Parkinson’s disease (PD) is a progressive nervous system disorder that affects movement and muscle control. And while there is no cure for Parkinson’s, there are treatments and lifestyle changes that can help ease the severity of symptoms in support of a better quality of life.
And the earlier you can recognize Parkinson’s disease symptoms, the sooner you can get a proper diagnosis and begin taking medications and performing exercises that may help delay the onset of more severe problems.
“There is growing evidence to suggest that exercise may have a protective effect for brain cells, so it is important to establish a regular program of physical activity,” says Albert Hung, MD, PhD, director of the Parkinson’s Foundation Center of Excellence at Massachusetts General Hospital. “Despite the absence of proven disease-modifying treatments, there are very effective medications to improve the symptoms of PD, so early recognition and treatment can improve mobility and overall quality of life if the symptoms are bothersome.”
Understanding Parkinson’s Disease
Parkinson’s disease occurs when certain brain cells weaken and die. These cells produce dopamine, a chemical messenger that has several functions, including motor control. Dopamine also plays a key role in motivation and reward, as well as attention and memory.
As dopamine levels drop, various neurological problems develop. Changes can include tremors, muscle rigidity, postural instability, difficulty swallowing, cognitive impairment, and much more.
The average age of PD onset is between 60 and 70 years old, and the risk increases with age. Men are somewhat more likely than women to develop Parkinson’s, but the condition can affect anyone.
And because early signs can come on gradually, it’s especially important to be aware of Parkinson’s disease symptoms that are subtle and could be mistaken for minor health issues, as well as the more obvious indications that PD may be developing.
Main Parkinson’s Disease Symptoms
Parkinson’s disease causes motor and non-motor symptoms, but there is no way to predict a person’s exact course of PD. Some people may develop noticeable mood changes, for example, while others have no significant changes in mood or personality. Likewise, the severity of tremors and the timeline of symptom progression are highly individualized experiences.
Research suggests that symptoms tend to appear once an individual has lost about 60% to 80% of their dopamine-producing cells, but there’s no way to tell which early signs of Parkinson’s disease will show up first.
Motor Symptoms of Parkinson’s
Tremor in Parkinson’s affecting the hands, arms, and legs is one of the most obvious symptoms, and often the most frustrating challenges for someone with PD. They can affect the ability to walk, exercise, and interfere with even basic tasks, such as cooking or using a phone or computer. The presence of these motor symptoms is what allows a doctor to make a clinical diagnosis of PD.
“Typical motor symptoms of Parkinson’s include tremor, especially a tremor on one side of the body that is present primarily at rest,” Dr. Hung says. “Others include slowness of movement, known as bradykinesia, along with stiffness and changes in walking and balance. People with PD may experience symptoms in different ways. While people most often associate tremor with PD, the clinical feature that defines Parkinsonism is the slowness of movement.”
When tremor in Parkinson’s develops, it often starts as a subtle twitch in a finger or thumb. The shaking is usually most noticeable when your hand is at rest on your lap or an armrest. When you use that hand, the tremor may temporarily stop.
Aside from a slower gait, walking changes may include shorter steps or a change in the way your arm swings. You may find that you take a couple of extra steps just to turn around or change direction.
Non-Motor Symptoms of Parkinson’s
Non-motor symptoms can start years before a person develops any of the motor symptoms, Dr. Hung says. Early non-motor symptoms in PD include loss of smell (hyposmia), constipation, and sleep disturbances. “A particular sleep disorder where people act out their dreams, called REM sleep behavior disorder, can be an early sign that someone is at risk for developing PD or a related condition,” he explains.
Some of the non-motor symptoms of Parkinson’s aren’t easily ascribed to the onset of PD. Individually, some symptoms, like reduced sense of smell, can be signs of any number of conditions. Everything from allergies and sinus infections to COVID-19 and Alzheimer’s disease can cause changes in smell and taste.
Early Warning Signs
In addition to a reduced sense of smell and sleep disturbances, some other early indications can include speech changes in Parkinson’s. Your voice may seem “breathy” or hoarse. Some people who develop voice changes with PD initially think that those around them are losing their hearing, but the problem is that the speaker is simply getting quieter.
Another early warning sign is a change in posture. In some cases, this means postural instability, which is difficulty maintaining your balance whether you’re moving or just standing in one place. But PD can also lead to stooping or hunching over when standing or walking.
Symptoms of depression or anxiety may also appear before more obvious changes in motor control. Some people with PD may look depressed or angry even when they’re not. They develop what is known as the “mask of Parkinson’s,” which is a neutral or serious facial expression that may contradict how that person actually feels. You may be in a good mood, but your expression suggests otherwise.
“Recognizing the earliest signs of PD can be challenging, especially when the typical symptoms such as tremor are not present,” Dr. Hung says. “Some early non-motor symptoms like reduced sense of smell or constipation may not be specific, while a condition like REM sleep behavior disorder can be a herald for PD motor symptoms that may not occur for some time. While tremor or a change in movement can be related to PD, it can also be caused by other conditions.”
You may not notice things like the mask of Parkinson’s, changes in your posture or gait, a softer voice, or even a slight tremor, but family members and friends may pick up on those signs and be concerned.
If loved ones bring these observations to your attention, hear them out. Try to be aware of how you’re moving, how things smell and taste, and whether any other physical or mental changes may be creeping up on you. “If you are experiencing any symptoms that may suggest PD, you should discuss this with your doctor and consider getting a referral to a neurologist if appropriate,” Dr. Hung says.
If your doctor suspects Parkinson’s you may be advised to undergo neurological and physical exams, as well as have blood tests and imaging, such as an MRI. A special type of scan that looks at dopamine transporter activity in the brain also may be helpful. You also may be prescribed a low dose of levodopa, a medication that boosts dopamine levels. A noticeable improvement of symptoms after taking levodopa can help confirm a PD diagnosis.
How Symptoms Progress
The timeline of symptom progression can be different for each person living with PD, although there are some patterns that depend on the specific symptoms a person is experiencing, according to Dr. Hung. “For example, people who have tremor-dominant PD generally have a slower rate of progression, while those who experience more problems with walking, balance, or cognitive function may see a faster rate of progression,” he explains.
While medication and exercise/physical therapy can sometimes slow down the progression of certain symptoms, there is no cure that can stop the worsening of PD. A tremor in one hand or one side of the body will eventually spread to both sides. At advanced stages, motor symptoms of Parkinson’s can lead to reliance on walkers or wheelchairs. Not everyone with PD develops Parkinson’s dementia, but when it happens, care in a skilled nursing facility may be necessary.
“Currently, there are no proven treatments to slow down the progression of PD, although this is a very active area of research, with multiple promising targets,” Dr. Hung says. “People who have early symptoms of PD may choose to participate in some of these research trials.”
Practical Tips for Managing Symptoms
The two primary means of managing Parkinson’s disease symptoms are medications and lifestyle adjustments.
Levodopa is often combined with a medication called carbidopa, which prevents levodopa from breaking down before it reaches the brain. Other drugs, called dopamine agonists, are taken to activate dopamine receptors in the brain to help extend the duration of levodopa’s effectiveness. Managing multiple medications can be a challenge, especially as side effects and interactions can change over time.
Exercise and other healthy lifestyle behaviors also may help, not just with muscle strength and control, but also with mood and energy. Look for physical therapists in your community who have experience working with people who have Parkinson’s. Hospitals and Parkinson’s support groups in your community also may have exercise programs and other activities to keep you feeling better and stronger in the months and years ahead.
While exercise can be much more challenging, depending on the nature of your symptoms, being physically active on a regular basis is still one of the best ways to stay physically fit and keep your muscles strong and flexible. Dr. Hung notes that current guidelines from the Parkinson’s Foundation and American College of Sports Medicine recommend at least 150 minutes of moderate to vigorous exercise per week. This recommendation aligns with similar guidelines from the American Heart Association to help maintain cardiovascular health.
