How to spot Parkinson's disease symptoms

A senior man grips his wrist with his other hand, as if trying to stop it from trembling.

After noticing a series of tiny changes in how he moved and functioned, Tom went to his doctor. He'd been feeling increasingly stiff. When he walked, one of his arms didn't swing like the other. And he'd gradually been walking ever more slowly. Stoic and adaptable, the 70-year-old felt he was doing well enough. But Tom grew more concerned when he developed a slight tremor in one of his hands.

Tom is like many people who don't realize they're dealing with early Parkinson's disease symptoms. A progressive brain disorder that damages nerve cells producing dopamine, a chemical messenger that helps brain cells communicate, Parkinson's disease affects about 1.1 million Americans. More than 90,000 others are diagnosed every year, according to the Parkinson's Foundation.

Signs of Parkinson's disease tend to mount gradually over years and can be easy to mistake for normal aging. But recognizing clues early can boost your ability to effectively manage the condition, says Dr. David K. Simon, director of the Parkinson's Disease and Movement Disorders Center at Harvard-affiliated Beth Israel Deaconess Medical Center. "When people first start to develop Parkinson's, they may write it off as due to aging or other reasons," he says."

Early motor signs

Long before Parkinson's is diagnosed, you might experience small changes in movement. These are among the most common:

Tremor in one hand. A telltale sign is when your hand trembles at rest. (This differs from a condition called essential tremor, where someone's hand shakes while they're using it.) "It might be intermittent at first, and often on one side at the beginning," Dr. Simon says. He adds that a small fraction of patients never develop this symptom.

Slower movement. Everyday tasks such as walking, typing, buttoning a shirt, or handwriting start to take longer. "Your handwriting can also become a little sloppier and often smaller," he says.

Mild balance and gait changes. You might feel slightly unsteady, perhaps stumbling more. You may also develop a shuffling gait, and one of your arms might not swing while you're walking.

Muscle stiffness. Everyday stiffness usually eases as we move about, but stiffness due to Parkinson's doesn't. Instead, you can feel rigid. "It can be just a little harder to get up from a chair or soft couch, or in or out of the car," Dr. Simon says.

Other clues

Although Parkinson's is classified as a movement disorder, several of its early signs have nothing to do with how fluidly you move. These are called non-motor symptoms and include the following:

Loss of smell. Years before movement is affected, some people who will later develop Parkinson's notice a diminished sense of smell. "Sometimes people report this a decade or more before the onset of motor symptoms," Dr. Simon says.

Sleep changes. Primarily, these involve a condition called REM sleep behavior disorder (RBD), where someone physically acts out their dreams during REM (rapid eye movement) sleep. "When we dream, most of us don't move or kick or yell because these motions are inhibited," he explains. "But with RBD, this is impaired." People with RBD have an 80% risk of developing Parkinson's over the following 10 years; if it happens along with loss of smell, the odds are even higher.

Mood shifts. Anxiety and depression may be part of how Parkinson's first shows up. "They're highly common, but even more so in people who go on to develop Parkinson's disease," Dr. Simon says.

Voice changes. Your voice may become softer, hoarser, or more monotone.

Facial "masking." Your face may consistently look "blank" or overly serious.

Digestive issues. Constipation is common in early Parkinson's patients, since the disease process may begin in nerves connected to the gut. "Of course, constipation is very common in people who don't get Parkinson's," Dr. Simon says, "but significant constipation does mean someone is at higher risk of developing it."

Diagnosis and treatment

While there's no single sign of early Parkinson's that's considered a red flag, Dr. Simon says, it's time to visit a doctor when a symptom lingers or worsens, is joined by others, or spreads to both sides of the body. A cluster of Parkinson's symptoms is often enough to make the diagnosis. But your doctor may order brain imaging or other tests if symptoms are really subtle or atypical.

People with Parkinson's disease should start treatment when symptoms become bothersome, limit function, or interfere with quality of life. Parkinson's treatment typically includes carbidopa/levodopa (Rytary, Sinemet), a medication that's converted into dopamine in the brain. Others include dopamine agonists, which mimic the brain chemical, and drugs that inhibit an enzyme that breaks down dopamine.

First steps after a Parkinson's diagnosis

It's official: you or a loved one has Parkinson's disease. But while the condition is incurable, there's much that people with it can do - beyond taking medications - to control symptoms and feel and function better.

Exercise. Nearly all types of physical exercise likely have benefits. Research is ongoing to try to better understand the type, amount, and intensity of exercise that is best. Physical therapy also can help.

Sing. Various singing groups exist just for people with Parkinson's, helping their voices stay stronger and steadier.

Get Big and Loud. Big and Loud therapy is an exercise and speech program that focuses on practicing bigger movements and a louder voice. Other speech therapy programs also can be effective for improving speech in people with Parkinson's.

Seek support. This can include patient support groups, individual therapy, or consultation with a social worker for counseling and to point you toward appropriate resources and programs.