What are the very early symptoms and signs of Parkinson’s disease?
Parkinson’s disease is recognized widely, both by doctors and by patients, as a problem with movement of body parts such as hands.
However, Parkinson’s disease can produce non-movement (also called non-motor) symptoms as well. In fact, it is these non-motor symptoms that are often the first symptoms of Parkinson’s disease.
The most common Non-Motor Symptoms can be recognized by the short-form CARD. These letters stand for:
- C = Constipation. People who have Parkinson’s disease almost always have constipation, and constipation can happen before any of the movement problems in Parkinson’s disease. In fact, now many people have started thinking that Parkinson’s disease starts in the gut (intestines). Some researchers believe that a virus or prion (a different class of bugs, similar but even smaller than viruses) first infects the intestines and then gradually moves upwards through the “vagus” nerve, and reaches the brain. In short, constipation is a very early very frequent symptom in Parkinson’s disease.
- A = Anosmia = Problems with smell. Patients with Parkinson’s disease may have trouble smelling their food. In the later stages, even harsh smells such as rotting material may be difficult for the patient to smell.
- R = REM Behavior Disorder (RBD) = Problems with sleep. This is a peculiar sleep problem. When a person without Parkinson’s disease sleeps, the body is paralyzed so that the patient cannot move and act out their dreams – This is a normal process. When Parkinson’s disease patients dream, this does not happen so that they act out their dreams. They may start talking when sleeping, and occasionally walk or run while sleeping, and sometimes even have trashing movements of the body. Occasionally these movements may be very violent and hurt the patient or the person sleeping next to him/her.
- D = Depression. Patients with Parkinson’s disease can start to get depressed many years before the movement problems appear.
Other than these common symptoms, patients with Parkinson’s disease can present to the doctor with symptoms that appear very “strange” or “vague” at first:
- Back pain with no clear cause
- Cramping of hands or feet
- Difficulty swallowing or speaking
- Subtle problems in using hands for fine jobs e.g. typing or cooking
What are the early signs and symptoms of movement problems in Parkinson’s disease?
There are three cardinal (most important) signs of movement in Parkinson’s disease: Slowness, Stiffness and Shaking. So, Parkinson’s disease is characterized by 3 symptoms:
- Shaking = Tremor. This is the most easily recognized sign of Parkinson’s disease. Usually the shaking only affects one hand or one leg in the early stages of the disease. The affected limb may shake both while at rest, and while it is moving. Occasionally there might be shaking of the head.
- Slowness = Bradykinesia. The patients movements become slow. Sometimes only the movements of a particular hand/leg become slow. But usually there is some slowness of movement of the entire body. This is best noticed while walking. Relatives will often say “Well, she was one of the fastest walkers in the family. Now she walks slowly so that she gets left behind when we are walking in a group. After every 10 feet or so we have to wait so that she can catch up with us. Perhaps it’s old age…?”. This isn’t old age – It is frequently Parkinson’s disease and the good news is that it is curable.
- Stiffness = Rigidity. The patients body parts become stiff. This may be restricted to one hand so that, for the example, the patient has difficulty buttoning his shirt. A frequent complaint is that the patient is not able to reach the top of their head to comb or tie their hair. If a leg has become stiff, the patient may feeling like he/she is dragging it while walking.
In addition, Parkinson’s disease patients may have the following problems:
- An expressionless face.
- Bending forwards while walking.
- Shuffling while walking.
- Freezing or getting stuck while walking.
- Decrease in dexterity, or fine motor skills such as drawing.
- Unsteadiness or falls.
- Problems with thinking or memory (Dementia).
Is it possible, even for doctors, to miss the early signs and symptoms of Parkinson’s disease?
Yes. Doctors are human.
There is a tremendous increase in human knowledge over the years. Each branch of medicine has become extremely detailed, and it is not possible for any single person to recognize the symptoms of all diseases. Therefore the diagnosis of Parkinson’s disease is often missed, especially in the early stages.
Also as noted above, the symptoms can be very vague e.g. low back pain. An imaging test called Trodat scan, or another test called the f-DOPA-PET scan can help diagnose such cases. But please note that it is not possible to do such a scan in all such cases, neither is it required in most cases.
Sometimes the symptoms are so subtle that when the doctor examines you, everything might be perfectly normal. There is no reason to think negatively about such an occurrence – it indicates one of two things: either you don’t have Parkinson’s disease, or that your Parkinson’s disease is so mild that treatment is not needed at this stage.
Because of these multifactorial problems, the diagnosis of Parkinson’s disease is often delayed. In some cases it may be delayed inordinately – it is not unusual for 5 years or more to go by, before the patient is finally diagnosed with Parkinson’s disease.
What are the most important signs of Parkinson’s disease?
When you visit a doctor, he/she will try to elicit the signs of Parkinson’s disease. He/She may do the following things to look for these problems:
- Shaking – Sit relaxed with legs dangling and hands resting on your thighs. Observe your hands and feet. Then outstretch your hands in front of you, or hold them in front of your chest.
- Slowness – Ask you to walk as fast as possible, or tap your fingers or feet as fast as possible.
- Stiffness – Ask you to relax and then try to move your wrist gradually clockwise and counterclockwise.
- Stand still – then he/she may try to push you slightly to see if you have any tendency to fall.
- He/she may do some tests to check your thinking and/or memory.
How can you test yourself for Parkinson’s disease?
The diagnosis of Parkinson’s disease is based on a combination of the symptoms and signs mentioned above. The diagnosis should always be made by a doctor who is familiar with Parkinson’s disease, preferably a neurologist.
A rough online tool that asks you to elicit the symptoms and signs of Parkinson’s disease can be accessed by pressing the button below. But note that this is only given as a memory aid, and this calculator should not be used to diagnose Parkinson’s disease by itself. If you have any of the above mentioned symptoms, visit a neurologist in person.
Dr. Kharkar is a Neurologist, Epilepsy specialist & Parkinson’s disease specialist in Mumbai, Maharashtra, India.
He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, University of California at San Francisco (UCSF), USA & Kings College in London.
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