Parkinson's disease creeps up slowly, starting with mild symptoms that are easy to ignore at first. What follows are three cardinal features of the disorder (#1 through #3 below) that doctors look for, along with seven related signs (#4 through #10) that could be additional evidence of the illness.
If you notice these kinds of changes either in yourself or a loved one, consider seeking an opinion from a neurologist who specializes in movement disorders. Parkinson's disease can be tricky to identify, and not every patient will have all the possible symptoms. So a careful clinical examination by an expert is crucial.
According to widely used guidelines from the United Kingdom Parkinson's Disease Society Brain Bank, the first indicators of a Parkinson's diagnosis are sign #1 and at least one of signs #2 through #4.
1. He or she moves very slowly and seems clumsier. It takes longer than usual to button a shirt, make a phone call, or do any task that requires hand coordination -- and there's no other obvious explanation for it. This slowness of movement is known as bradykinesia. As the disease progresses, Parkinson's disease patients may find themselves momentarily "freezing" like a statue while walking or turning, unable to take the next step.
2. His or her hand or leg shakes when in a resting position. About 70 to 80 percent of Parkinson's disease patients have a "resting tremor" in the hands, arms, legs, jaw, or face. The shakiness occurs when, say, the patient rests her hand relaxed in her lap, as opposed to when moving to pour a cup of tea. The trembling could make it look as if she's rolling a pill between her thumb and forefinger.
If your loved one's hand is shaking while engaged -- holding a cup or writing with a pen, for example -- she may instead have what's called an "essential tremor," not Parkinson's disease.
3. He or she complains about feeling stiff or sore. Rigidity of the muscles in the arms, legs, and body makes it harder to move. Getting out of bed in the morning, or standing up from a chair, can be difficult. Patients with Parkinson's disease make fewer spontaneous body gestures and lose facial expressiveness. When flexing a bicep and then straightening the arm out, there may be a jerkiness to the motion, as if the arm is catching on a cogwheel.
More signs of Parkinson's disease
4. He or she has been tripping or is unsteady on the feet. Another typical clue of Parkinson's disease is that patients have poor balance and tend to fall over, sometimes suddenly and for no apparent reason. They also tend to take small, shuffling steps. One major caveat, though: Changes in balance and gait tend to emerge as the disease progresses, not in the first couple of years. If your loved one is experiencing these kinds of troubles with few or no other Parkinson's signs, it probably indicates a different diagnosis.
5. The problems start on one side of the body. Whether it's a trembling pinky finger or a strange stiffness in the foot, the motor symptoms of Parkinson's disease almost always affect just one side at first. Later, sometimes after many years, they spread to the other side.
6. His or her handwriting has changed. One of the first oddities that many Parkinson's disease patients notice is that their handwriting has become smaller and cramped -- an early hint of motor difficulties.
7. He or she seems sad and low on energy. Parkinson's patients commonly develop depression before showing problems with movement. Experts believe the mood disorder is part of Parkinson's disease itself, not simply a reaction to having the illness.
8. When he or she walks, one arm doesn't swing as much as the other. In addition to moving slowly, Parkinson's patients typically move less overall. For example, they may swing their arms less often than normal (usually on one side, at first). They also blink less and swallow less.
9. He or she doesn't notice odors. Very early on, people with Parkinson's disease often lose their sense of smell because the neurodegenerative process affects the olfactory system. However, a reduced sensitivity to smells can also result from other causes.
10. His or her speech is harder to hear and understand. Parkinson's disease can make the voice softer, muffled, and slurred.