Motor symptoms of Parkinson’s disease
Reviewed by The motor symptoms of Parkinson’s refer to signs of the disease that affect movement. Four hallmark symptoms are characteristic of Parkinson’s and are key to diagnosing this neurodegenerative disorder: resting tremor, bradykinesia (slowness of movement), rigidity, and postural instability.
People with Parkinson’s may experience other motor symptoms, such as freezing, impaired coordination, and difficulty speaking. Nonmotor symptoms are also associated with the disease. Because Parkinson’s is a progressive disease, most symptoms begin slowly and worsen over time.
Four cardinal motor symptoms of Parkinson’s
Parkinson’s disease is defined by four cardinal motor symptoms, and, together, these are known as parkinsonism. A formal diagnosis generally requires bradykinesia plus at least one other sign from this group. They result from a progressive loss of dopamine-producing neurons in the brain, which disrupts the brain’s normal control of movement.
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| Cardinal Symptom | Description |
|---|---|
| Resting tremor | Involuntary shaking of a limb that occurs at rest and temporarily stops or decreases with voluntary movement |
| Bradykinesia | General slowing and reduction in the size of movement, affecting things such as walking, handwriting, and facial expression |
| Rigidity | Increased stiffness and resistance when a limb is moved passively, felt as either smooth or ratchet-like |
| Postural instability | Impaired balance reflexes that make it hard to stay upright, usually appearing later in the disease |
Resting tremor
Resting tremor in Parkinson’s is an involuntary shaking that appears when a limb is relaxed. It temporarily stops or decreases with voluntary movement once an individual starts using that limb intentionally.
Resting tremor usually begins on one side of the body, often in a hand or foot. It can appear as a pill-rolling motion between the thumb and index finger. This kind of tremor can also affect the jaw, chin, lips, or tongue, and tends to worsen with stress and ease during sleep.
Around 76.1% of people with Parkinson’s experience resting tremor at some stage. Other individuals with Parkinson’s may develop action tremors, which occur with voluntary movement. Some people have one or another form of tremor; many people with Parkinson’s disease have both.
Bradykinesia
Bradykinesia is the slowness of movement. It is the most consistent motor feature of Parkinson’s, as it must be present for a clinical diagnosis.
Bradykinesia in Parkinson’s can show up in everyday life as smaller handwriting, reduced arm swing while walking, a softer or fading voice, and a less expressive face. It also reduces the size and speed of repeated actions. All these changes can cause difficulties with practical daily tasks, such as buttoning shirts or tying shoelaces.
Rigidity
Rigidity in Parkinson’s involves increased resistance to passive limb movement. It occurs when muscles remain tense rather than contracting and relaxing normally. Many individuals with Parkinson’s describe rigidity as an internal stiffness.
Rigidity often appears early during the course of Parkinson’s. Because it causes muscle stiffness, healthcare providers sometimes mistake it for arthritis or a shoulder injury. Combined with bradykinesia, rigidity also contributes to the reduced arm swing that affects some individuals with the disease.
Postural instability
Postural instability is a loss of the automatic reflexes that keep the body upright. It typically emerges later in the disease, often years after other symptoms start.
Postural instability involves the inability to maintain a steady, upright posture or to prevent falls. In individuals with Parkinson’s, such balance problems may co-occur with a tendency to list or fall backward. In fact, even a light push can cause an individual with Parkinson’s to step backward or fall.
Postural instability in Parkinson’s acts as a major driver of falls in individuals with the condition. One clinical study attributes around 80% of falls in people with Parkinson’s to postural instability, alongside motor freezing.
Secondary motor symptoms and complications
In addition to the cardinal symptoms of Parkinson’s, some individuals also develop a wider set of motor problems that affect daily life. These represent the secondary motor symptoms of Parkinson’s.
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| Symptom | Description |
|---|---|
| Freezing of gait | Temporary, involuntary inability to move the feet forward, often described as feeling glued to the floor |
| Micrographia | Progressive shrinking of handwriting size, often one of the earliest visible signs of the disease |
| Dystonia | Sustained, painful muscle twisting or cramping, most often in the foot and worst in the early morning |
| Speech and voice changes | Reduced loudness, monotone pitch, and imprecise articulation |
| Swallowing problems and drooling | Difficulty swallowing that lets saliva pool in the mouth, causing drooling |
| Posture and balance changes | Reduced ability to maintain balance or recover from a stumble, raising the risk of falls |
| Restlessness | Inner urge to move, or akathisia, that isn’t fully relieved by movement or activity |
Freezing of gait
Freezing of gait is a temporary, involuntary inability to move the feet forward, sometimes described as feeling “glued to the floor.”
A meta-analysis of dozens of studies found the overall prevalence of freezing of gait in Parkinson’s to be around 40%. This rate rises sharply with age and disease duration, increasing from about 22% in individuals with the disease for less than five years to more than 70% in those with the disease for 10 years or more. Freezing episodes usually last only a few seconds, but they raise the risk of falls.
Micrographia
Micrographia is an abnormal shrinking of handwriting. It affects more than 60% of people with Parkinson’s at some point during the disease. It can appear years before a formal diagnosis of Parkinson’s, making it one of the earliest visible clues to the condition. This issue occurs when Parkinson’s causes difficulties with scaling and maintaining the amplitude of repetitive movements.
Dystonia
Dystonia can occur as part of the Parkinson’s disease process or in relation to medication fluctuations. Certain forms of the condition, such as young-onset Parkinson’s, may cause dystonia independently of medication fluctuations.
In Parkinson’s, dystonia most often affects the foot, causing toe curling or inward turning of the ankle. If related to medication fluctuations, it tends to be worst first thing in the morning, when overnight medication has worn off, and dopamine levels sit at their lowest point. The neck, jaw, abdomen, and various facial muscles can all experience dystonia.
Speech and voice changes
Up to 90% of people with Parkinson’s develop speech and voice changes. These changes most commonly follow a pattern called hypokinetic dysarthria. This pattern shows up as reduced loudness, a monotonous quality, breathiness, and imprecise consonant pronunciation. Hypokinetic dysarthria tends to worsen as the disease progresses.
Speech and voice changes can begin early in Parkinson’s, sometimes before other motor symptoms become obvious.
Swallowing problems and drooling
Swallowing difficulty, or dysphagia, affects roughly 37% of people with Parkinson’s worldwide, according to one meta-analysis. Dysphagia in Parkinson’s disease can contribute to a variety of problems, including malnutrition, pneumonia, and prolonged hospital stays. It may even increase the mortality rate among people with Parkinson’s.
Drooling is closely linked to swallowing issues. Drooling in Parkinson’s usually stems not from producing excess saliva, but rather from dysphagia. People with Parkinson’s rate drooling as one of the 10 most bothersome symptoms of their condition.
Restlessness
Restlessness in Parkinson’s can take the form of akathisia, which is an inner urge to move that does not fully settle even with movement.
Clinical studies suggest that akathisia may occur in anywhere between roughly 7% and 54% of people with Parkinson’s. This wide range likely results from scientists using inconsistent methods for detecting akathisia. The symptom is frequently linked to more advanced disease and “off” periods when the medication has worn off.
Although restlessness can be confused with restless legs syndrome, the two conditions remain quite distinct. Restless legs syndrome is localized to the legs, follows a clear evening pattern, and eases with movement. By contrast, akathisia is more generalized, lacks a daily rhythm, and resolves only partly with activity.
Managing and tracking motor symptoms
Parkinson’s motor symptoms rarely respond to one treatment type alone. Finding the right mix of care and tracking how the body responds from day to day can make a significant difference in management.
Building a multidisciplinary care team
Parkinson’s disease affects movement, mood, sleep, and overall function. No single specialist can manage all symptoms of the condition. Effective care usually brings together a neurologist or movement disorder specialist, physical and occupational therapists, speech-language pathologists, and mental health professionals.
A 2020 survey of 20 expert Parkinson’s disease centers found no single guideline for how multidisciplinary care is organized. The survey authors took feedback from people with Parkinson’s on the effectiveness of these different approaches to collaborative care. Based on patient feedback, the authors recommended a patient-centered approach, a dedicated care team coordinator, and access to multidisciplinary care for individuals newly diagnosed with Parkinson’s.
Combining treatments as the disease progresses
The medication levodopa remains the foundation of Parkinson’s treatment, especially for motor symptoms.
However, the medication can lose effectiveness as the disease advances and may cause movement complications. These limitations mean that combination therapy is often needed to secure the best possible health outcomes.
For individuals with more advanced forms of Parkinson’s, clinicians can combine deep brain stimulation and continuous levodopa infusion. In one retrospective study tracking 59 people with Parkinson’s, 57 showed improvement with this combination of advanced therapies when the single therapy failed to work.
Evidence indicates that maintaining a healthy lifestyle, exercising regularly, and getting adequate sleep can improve health outcomes for people with Parkinson’s, potentially reducing mortality risk. Many individuals also benefit from physiotherapy for Parkinson’s disease, as well as specialized forms of speech therapy like LSVT LOUD, which helps patients speak more loudly and with greater responsiveness.
Tracking “on” and “off” periods
Motor fluctuations are the shifts between “on” periods, when medication is working, and “off” periods, when symptoms return. These shifts can be hard for doctors to observe during a short office visit, making a daily symptom diary beneficial for treatment and management.
However, paper diaries have drawbacks. Research suggests that individuals can lose motivation to keep these diaries or fill them in all at once toward the end of the day. This can lead to incomplete or inaccurate records that might undermine treatment decisions.
These limitations have raised interest in digital monitoring tools, such as wrist-worn sensors that track changes in movement. Some research suggests that these sensors can achieve 91% accuracy in detecting Parkinsonian motor changes.
Whichever method is used, consistent tracking provides healthcare teams with the timing data needed to adjust medication doses to an individual’s personal rhythms. It is also important for loved ones and caregivers to recognize “off” periods, as remaining attuned to these additional challenges offers a way to cultivate better emotional support.
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