What are the Early Symptoms and Signs of Parkinson’s Disease?

Parkinson’s disease is recognized widely by doctors and by patients as a problem with the movement of body parts, mostly 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 with Parkinson’s disease almost always have constipation. Constipation generally happens before any of the movement problems set in. Many people have started thinking that Parkinson’s disease starts in the gut. Or more specifically, in the intestines. Some researchers believe a virus or prion (a different class of bug, similar but smaller than viruses) first infects the intestines. It then gradually moves upwards through the “vagus” nerve, where it eventually reaches the brain. In short, constipation is a frequent early symptom of Parkinson’s disease.

    Constipation can be a very early symptom of 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 like rot may be difficult for the patient to smell.

    People with Parkinson’s disease may have difficulty smelling before they develop any other symptoms.

  • R = REM Behavior Disorder (RBD) = Problems with sleep. When a person without Parkinson’s disease sleeps, the body is paralyzed so that the patient cannot move or act out their dreams. This is a normal process. When Parkinson’s disease patients dream, this does not happen, and they act out their dreams. They may start talking when sleeping, and occasionally walk or run while sleeping, and sometimes thrash wildly. These movements can be violent and hurt the patient or the person sleeping next to them.

    Patients with Parkinson’s disease may move excessively while sleeping, sometimes talking or hitting whoever is near them.

  • D = Depression. Patients with Parkinson’s disease can start to get depressed many years before the movement problems appear.

    Depression is common in Parkinson’s disease. Just like many of the other problems, it is treatable.

Other than these common symptoms, patients with Parkinson’s disease can show symptoms that appear strange or vague at first:

  • Back pain with no apparent cause

    Parkinson’s disease patients frequently complain of back pain.

  • Cramping of hands or feet
  • Fatigue
  • Difficulty swallowing or speaking
  • Subtle problems in using hands for fine jobs like typing or cooking

What are the Early Signs and Symptoms of Movement Problems in Parkinson’s Disease?

There are three cardinal signs of movement in Parkinson’s disease: slowness, stiffness, and shaking. As such, Parkinson’s disease is characterized by 3 symptoms:

  1. Shaking = Tremor. This is the most easily recognizable 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 while at rest and while it’s moving. There may also be shaking of the head.

    Shaking of a hand or leg or both is the most commonly recognized symptom of Parkinson’s disease.

  2. Slowness = Bradykinesia. The patient’s movements become slow. Sometimes only the movements of a particular hand or leg become slow. Usually, there is some slowness of movement in 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 and 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 often Parkinson’s disease, and the good news is that it is curable.

    Patients with Parkinson’s disease can get “left behind” when walking in a group because they walk slowly.

  3. Stiffness = Rigidity. The patient’s body parts become stiff. This may be restricted to one hand, causing the patient difficulty in simple tasks like buttoning their 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 feel like they’re dragging it while walking.

    Stiffness of arms may make it difficult to comb your hair or to wear some dresses.

In addition, Parkinson’s disease patients may have the following problems:

There are many problems with body movement in Parkinson’s disease.

  • An expressionless face.
  • Bending forward 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 for Doctors to Miss the Early Signs of Parkinson’s Disease?

Yes, doctors are human.

There has been a tremendous increase in human knowledge over recent years. Despite each branch of medicine improving, it is still not possible for a single person to recognize the symptoms of all the diseases. Therefore, the diagnosis of Parkinson’s disease is often missed, especially in the early stages.

Medical knowledge is vast. It is still impossible for one doctor to know everything.

As noted above, the symptoms of Parkinson’s disease can be vague. An imaging test called Trodat scan, or another test called the f-DOPA-PET scan, can help diagnose such cases. Please note that it is not possible to do one of these scans in all cases, neither is it required in most cases.

A TRODAT / fDOPA-PET scan may help in the early diagnosis of Parkinson’s disease.

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 it means your Parkinson’s disease is so mild that treatment is not needed at this stage.

Because of these multi-factorial 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, they will try to elicit the signs of Parkinson’s disease. They may do the following things to look for these problems:

Only a doctor can make the diagnosis of Parkinson’s disease.

  • Shaking – Sit relaxed with your legs dangling and your 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; 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 – The doctor may try to push you slightly to see if you have any tendency to fall.
  • The doctor 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.

The online test on this website may help you identify the possibility of having Parkinson’s disease.

A rough online tool that asks you to elicit the symptoms and signs of Parkinson’s disease is available on this website: here. Please 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 symptoms mentioned above, visit a neurologist in person.

Dr. Siddharth Kharkar

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, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

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