremor. This involuntary shaking movement that typically affects the hands, but can also involve the limbs, jaw, or other parts of the body. It’s important to note that tremor alone does not confirm Parkinson’s disease. Many other conditions, such as essential tremor or dystonia, can also cause shaking movements.
- Essential tremor usually appears during voluntary movement such as reaching for an object or writing, and can affect the hands, head, voice, or legs.
- Dystonic tremor is linked to dystonia, a group of movement disorders that cause involuntary muscle contractions. When dystonia affects muscles in the hands or neck, it can produce irregular, twisting tremors that may resemble Parkinson’s symptoms.
Because these tremors can look similar, distinguishing them from a Parkinson’s tremor often requires assessment by a specialist.
What is Parkinson’s tremor?
A tremor caused by Parkinson’s can appear in two ways:
A resting tremor
A resting tremor occurs when the affected limb is relaxed and supported, for example, when your hands are resting in your lap. The most common type of tremor in Parkinson’s is known as a ‘pill-rolling’ tremor, where the thumb and index finger move rhythmically as if rolling a small object. This is one of the most characteristic early signs of the condition.
An action tremor
An action tremor can occur when performing tasks such as lifting, writing, or maintaining posture. While less common, it can still be part of the Parkinsonian tremor spectrum.
There are additional tests that can be done such as a DaTSCAN, which can help visualise dopamine activity in the brain and distinguish Parkinson’s from conditions like essential tremors.
2. Difficulty walking (Gait changes)
Changes in walking, or gait, are common early motor signs of Parkinson’s disease. These alterations are often subtle at first but may gradually become more noticeable over time.
People with Parkinson’s may experience:
- Slower walking or shuffling steps
- Dragging feet, which can make movement appear stiff or hesitant
- Irregular pace, where the speed of walking suddenly increases or decreases
- Changes in stride length, with steps becoming shorter or uneven
Freezing episodes
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.
3. Cramped or Small Handwriting (Micrographia)
One of the early motor signs of Parkinson’s disease is micrographia, a condition where handwriting becomes unusually small, cramped, or progressively smaller as you write. This change can make writing more difficult to read and may affect daily tasks that require fine motor skills, such as buttoning clothes, typing, 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?
Micrographia occurs due to bradykinesia, which is the slowing of voluntary movement, and reduced fine motor control. The brain’s impaired regulation of hand movements makes it challenging to maintain consistent size and spacing in handwriting.
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.
4. 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.
5. Poor balance
Impaired balance is a common motor symptom in Parkinson’s disease. The condition affects basal ganglia, a group of nerve cells deep in the brain that play a key role in controlling movement, coordination, and postural stability. Damage to these nerves can make it difficult to maintain balance, increasing the risk of falls.
Neurologists often evaluate balance using the pull test. In this assessment:
- The specialist gently pulls the patient backward by the shoulders.
- They observe how the patient responds and how many steps it takes to regain stability.
Healthy individuals typically recover balance with one or two steps. In contrast, someone with Parkinson’s may take multiple small, shuffling steps to stabilise themselves, reflecting postural instability, a hallmark of the disease.
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.
6. 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.
7. 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.
8. 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.
Non-Motor Related Symptoms
While Parkinson’s disease is often associated with movement difficulties, many early signs actually affect areas beyond physical motion. These non-motor symptoms can involve changes in the senses, sleep patterns, mood, digestion, and cognitive function. Often subtle and easy to overlook, they may appear years before noticeable motor problems, making awareness of these symptoms important for early detection and management.
Below are common early non-motor related symptoms:
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 and detecting different odours
- Difficulty with telling the difference between odours.
Smell tests are sometimes used in clinical settings to evaluate hyposmia. While these tests can provide helpful information, their results are not definitive on their own.
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.
Early recognition of non-motor symptoms like hyposmia can lead to earlier diagnosis and intervention, helping people manage the disease more effectively over time.
2. Sleep Problems
Sleep disturbances are a common non-motor symptom in the early stages of Parkinson’s disease. Many people notice changes in their sleep patterns long before movement-related symptoms become apparent. Parkinson’s can affect both the quality and quantity of sleep, leading to daytime fatigue and reduced overall well-being.
Some common sleep-related issues include:
- Sleep apnea
- Insomnia
- Daytime exhaustion
- Uncontrolled movements while sleeping
- Narcolepsy
- Nightmares
Sleep disturbances not only affect daily functioning but can also be an early indicator of Parkinson’s disease. Addressing sleep issues early with a healthcare professional can improve quality of life and may even help manage other Parkinson’s symptoms more effectively.
3. 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.
4. Psychological symptoms
Parkinson’s disease can have a significant impact on mental and emotional well-being. The condition lowers dopamine levels in the brain, a neurotransmitter that plays a key role in regulating mood, motivation, and cognitive function. As a result, people with Parkinson’s may experience a variety of psychological and cognitive challenges, even in the early stages of the disease.
Common psychological symptoms include:
- Depression – Persistent feelings of sadness, hopelessness, or loss of interest in daily activities.
- Anxiety – Excessive worry, nervousness, or fear that can affect sleep and concentration.
- Psychosis – Hallucinations or delusions, which may occur in some cases, particularly later in the disease or as a side effect of medication.
- Cognitive changes – Including dementia, confusion, and difficulty with attention or memory.
- Executive function difficulties – Challenges in organising tasks, planning, and problem-solving.
Psychological symptoms can significantly affect quality of life and may sometimes appear before noticeable movement problems. Early recognition and intervention, including therapy, medication, or lifestyle adjustments, can help manage these challenges and improve daily functioning.
5. Weight loss
Unexplained weight loss is a less obvious but common non-motor symptom of Parkinson’s disease. Changes in body weight can occur early in the disease and may signal underlying changes in metabolism, appetite, or daily activity levels.
Several factors can contribute to weight loss in Parkinson’s disease:
- Increased energy expenditure – Tremors and other involuntary movements can burn extra calories, even during rest.
- Loss of appetite – Non-motor symptoms such as depression, reduced sense of smell (hyposmia), or digestive difficulties can make eating less appealing.
- Digestive issues – Constipation and slower gastrointestinal function may impact nutrient absorption or meal patterns.
- Medication effects – Some treatments may affect appetite, digestion, or metabolism.
Weight loss in Parkinson’s disease is often gradual but can affect overall health and nutritional status. Paying attention to changes in weight, along with other early symptoms, may prompt timely consultation with a healthcare professional. Early recognition can help address dietary and lifestyle adjustments and support better long-term management of the disease.
Noticing one or more of these symptoms doesn’t automatically mean you have Parkinson’s disease, but it’s important not to ignore them. Early evaluation can make a real difference, allowing for timely treatment and better management of symptoms. If you’re concerned about any of these changes, our team of specialists is here to help. Booking a consultation early can give you peace of mind and the tools to protect your health and quality of life.
