10 Early Signs of Parkinson's Disease That Doctors Often Miss


Let's be honest: A diagnosis of Parkinson's disease can be pretty unnerving. In fact, an April 2011 survey by the National Parkinson's Foundation revealed that people will avoid visiting the doctor to discuss Parkinson's even when experiencing worrisome symptoms, such as a tremor.

The problem, however, is that waiting prevents you from beginning treatment that -- although it can't cure Parkinson's -- can buy you time. "We now have medications with the potential to slow progression of the disease, and you want to get those on board as soon as possible," says Illinois neurologist Michael Rezak, M.D., who directs the American Parkinson's Disease Association National Young Onset Center.

Parkinson's disease (PD) occurs when nerve cells in the brain that produce the neurotransmitter dopamine begin to die off. When early signs go unnoticed, people don't discover they have Parkinson's until the disease has progressed. "By the time you experience the main symptoms of Parkinson's, such as tremor and stiffness, you've already lost 40 to 50 percent of your dopamine-producing neurons. Starting medication early allows you to preserve the greatest possible number of them," Rezak explains.

Here, 10 often-missed signs that can help you identify and get early treatment for Parkinson's.

1. Loss of sense of smell

This is one of the oddest, least-known, and often earliest signs of Parkinson's disease, but it almost always goes unrecognized until later. "Patients say they were at a party and everyone was remarking on how strong a woman's perfume was, and they couldn't smell it," says Rezak.

Along with loss of smell may come loss of taste, because the two senses overlap so much. "Patients notice that their favorite foods don't taste right," Rezak says.

Dopamine is a chemical messenger that carries signals between the brain and muscles and nerves throughout the body. As dopamine-producing cells die off, the sense of smell becomes impaired, and messages such as odor cues don't get through. Some researchers consider this change so revealing that they're working to develop a screening test for smell function.

More early signs of Parkinson's

2. Trouble sleeping

Neurologists stay on the alert for a sleep condition known as rapid eye-movement behavior disorder (RBD), in which people essentially act out their dreams during REM sleep, the deepest stage of sleep. People with RBD may shout, kick, or grind their teeth. They may even attack their bed partners. As many as 40 percent of people who have RBD eventually develop Parkinson's, Rezak says, often as much as ten years later, making this a warning sign worth taking seriously.

Two other sleep problems commonly associated with Parkinson's are restless leg syndrome (a tingling or prickling sensation in the legs and the feeling that you have to move them) and sleep apnea (the sudden momentary halt of breathing during sleep). Not all patients with these conditions have Parkinson's, of course, but a significant number of Parkinson's patients -- up to 40 percent in the case of sleep apnea -- have these conditions. So they can provide a tip-off to be alert for other signs and symptoms.

3. Constipation and other bowel and bladder problems

One of the most common early signs of Parkinson's -- and most overlooked, since there are many possible causes -- is constipation and gas. This results because Parkinson's can affect the autonomic nervous system, which regulates the activity of smooth muscles such as those that work the bowels and bladder. Both bowel and bladder can become less sensitive and efficient, slowing down the entire digestive process.

One way to recognize the difference between ordinary constipation and constipation caused by Parkinson's is that the latter is often accompanied by a feeling of fullness, even after eating very little, and it can last over a long period of time. When the urinary tract is affected, some people have trouble urinating while others begin having episodes of incontinence. The medications used to treat Parkinson's are effective for this and other symptoms.

More early signs of Parkinson's

4. Lack of facial expression

Loss of dopamine can affect the facial muscles, making them stiff and slow and resulting in a characteristic lack of expression. "Some people refer to it as 'stone face' or 'poker face,'" says neurologist Pam Santamaria, a Parkinson's expert at the Nebraska Medical Center in Omaha. "But it's really more like a flattening -- the face isn't expressing the emotions the person's feeling."

The term "Parkinson's mask" is used to describe the extreme form of this condition, but that doesn't come until later. As an early symptom, the changes are subtle: It's easiest to recognize by a slowness to smile or frown, or staring off into the distance, Santamaria says. Another sign is less frequent blinking.

5. Persistent neck pain

This sign is particularly common in women, who have reported it as the third most-common warning sign they noticed (after tremor and stiffness) in surveys about how they first became aware of the disease.

Parkinson's-related neck pain differs from common neck pain mainly in that it persists, unlike a pulled muscle or cramp, which should go away after a day or two. In some people, this symptom shows up less as pain and more as numbness and tingling. Or it might feel like an achiness or discomfort that reaches down the shoulder and arm and leads to frequent attempts to stretch the neck.

More early signs of Parkinson's

6. Slow, cramped handwriting

One of the symptoms of Parkinson's, known as bradykinesia, is the slowing down and loss of spontaneous and routine movement. Handwriting is one of the most common places bradykinesia shows up. Writing begins to become slower and more labored, and it often looks smaller and tighter than before. "Sometimes a family member will notice that someone's handwriting is becoming very spidery and hard to read," Santamaria says.

Washing and dressing are other areas where bradykinesia appears. Someone may take a long time to get dressed or be unable to deal with zippers and other fasteners.

7. Changes in voice and speech

As the brain signals and muscles that control speech are affected by Parkinson's, a person's voice begins to change, often becoming much softer and more monotone. This is frequently one of the first early signs of Parkinson's that family and friends notice, often long before the patient becomes aware of it.

Slurring words is also characteristic of Parkinson's, because as the facial muscles stiffen, it becomes harder to enunciate clearly. "Some patients begin to have trouble opening their mouths as wide, making speech harder to hear and understand," says Rezak. This subtle sign is so characteristic of Parkinson's that researchers are working on a voice analysis technique that might eventually be used as an early screening and diagnostic tool.

8. Arm doesn't swing freely

"Reduced arm swing" is how doctors describe this symptom, but that doesn't fully capture what some Parkinson's patients first remember noticing. Instead, think of this sign as a subtle stiffness and reduced range of motion: reaching for a vase on the highest shelf or stretching out to return a serve in tennis and noticing the arm won't extend as far.

"With the onset of Parkinson's, people begin to have what we call increased tone, which means the muscles are stiffer and more limited," says Santamaria. "The arm just won't go where the brain tells it to go." Some people first notice this when walking, as one arm swings less than the other. One way to distinguish this symptom from arthritis or injury: The joints are unaffected and there's no pain.

More early signs of Parkinson's

9. Excessive sweating

When Parkinson's affects the autonomic nervous system, it loses its ability to regulate the body, which can cause to changes in the skin and sweat glands. Some people find themselves sweating uncontrollably when there's no apparent reason, such as heat or anxiety. For a woman, these attacks may feel much like the hot flashes of menopause. The official term for this symptom is hyperhidrosis.

This condition can also show up in the form of excessively oily skin or an oily scalp resulting in dandruff. Many Parkinson's sufferers also notice a problem with excessive saliva, but this is actually caused by difficulty swallowing rather than producing more saliva.

10. Changes in mood and personality

Experts aren't certain why, but there are a variety of related personality changes that come with Parkinson's, including pronounced anxiety in new situations, social withdrawal, and depression. Several studies show that depression, in someone who hadn't previously experienced it, was the first sign many Parkinson's patients and their families noticed, but at the time they weren't able to attribute it to Parkinson's.

Some people also experience subtle changes in their thinking abilities, particularly in concentration and the so-called "executive functions" that govern planning and executing tasks. The first sign of decline is loss of ability to multitask. "People who used to be able to do three or four things at once perfectly well find that they have to do one thing at a time or they can't keep it all straight," Rezak says. Some experts believe that thinking problems and mood issues go hand in hand -- that the sense of slipping mentally leads to anxiety, feeling overwhelmed, and social withdrawal.

3 months ago, said...

I was diagnosed with parkinsons,I have been taking propranolol for yrs,I have developed other symptoms ,my brain feels tight which makes my left eye feel tight also,at night when my meds wear off I get paranoid, I see things that are not there.I am afraid to drive or ride my motorcycle,..What questions should I be asking my Dr.??? tired of being scared

5 months ago, said...

I have most of the symptoms in this list but I am only 42 years old. I was diagnosed with fibromyalgia instead of parkinson. My dad as Parkinson disease so I would think that I have the same. The tremors show only when I'm trying to grab something. But all the other symptoms are all there. I have difficulty to walk and swallow. I have digestive problems. I grind my teeth. I have difficulty sleeping. I have rapid eye movement when I'm trying to sleep. I can't concentrate. I fall down when I walk. I trip a lot because my distance is not good. But because my doctor is the friend of my dad he doesn't believe me. I have cramps in my hand when I write. I talk slowly. I have disconnect with the society. I have depression and high anxiety. What should I do.

5 months ago, said...

Is Parkinson's Disease known to be heridetary?

12 months ago, said...

I believe that I may have several symptoms that point to Parkinson's. However my wife thinks I'm being paranoid and self diagnosing.

almost 2 years ago, said...

the article states, "We now have medications with the potential to slow progression of the disease, and you want to get those on board as soon as possible," says Illinois neurologist Michael Rezak, M.D., who directs the American Parkinson's Disease Association National Young Onset Center. I see this often in articles, however no-one can ever tell me which drugs slow the progression of Parkinson's Disease. The Michael J Fox Foundation for Parkinson's Research states "There are treatments available to lessen the effects of Parkinson’s symptoms for some window of time, but this is all they can do — offer symptomatic relief. What we don’t have is a disease-modifying treatment, something that would actually halt or slow the progression of the disease." Based on this information, regardless of when treatment is started, early or late, since treatment only offer symptomatic relief and some of the medications like Carbidopa/Levadopa (Sinemet) has long term side effects including dyskinesia, hallucinations and illusions, waiting to start treatment might not be a bad idea. As always, since PD symptoms are different in every patient you should consult a Movement Disorder Specialist (MDS), to discuss what treatment options are best in the case of each patient. Please let me know if there is a drug that can slow the progression and not just treat symptoms, as I would love to have my MDS prescribe it to me. Please review your information regarding Parkinson's Disease treatments.

about 2 years ago, said...

The shaking in my left hand and arm seems to be progressing. It is the only symptom I have so far. I will be 84 next month and have really slowed down. What kind of medication is available?

over 2 years ago, said...

I was diagnosed with Essential Tremor in October. Recently my neurologist said he thinks that I may have or be getting PD as well. After reading your great article, I won't be surprised if he's right. While I'm determined to be strong, I feel that my husband and I need to go ahead and see an elder care lawyer about how to protect our assets so that my medical challenges don't wipe us out. The last thing that I want is for my 67 year old husband to be short funded.

over 2 years ago, said...

Change in handwriting Numbness or sensation in the ball of the feet are also possible signs. Hoarseness or a slight roughness in the voice. Thanks for all the info . Caring . Com is a great help. Sincerely, Maree L Meehan

over 2 years ago, said...

My mother had Parkinsons. She lived a good life, passing away at 85. The last 3-4 years were pretty tragic for the family though, and I lived some 12000 miles away, although I did visit a year before she passed. It was all very sad. I have noted all the reported facts in the article, and I note that some are applying to me at this time. I had best consult with my Dr about these matters sooner rather than later, as I may be offered some delaying medication. I am now 73(within a few days anyhow)

over 2 years ago, said...

My husband and I are two college-educated adults(he actually taught college-level psychology) and we have been reduced to poverty by Parkinsons! I am praying I will not have to live into very old age. One of his former employers let go all employees that had chronic illnesses-even those who had been reviewed and given raises

over 2 years ago, said...

Sorry, but most of these are not EARLY signs but LATE signs!, when the Parkinson's has already been diagnosed!

about 3 years ago, said...

Since this article was presented at Caring.com a lot more has been made public about the early signs of both motor-predominant and non-motor symptoms of Parkinson's disease. What is so very important is that not only neurologists specializing in motion disorders but also primary care physicians become fully aware of the symptoms so that they can start putting both the pieces but lives together to improve quality of life through the various forms of treatment currently available for PD. It is crucial that those with non-motor predominant PD begin treatment early because this form does predict a shorter life span. http://parkinsonsfocustoday.blogspot.com/2011/04/early-warning-signs-of-parkinsons.html

about 3 years ago, said...

Unfortunately, my husband had every single one of these symptoms except for neck pain, had them for years. He even occasionally mentioned one or two to his doctor, who never followed up on any of them. He even refused to see a doctor for nearly a year after developing a pronounced tremor in his right arm and leg. He has finally been diagnosed with Parkinson's. But if anybody in the medical community had ever suggested any of these symptoms was significant, we wouldn't have needed to wait so many years to start treatment. Kinda aggravating! Now I'd like to post all these symptoms on billboards all over the place so people would know about them.

about 3 years ago, said...

so what is the best drug that can handle the bradykinesia and the akinesia?

over 3 years ago, said...

knowing what to look for other then just shakes.

over 3 years ago, said...

STUNNING! I have most of these symptoms and no one has put them together. Meantime I have noticed many are becoming more pronounced. I will call for an appointment with my neurologist today. Thank you

over 3 years ago, said...

To anonymous recently dx'ed with PD: It is very difficult to make a timeline prognosis as there are too many variables. You will probably need to be as proactive as possible - with separate accents on both the pro and the active. Make sure that your medical staff is one that continuously updates their PD education and is willing to work with both you and your family to treat you and not just the disease. There have been very positive results with the right physical exercise therapy. Of all the things you can do for yourself to maintain the best quality of life, exercise therapy is right there at the top. Depending upon where you reside, there could be a great support group and/or excellent therapy center just waiting for you. Use all the resources available to you. Report all symptoms both motor and non-motor to your medical team. Stay on top and give them the info to be there with you. And remember that you are important to more people than you might realize, no matter what your physical condition. Let those people help you, let them express their love for you.

over 3 years ago, said...

General info.

over 3 years ago, said...

Everything that was written here is extremely important so, thank u very much for explaining this disease and it's symptons.

over 3 years ago, said...

I have recently been diagnosed with Parkinsons and appreciate the info in this article as I learn to cope with it. Was wondering what the timeline is until the disease robs me of a normal life and everyday activities.

over 3 years ago, said...

This article details the onset of Parkinson's disease perfectly. Thank you for your help. The details of the disease can help you manage the patient more effectively. This article defines Parkinson's. One sympton my uncle had early on that was missed was the balls of his feet had no feeling. The doctor thought he was a runner and somehow it was connected to that.