Symptoms of Parkinson's disease typically appear gradually and worsen over time. Symptoms and the speed of progression vary from person to person. Early detection of Parkinson's can help people live longer and more productive lives.
Knowing the following symptoms of Parkinson's disease can help diagnose it sooner.
Early Symptoms of Parkinson’s Disease
You may have minor symptoms that you might not notice right away. Some people will first notice a sense of weakness, difficulty walking, and stiff muscles. Others may have a tremor of the head or hands. Typically, symptoms start on one side of the body and later progress to both sides. But you may also find that symptoms are more severe on a certain side.
Early non-motor symptoms can affect your senses, gastrointestinal system, and sleep.
Motor Symptoms of Parkinson’s Disease
Parkinson's disease is a movement disorder characterized by the following symptoms. The presence of the first three symptoms helps doctors diagnose Parkinson's disease.
Tremor
Tremor is usually one of the first movement symptoms of Parkinson's disease. It appears as an uncontrollable, rhythmic shaking of a body part, usually the hands or fingers, but sometimes the foot or the jaw. Your hands might tremble when you are still or stress may cause them to shake. You may make a continuous "pill-rolling" motion of the thumb and forefinger. Your tremor might ease when you are moving or engaged in a task. Tremor can interfere with daily activities that call for fine motor skills such as writing, shaving, and dressing.
Rigidity
You may notice abnormal tone or stiffness in your body, particularly in your arm and leg muscles, which may stiffen due to Parkinson's. Your arm movements may be clipped and unsteady, and your muscles can feel tight and painful. Rigidity can reduce the swing of your arms when you walk and interfere with facial muscles, contributing to a condition known as "facial masking." Nighttime stiffness can create sleep problems, making it hard to fall or stay asleep.
Bradykinesia
Bradykinesia is the slowing of voluntary movements, such as walking or rolling over in bed, characteristic of Parkinson's disease. This slowness can take on several forms, including:
- Affecting automatic motions such as blinking
- Making "launching" movements such as getting up from a chair difficult
- An overall slowing of physical movement
- A still appearance and facial immobility
Bradykinesia can come and go, making it a quite challenging symptom. At times, you may need help with tasks such as tying your shoes, while at other moments, you might feel perfectly okay.
Posture instability
Parkinson's may cause your posture to sag and create issues with balance. This is because rigidity, bradykinesia, and tremors can affect how you walk and increase your risk of falling. Exercise can help you retain good posture, and engaging in physical therapy early can give you ways to keep and improve your balance.
Non-Motor Symptoms of Parkinson’s Disease
Vocal changes
Parkinson's can affect the movement in your face and throat, including your vocal cords. Changes to your voice and speech are often an early symptom of Parkinson's disease. Symptoms include speaking softly and in a monotone, mumbling, slurring, and stuttering.
Difficulty in swallowing and chewing
Trouble with swallowing, called dysphagia, can cause mild or serious issues in people with Parkinson's. For some, it can take the form of eating more slowly or having difficulty swallowing pills. For others, swallowing issues can mean unintended weight loss and choking that can lead to aspiration pneumonia — a potentially fatal condition caused by food or drink being inhaled into the lungs. When swallowing becomes less reflexive, patients may drool from too much saliva collection.
Eye problems
Eye symptoms in Parkinson's disease can stem from changes to the eyes' surface, retina, or eye movement. While vision problems are common as you age, there are some specific eye issues linked to Parkinson's disease:
- Light sensitivity
- Dry eye
- Gritty eyes
- Burning and redness
- Crusty eyelids
Other symptoms can be more vague. You might notice your vision isn't as sharp as it once was or you may have difficulty seeing in low light.
Bowel problems
The automatic nervous system controls many "automated" bodily functions, such as blood pressure, heart rate, and gastrointestinal and urinary functions. Parkinson's can interfere with the stomach's ability to empty, a condition called gastroparesis. Gastroparesis makes you feel full, even when you've eaten very little, and it can also lead to nausea. Being unable to empty the contents of your stomach regularly can prevent certain Parkinson's medications from traveling to the small intestine, where they are absorbed in order to work.
Constipation is another symptom of Parkinson's. Constipation can lead to:
- Abdominal bloating and cramping
- Straining to pass stools
- Hard stools
- Incomplete passing of stools
If you go several days without a bowel movement, your stools can get backed up, leading to an impacted colon.
Urinary problems
Urinary symptoms of Parkinson's tend to appear later in the course of the disease. The most common symptoms in people with Parkinson's are urgency and frequency.
Sleep disorders
With Parkinson's, you may find it hard to fall asleep (insomnia), wake frequently during the night, experience nightmares, or have daytime sleepiness. Another symptom is having intense dreams that can leave you disoriented or hallucinating upon waking.
A condition called rapid eye movement (REM) sleep behavior disorder, common in nearly half of those with Parkinson's disease, may cause you to "act out" in your sleep what you're dreaming.
Cognitive Symptoms of Parkinson’s Disease
The changes in your brain that slow your physical movement can also work to slow your cognitive abilities. Medicines you take to manage Parkinson's, or stress and depression due to the disease, can have an impact too. Cognitive issues are fairly common in people with Parkinson's, although the severity of them varies from person to person.
Some symptoms include:
- Slower thinking or processing of information (bradyphrenia)
- An inability to focus when your attention is divided in situations such as group conversations
- Difficulty recalling information
- Feeling overwhelmed when doing tasks on your own or faced with choices
- Difficulty finding the right words when speaking
- Visuospatial deficits that can interfere with tasks such as giving directions, putting together a puzzle, or avoiding obstacles in your path
Parkinson’s Disease and Mental Health Symptoms
Several mental health conditions are associated with Parkinson's disease.
Depression
This mood disorder causes ongoing feelings of hopelessness and sadness that eventually affect your ability to function. Depression is common in people with Parkinson's disease, and not just because of the challenges of living with the disease. Doctors now believe that Parkinson's contributes to changes in the parts of your brain that control motivation and mood. Symptoms of depression include:
- Apathy or lack of interest and motivation
- Fatigue
- Difficulty concentrating
- Insomnia
Anxiety
Anxiety symptoms often coexist with depression. Anxiety can be general (an overall feeling of unease), come on suddenly, or cause you to avoid social contact. Like depression, anxiety can impact your daily life, with symptoms such as:
- Excessive worry or fear
- Intrusive thoughts
- Feelings of terror
- Nightmares
- Repetitive behaviors
Psychosis
Psychosis in Parkinson's takes the form of hallucinations, typically seeing people, animals, or objects that aren't present. Early on, people are usually aware that they're hallucinating, but as their disease progresses, hallucinations appear along with delusions, which have symptoms such as:
- Religious ideation
- Feelings of persecution
- Jealously
- Stealing
- Guilt
- Feeling superior or invincible (grandiosity)
Lack of impulse control
The dopamine your brain produces acts as a so-called "reward center." This dopamine release gives you a sense of pleasure when you do something your body needs or likes. Impulse control disorder is one of the primary reasons people with Parkinson's are referred to mental health providers. Lack of impulse control can lead to serious financial, legal, and personal issues. For some, dopamine therapy and other factors trigger a lack of control over certain impulses, including the following compulsive behaviors:
- Gambling
- Sex
- Eating
- Shopping
- Creativity
Suicide
Thoughts of suicide among people with Parkinson's disease are twice as common as in people without it. Watch out for the following suicide risk factors:
- Being male
- General onset of motor symptoms of Parkinson's
- Depression, including postoperative
- Delusions or other psychiatric disorders
- Higher dosages of levodopa
- Deep brain stimulation in certain areas of the brain
- Impulse control disorder
Parkinson's Disease Stages and Symptoms
Doctors now recognize three early phases of Parkinson's disease:
- Preclinical: Dopamine production is decreasing, but there are no noticeable physical symptoms.
- Prodromal: You may have some symptoms, but they aren't enough to make a concrete diagnosis.
- Clinical: Symptoms are fully present and noticeable.
After you're diagnosed, the symptoms and stages of Parkinson's vary by individual, developing rapidly or sometimes over decades. Understanding the progression of Parkinson's can help you mentally prepare for what may come next. The following stages on the Hoehn & Yahr Scale represent the level of disability caused by the disease.
| Stage | Severity | Symptoms |
| 1 | Early | Symptoms of tremor and movement are usually on one side; changes in posture, gait (walk), and facial expressions can occur. Symptoms typically don't interfere with everyday activities. |
| 2 | Mild to moderate | Worsening symptoms including tremor, rigidity, and movement disorders impacting both sides of the body. Problems with walking and posture may appear. Daily tasks become more difficult and time-consuming. |
| 3 | Medium | Balance becomes unsteady, falls are increasingly common, and motor symptoms continue to worsen; the ability to perform daily activities is more limited. |
| 4 | Severe | Symptoms are greatly disabling, although a person may still be able to walk or stand with the help of assistive devices such as a cane or walker. Living independently is not advised, as a person would need a lot of help with daily activities. |
| 5 | Advanced | Leg stiffness may make standing or walking too great a challenge; a person may be bedridden or need to use a wheelchair; 24-hour care is required. |
When to Call Your Doctor About Parkinson's Disease
Contact your doctor about Parkinson's if:
- You suspect Parkinson's disease might be at the root of any of the symptoms listed above. Drugs and other therapies are very effective in the treatment of Parkinson's disease. There are many ways to help a person with Parkinson's disease.
- You have been diagnosed with Parkinson's and notice changes in your symptoms or in how well your medicine is working. Be sure to keep any regularly scheduled or follow-up appointments with your doctor.
- You believe you have symptoms of Parkinson's or develop new symptoms. Early treatment can make a big difference in managing the disease.
Takeaways
Loss of motor control is the most familiar symptom of Parkinson's disease. However, people with Parkinson's can also have a range of non-motor issues including sensory, swallowing, gastrointestinal, sleep, and mental health symptoms. Doctors classify stages of Parkinson's based on the severity and types of symptoms you have as the disease progresses.
FAQs on the Symptoms of Parkinson’s Disease
What are the five early signs of Parkinson's disease?
Early symptoms of Parkinson's disease include:
- Slight trembling of your hands, fingers, or chin at rest (tremor)
- Changes in your handwriting, making it look cramped or crowded
- Loss of smell
- Sudden movements while sleeping
- Stiffness of your arms, legs, or body
What happens if you have Parkinson's?
Your doctor will manage your disease with medications that either directly treat Parkinson's or help control its symptoms. Another treatment option in the later stages of the disease is deep brain stimulation, in which a device delivering mild electrical impulses is implanted in brain areas affected by Parkinson's. There are also some experimental treatments, but they are not available for widespread use.
What is the life expectancy of Parkinson's disease?
Although it's a progressive condition, Parkinson's symptoms usually develop over time, and it takes a while for symptoms to get worse. Most people have a normal life expectancy with this disease.
At what age do people get Parkinson's disease?
The average age for the onset of Parkinson's is 60. It can occur in people as young as their 20s, but it's likely inherited.
