Parkinson’s disease symptoms
Reviewed by Parkinson’s disease damages dopamine-producing brain cells, causing tremors, rigidity, slowed movement, and gait and balance problems. The condition also causes nonmotor symptoms affecting cognition, sleep, and mental health.
Parkinson’s disease symptoms generally begin subtly and worsen over time. Motor symptoms typically start on one side before affecting both, though specific symptoms and progression vary by person.
Early signs and initial symptoms of Parkinson’s
Nonmotor symptoms often rank among the first signs of Parkinson’s disease. This occurs because brain changes driving the condition can begin a decade or more before classic motor symptoms appear — a timeframe known as the prodromal phase.
Early signs of Parkinson’s emerging during this phase include:
- loss of smell
- constipation
- difficulty sleeping
- unusually small handwriting
- soft or quiet speech
- reduced facial expressions
- reduced arm swing while walking
Recognizing these symptoms can help with early detection and timely treatment.
Motor symptoms of Parkinson’s disease
Changes in movement characterize Parkinson’s disease, making these physical signs central to confirming a diagnosis. Clinicians commonly divide these movement difficulties into four main categories:
- bradykinesia (slowed movements)
- tremor
- rigidity
- postural instability or gait disturbance (balance issues and walking difficulties)
Slowed movements
Bradykinesia, or abnormally slowed movement, is a core diagnostic marker of Parkinson’s. Formal diagnostic criteria require this feature along with at least one other motor symptom, such as tremor or rigidity.
Bradykinesia may manifest in a number of ways, such as:
- general slowness during physical activity
- fewer automatic actions, such as blinking or swinging arms while walking
- difficulty starting movements, including rising from a chair
- decreased facial expressiveness
This slowness can feel like severe fatigue or muscle weakness, making daily tasks like dressing or eating slower and more difficult.
Tremor
Tremor, or involuntary shaking, is frequently the initial motor symptom, starting on one side before potentially spreading to both sides. While shaking makes tasks like writing or dressing difficult, the movement proves most noticeable at rest and typically fades during activity.
Hand tremors often resemble rolling a small object between the thumb and forefinger or cause the palm to rotate up and down. Tremor can also affect the jaw, mouth, or legs, while some individuals experience an internal vibration in the chest or abdomen. However, not everyone with Parkinson’s experiences tremor.
Rigidity
Rigidity refers to abnormally stiff, tight muscles that limit range of motion, most often in the arms, legs, and torso. This stiffness hinders standing up, reduces arm swing, restricts facial expressions, and impairs balance. Muscle pain and difficulty turning over in bed can further disrupt sleep.
When another person attempts to bend a rigid limb, it may move in short, jerky steps, a pattern termed “cogwheel” rigidity. Rigidity usually begins on one side and becomes more widespread as the disease progresses, though it remains less prominent in the earliest stages of Parkinson’s.
Balance and walking difficulties
Difficulties with balance and walking affect most individuals, typically emerging in later stages of the disease. Balance problems, or postural instability, increase the risk of falls, though targeted exercises and clearing obstacles at home can help prevent falls.
People with Parkinson’s commonly experience changes in how they walk due to shakiness, stiffness, and slowed movement.
They may experience:
- taking shorter, slower steps
- difficulty turning around (usually needing to take many small steps to do so)
- shuffling while walking
- holding the arms and torso rigid while moving
Many individuals also experience akinesia, a temporary inability to start or maintain movement. These episodes appear as delayed movement, freezing mid-movement, or total immobility — frequently occurring when passing through doorways or turning corners, thereby elevating the risk of falls.
Other motor symptoms
Bradykinesia, tremor, rigidity, and gait and balance problems are the main motor symptoms of Parkinson’s, but others can develop, including:
- dystonia, or painful muscle cramps
- difficulty maintaining an upright posture, which can lead to stooping and abnormal curvature of the spine (scoliosis or kyphosis)
- festination, a walking pattern that involves taking short, rapid steps while leaning forward
- micrographia, or abnormally small handwriting, due to rigidity and slowed movement
- speech changes, such as slurring or an unusually soft and quiet speaking voice
Medication-related dyskinesia
Levodopa effectively manages motor symptoms, yet long-term use can trigger dyskinesia, which is characterized by involuntary, uncontrolled body movements. Adjusting medication dosing or timing helps manage this side effect.
Nonmotor symptoms of Parkinson’s disease
Parkinson’s frequently causes nonmotor symptoms across all stages, occasionally creating greater daily disruption and may be more disabling than movement symptoms.
Autonomic dysfunction
Parkinson’s can disrupt the autonomic nervous system, which controls involuntary functions such as digestion and blood pressure.
Symptoms may include:
- increased sweating (hyperhidrosis)
- orthostatic hypotension, a drop in blood pressure upon standing that can cause dizziness or fainting
- constipation or bowel incontinence
- frequent or urgent urination
- sexual difficulties, such as erectile dysfunction or vaginal dryness
Impaired muscle coordination can also cause swallowing difficulties (dysphagia), while reduced automatic swallowing leads to drooling.
Mood and emotional changes
Brain changes affecting dopamine, norepinephrine, and serotonin disrupt emotional regulation, and can cause mood issues, such as depression, anxiety, and apathy. These can have a significant impact on well-being and quality of life. Mood disturbances with Parkinson’s can include:
- depression: Overwhelming sadness or hopelessness affects roughly 50% of people with Parkinson’s.
- anxiety: Persistent worry or stress impacts approximately 40% of individuals with Parkinson’s.
- apathy: A lack of motivation makes it difficult to initiate everyday tasks.
- psychosis: Hallucinations (seeing, hearing, or otherwise sensing something that isn’t there) or delusions (fixed beliefs with no basis in reality) affect 20% to 40% of patients over time.
Cognitive changes
Dopamine loss impairs memory and executive functioning. Common cognitive changes include:
- difficulty paying attention or concentrating
- problems with decision-making and multitasking
- short- and long-term memory issues
- language issues, such as trouble recalling a specific word
- slowed thinking
- having less drive or motivation to start speaking, thinking, or doing things, known as abulia
For some people, these symptoms are mild and may not interfere with daily activities.
About 40% of people with Parkinson’s may develop dementia, meaning cognitive problems become severe enough that they cause issues in day-to-day life. Dementia typically develops after living with Parkinson’s for many years.
Sensory issues
Many people with Parkinson’s experience changes in sensation, such as:
- a loss of smell (hyposmia), which can also reduce the sense of taste
- vision problems such as blurred or double vision, dry eyes, or trouble opening eyes
- numbness, tingling, or burning sensations, especially in the feet and legs
Sleep issues
More than 75% of people with Parkinson’s experience sleep issues, including:
- difficulty falling asleep
- waking up frequently in the night or very early in the morning
- difficulty turning over or getting comfortable in bed
- excessive daytime sleepiness
- sudden attacks of sleepiness
REM sleep behavior disorder causes people to act out dreams with noises and sometimes violent movements.
Restless legs syndrome causes discomfort and an urge to move the legs, especially at rest or bedtime.
Sleep problems can contribute to fatigue that disrupts daily activities and may not improve with rest. Fatigue can occur at any stage of Parkinson’s.
How Parkinson’s symptoms progress over time
Parkinson’s symptoms gradually worsen, but progression varies by person.
The five stages reflect increasing disability:
- Stage 1: Mild symptoms affect one side of the body without significantly disrupting daily activities.
- Stage 2: Symptoms affect both sides, yet independence remains intact.
- Stage 3: Balance issues emerge, increasing fall risks and complicating daily tasks.
- Stage 4: Severe symptoms restrict mobility, requiring substantial daily assistance.
- Stage 5: Patients require a wheelchair or full assistance to move, alongside round-the-clock care.
Managing and tracking Parkinson’s symptoms
Managing Parkinson’s disease symptoms requires an individualized care plan that evolves alongside the disease.
Core management strategies:
- Building a care team: A movement disorder specialist and rehabilitation therapists address physical mobility, daily tasks, speech, and swallowing difficulties, while additional specialists target nonmotor symptoms.
- Tracking symptoms: Maintaining a daily symptom diary helps record functional changes and medication responses, providing critical data to guide physicians in adjusting treatments.
- Maintaining healthy habits: Prioritizing a nutrient-dense diet, regular exercise, consistent sleep, and stress management supports overall quality of life and enhances symptom control.
- Following a treatment plan: Prescribed medications, rehabilitation therapies, and, when appropriate, deep brain stimulation can help manage symptoms.
Parkinson's News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
