Parkinson’s disease symptoms can include tremor and trouble with movement, along with emotional and cognitive changes.

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Parkinson's disease symptoms can vary significantly from person to person. Some people may have range of motor symptoms, like tremor, stiffness, and slow movements. Others may also experience the non-motor symptoms of Parkinson's disease, such as anxiety, cognitive changes, and loss of smell.

It has to do with a chemical messenger known as dopamine, which plays a role in the brain's ability to control movement, coordination, and emotional responses. In Parkinson's disease, the brain cells that produce dopamine either stop doing their job or they die out, resulting in both motor and non-motor symptoms.   It's not always easy to tell if someone you care about has Parkinson's disease. Let's take a closer look at the symptoms of the disease and signs that someone should make an appointment with their doctor.

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What are the motor symptoms of Parkinson's disease?

Motor symptoms of Parkinson's disease have to do with changes to the way a person moves. A person with the disorder may experience stiffness and shaking. As Parkinson's progresses, they may have trouble walking and talking. Here are some of the most common motor symptoms of Parkinson's disease:

Tremor

"The symptom people most commonly notice first is the tremor," Lynda Nwabuobi, MD, assistant professor of clinical neurology at Weill Cornell Parkinson's Disease and Movement Disorders Institute, tells Health. "The tremor is a resting tremor, meaning that your arm is completely relaxed but then you see the hand shaking." 

The tremor typically starts on one side of the body, usually in the hand, foot, or leg. It's also possible to experience a resting tremor in the jaw, chin, mouth, or tongue. As the disease progresses, a person may develop a tremor in the other side of their body, as well. While tremor is a symptom of Parkinson's disease, it could be from another disorder, such as multiple sclerosis. It can also be caused by stress, strenuous activity, or certain medications. That's why it's worth consulting your doctor if you notice a tremor (or any other symptom of Parkinson's disease).

Rigidity

Rigidity is another one of the main motor symptoms of Parkinson's disease, and it's just what it sounds like: a stiffness or tightness in the limbs.

Early on in the disease, a person with Parkinson's might mistakenly assume their stiffness is coming from an injury or arthritis, or simply growing older. But rigidity from Parkinson's is more severe than typical stiffness from arthritis or aging. A person with Parkinson's disease may notice this symptom in just one side of their body, or both. Rigidity can also reduce a person's range of motion, which can create pain in the affected joints and muscle.

Bradykinesia

The third telltale motor symptom of Parkinson's disease is bradykinesia, meaning slowness of movement. It can affect how a person walks, gets around, and initiates movements (like standing up from a chair).

Bradykinesia can also cause changes in a person's expression, also known as facial masking.

"Individuals with this symptom tend to have a blank expression," says Dr. Nwabuobi. "They look depressed. But it's [due to] a loss of the typical facial movements that we naturally have."

Other signs of bradykinesia in Parkinson's include:

  • trouble with fine motor coordination
  • slower-than-usual physical actions
  • reduced rate of blinking
  • shuffling while walking
  • arms swinging less than usual while walking

Posture changes

Poor posture and instability are typically later-stage symptoms of Parkinson's disease. At this point in the disease, a person might have more trouble maintaining an upright, balanced posture and they may also start falling more. This symptom of Parkinson's disease also includes rounded shoulders, a reduction in the curvature of the lower back, and the body or head leaning forward.

What are the non-motor symptoms of Parkinson's disease?

While Parkinson's disease is often associated with movement changes, there are a variety of non-motor symptoms, as well. Non-motor symptoms refer to the many other changes to a person's health and wellbeing that can happen from Parkinson's.

These symptoms can sometimes have an even greater impact on a person's life than tremor, rigidity, and slow movement, so it's important to keep an eye out for them in someone with the disorder. Here are some of the non-motor symptoms of Parkinson's disease to look out for:

Trouble speaking

Some people with Parkinson's disease experience a change in how they sound and communicate. Since this could be due in part to bradykinesia, as well as cognitive changes, speaking problems are sometimes considered both a motor and non-motor symptom of Parkinson's disease.

In particular, you may notice someone speaking in a softer, breathier voice that tends to be monotone. As the disease progresses, they may begin to speak more rapidly, with words knocking into one another to the point where they sound inarticulate. Slurring, mumbling, or trailing off are other symptoms of Parkinson's disease. It's important to keep in mind that trouble speaking can also be a side effect of stroke and other conditions—it doesn't always mean the person has Parkinson's.

Loss of smell

A loss of smell or a decreased sensitivity to odors can be an early symptom of Parkinson's disease. And not just early as in it can be one of the first signs of Parkinson's, but early as in it may occur years before a diagnosis.

"We know that the pathology of Parkinson's disease actually starts many, many years before you develop motor symptoms," says Dr. Nwabuobi. "We think at least about 30 years."

In fact, when she asks people with Parkinson's disease about their medical history, they'll often admit they haven't had a strong sense of smell in many years, explains Dr. Nwabuobi.

But since loss of smell often doesn't make a huge impact on a person's life, this non-motor symptom of Parkinson's disease tends to go overlooked, or mistakenly attributed to other things.

"Losing your sense of smell, it's kind of non-specific," says Dr. Nwabuobi. "It could be from your allergies, right?"

Sleep problems

Around 75% of people with Parkinson's disease notice sleep problems, according to the Parkinson's Foundation. 

"There are many sleep problems in Parkinson's," says Dr. Nwabuobi. "Unfortunately, people with Parkinson's have a lot of insomnia, and we have to try and fix that because when they don't sleep well they don't feel well the next day."

An early, sleep-related symptom of Parkinson's disease that can occur years in advance is acting out dreams. "The spouse will say, 'Oh yeah, he kicks a lot in his sleep,'" says Dr. Nwabuobi. "'He's done that since we were first married."  But it's not just the disease itself that can cause sleep troubles—some of the medications used to treat the symptoms of Parkinson's disease can also disrupt a person's sleep. A doctor may recommend adjusting medications if a person with Parkinson's disease is experiencing ongoing sleep problems that affect their quality of life.

Anxiety and depression

Non-motor symptoms of Parkinson's disease also include changes to mental health. Around half of people with Parkinson's have depression at some point in the course of their disease, while about 40% develop an anxiety disorder.

These mental health conditions can be part of an emotional reaction to having a chronic illness, and the stress and uncertainty that come along with that. But they can also be caused by Parkinson's itself, due to imbalances of neurotransmitters. (In fact, there's a complicated link between depression and brain diseases that may have impacted Robin Williams.)

Psychosis

More than half of people with Parkinson's disease will experience hallucinations and/or delusions over the course of the disease. Hallucinating means seeing, hearing, or experiencing things that aren't really there or happening. Harboring delusions means believing false things that aren't based in reality. It's unclear what causes these non-motor symptoms of Parkinson's disease. It could be a side effect of medications or the result of brain changes that happen over the course of the disease.

Cognitive changes

Cognitive changes tend to be a non-motor symptom of Parkinson's disease in older adults, who may begin to lose their executive function. They may have trouble:

  • planning and finishing common activities
  • concentrating on a task
  • shifting between tasks
  • remembering things
  • making decisions
  • thinking quickly
  • finding a word they're trying to come up with

If these Parkinson's symptoms occur early in the disease (before motor symptoms), it's possible that a person has a different disorder, such as Lewy body dementia.

Other non-motor symptoms

In addition to cognitive changes, mental health disorders, and trouble sleeping, there are a variety of other non-motor symptoms of Parkinson's disease to be aware of. These include:

  • Urinary incontinence
  • Vision changes
  • Weight loss or gain
  • Apathy
  • Fatigue
  • Constipation
  • Nausea
  • Small handwriting
  • Swallowing problems
  • Breathing difficulties
  • Dizziness
  • Vertigo

With that said, these symptoms aren't exclusive to Parkinson's disease. There are many other things that can cause changes to a person's health and wellbeing (i.e. nausea could come from a stomach bug), so it's important to get new symptoms checked out by a doctor to figure out what's really going on.

How is Parkinson's disease diagnosed?

A person doesn't need to have all the signs and symptoms of Parkinson's disease to be diagnosed with it.

"In general, people have a combination of the motor symptoms and the non-motor symptoms," says Dr. Nwabuobi. "Some people have more non-motor symptoms than motor and vice versa, but in order to have a diagnosis of Parkinson's, you definitely need the motor symptoms. We're looking for specific things [in a physical exam], including a rest tremor, bradykinesia, rigidity, and poor balance."

According to the Parkinson's Foundation, a person needs to have two of the four main motor symptoms of Parkinson's over a period of time to be diagnosed with the disease.

What are the treatments for Parkinson's disease?

Unfortunately, there's no cure for Parkinson's yet. But the good news is that there are highly effective medications that help manage Parkinson's disease symptoms. 

"I tell people, 'If you're to get a neurodegenerative disease, Parkinson's is not a bad one to have, because we have a lot of very good medications that treat it,'" says Dr. Nwabuobi. 

The main purpose of Parkinson's medications is to reduce tremor, stiffness, and slowness.

"But none of these medications have been shown to actually slow the progression of the disease," advises Dr. Nwabuobi. 

With that in mind, a person doesn't necessarily have to start medication as soon as they're diagnosed, she adds. If the Parkinson's disease symptoms are mild and aren't making an impact on a person's quality of life, they may not need medications right away.

If, over time, medications stop managing symptoms of Parkinson's disease, surgery may become an option. This includes deep brain stimulation, which involves implanting a device that sends electrical signals to the areas of the brain responsible for movement. 

But medications and surgery aren't the only way to address Parkinson's disease symptoms. Lifestyle interventions—particularly aerobic exercise—can also help a lot. Dr. Nwabuobi recommends that people with Parkinson's exercise 30 minutes a day, five days a week.

"It's the one thing that we have some evidence may slow the progression of the disease," she says. "I can tell which of my patients are exercising and which are not. You can see the fluidity in their movements. They feel better and they look better."

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