Early Signs of Parkinson’s Disease
Parkinson's disease is a progressive condition that affects the nervous system. It causes symptoms like tremors, slow movement, and poor control over complex movements.
While there is no cure for Parkinson’s, early diagnosis and symptom management through medications, exercise, and lifestyle changes can help improve quality of life and slow disease progression.
Michael Hayes, MD, a Mass General Brigham neurologist, frequently cares for patients living with Parkinson’s disease at Brigham and Women’s Hospital. Dr. Hayes describes the early signs of this condition, diagnosis, and typical symptom progression.
What are the early symptoms of Parkinson’s disease?
The key early non-motor (non-movement) signs of Parkinson's disease typically occur before motor (movement) signs.
Early non-motor signs and symptoms
These include:
Constipation
Loss of sense of smell (anosmia)
REM sleep disorder (acting out dreams)
Early motor signs and symptoms
These include:
Changes in handwriting, especially handwriting that becomes smaller and more cramped, and less hand dexterity in general
Slowness of movement (bradykinesia) that’s often asymmetric (affecting one side of the body more than the other)
Subtle gait changes, like a slight dragging of one leg
Tremor, especially a slow, resting tremor that’s asymmetric
“The non-motor signs can appear before you develop any of the more classic Parkinson's symptoms like tremor and balance issues,” says Dr. Hayes. “These non-motor signs can occur decades before motor symptoms.”
When do Parkinson’s disease symptoms typically begin?
According to Dr. Hayes, the motor symptoms of Parkinson’s disease are most common in people over 50. “But we see some of the non-motor symptoms even decades before,” he says. However, the age of onset for early symptoms can vary significantly. “I’ve also seen people in their 20s who have Parkinson’s motor symptoms, but it’s much less common.”
Why is it challenging to diagnose early signs of Parkinson’s disease?
It’s challenging, or even impossible, for providers to diagnose Parkinson’s disease based only on the early non-motor symptoms. Dr. Hayes says this difficulty is partly because early non-motor signs are often due to conditions unrelated to Parkinson’s disease.
“Until there are motor symptoms, we typically can’t make the diagnosis,” says Dr. Hayes. There’s no single test for Parkinson’s disease. Instead, providers must do an evaluation. He says that providers can typically make a Parkinson’s disease diagnosis based on 3 signs:
Resting tremor on one side of the body (asymmetric tremor)
Slowing of movement on one side of the body (asymmetric bradykinesia)
Improvement of symptoms with dopaminergic medication, a common Parkinson’s treatment
However, Dr. Hayes notes that early symptoms can vary. Some people who have early-stage Parkinson’s disease have tremors or slowing movement on both sides of the body, or they don’t respond to dopaminergic medication. Some people with Parkinson’s disease never develop tremor.
There are further tests and scans that help providers determine whether symptoms are due to Parkinson’s disease. But early in the disease progression, it may be difficult for doctors to distinguish Parkinson’s disease from other conditions, such as:
Lewy body dementia
Multiple system atrophy (MSA)
Normal pressure hydrocephalus (NPH)
Progressive supranuclear palsy (PSP)
What are the later motor and non-motor symptoms of Parkinson’s disease?
As Parkinson’s disease progresses, it impacts complex movements more and more.
“Parkinson’s doesn’t cause the loss of movement of a specific limb or part of the body, but the loss of the ease of complex movements,” says Dr. Hayes. “Movements such as walking that you generally do on autopilot become more difficult, so you have to start focusing on the individual movements to make them happen.”
Later-stage motor symptoms of Parkinson’s disease include:
Balance problems
Lack of natural, subconscious body movements, such as gesturing while in conversation
Masked face, where facial expressions no longer happen naturally
Poor coordination
Speech difficulties
Worsening tremor
Later-stage non-motor symptoms also typically develop, such as problems with:
Bladder control
Blood pressure control
Cognitive function
Constipation
What should you do if you have early signs of Parkinson’s disease?
The symptoms and progression of Parkinson’s disease are individual and can vary significantly. “Early on, there may be no real impact on your life,” says Dr. Hayes. “People often attribute early non-motor symptoms of Parkinson’s disease — and even some early motor symptoms — to aging, and they don’t seek help.”
If you have any motor symptoms, it’s essential to have a provider evaluate you. There isn’t a cure for Parkinson’s disease, but treatment helps you manage symptoms and extend your quality of life. There are many proven ways to reduce the impact of Parkinson’s disease and preserve independence, including:
Medications
Focused ultrasound thalamotomy
Continuing to learn new things
Maintaining social connections
If you experience any of the early signs of Parkinson’s disease, your health care provider can make referrals to specialists who can help. You and your Parkinson’s care team can work together to determine the next steps.
