Health Conditions A-Z Neurological Disorders Parkinson's Disease Signs and Symptoms of Parkinson's Disease By Mark Gurarie Mark Gurarie Mark Gurarie is a freelance writer covering health topics, technology, music, books, and culture. He also teaches health science and research writing at George Washington University's School of Medical and Health Sciences. health's editorial guidelines Published on January 3, 2023 Medically reviewed by Nicholas R. Metrus, MD Medically reviewed by Nicholas R. Metrus, MD Nicholas R. Metrus, MD, is a neurologist and neuro-oncologist with Atlantic Health System. He has completed research on complications of cancer and primary brain tumors like hypermutator gliomas that has been presented at national and international conferences. learn more Share Tweet Pin Email In This Article View All In This Article Cardinal Symptoms Additional Motor Symptoms Cognitive Symptoms Other Non-Motor Symptoms When to See a Healthcare Provider RealPeopleGroup / Getty Images Parkinson’s disease is a neurological disorder characterized by tremors, slow or interrupted movements (known as “bradykinesia”), rigidity, and muscle stiffness, as well as an inability to maintain posture and coordination, among others. Primarily affecting people over 60, this chronic and incurable disease is progressive, with symptoms worsening over time. It can also lead to Parkinson’s dementia, in which there are serious cognitive and memory problems. Parkinson's disease is the second most common neurological disorder worldwide—affecting 2–3% of those over 65. It can significantly impact both physical and mental health. This article breaks down the symptoms of this disease, as well as what signs tell you it’s time to seek help. Parkinson's Disease Overview Cardinal Symptoms At its core, Parkinson’s disease is caused by the degeneration and death of brain cells in the basal ganglia of the brain. This region regulates your motor skills—your ability to move and stay balanced—so the primary, or “cardinal” symptoms of this condition affect your ability to move. There are four such symptoms of Parkinson’s disease: Tremor: Tremors, or uncontrollable shaking in the arms, hands, feet, jaw, tongue, and lips, are characteristic of Parkinson’s disease. This generally arises on one side of the body first and occurs while these parts of the body are at rest, lessening with activity. Bradykinesia: This is characterized by a slowing or consistent interruption of physical movement. Initiating movements becomes challenging and is accompanied by feelings of fatigue, lack of coordination, and weakness. About 80% of patients experience bradykinesia at the onset of symptoms.Rigidity: Rigidity is stiffness in the muscles and resistance to movement or any applied pressure. As with bradykinesia, this symptom tends to set on first on one side of the body before spreading. Characteristic signs include striatal hand—a “locking” of the knuckles and joints in the hand—stooped posture, and reduced arm swing when walking, among others.Postural instability: An inability to maintain proper, erect posture is another hallmark of Parkinson’s disease. This issue can affect balance and ability to move, leading to falls. It is typically a sign of more advanced cases. Parkinson's Disease Symptoms Everyone Should Know Additional Motor Symptoms Parkinson’s disease can also cause a host of other problems with motor function. These can be broken into four categories: those affecting the head or face (craniofacial), movements of the eye (visual), the system of muscles and bones (musculoskeletal), and the ability to walk (gait). Craniofacial Symptoms Several Parkinson’s disease symptoms directly affect the face and head. These include: Hypomimia, or “masked face,” which is the inability to produce facial expressionsReduced amount of time you blink spontaneouslyHypokinetic dysarthria, an inability to coordinate muscles for speech and breathingHypophonia, which is an inability to speak loudly, leading to a quiet, breathy, or monotone voiceAn inability to chew properly, known as dysphagiaExcessive drooling Visual Symptoms Parkinson’s disease can also affect the visual system and the movements of the eye. This can lead to several issues: Hypermetric saccades: Saccades are when your eye rapidly shifts focus from one object to another. Severe cases of Parkinson’s disease impact this ability, leading to difficulties with focusing.Blurred vision: Blurriness and lack of focus in the visual field may arise due to the progression of the disease.Impaired contrast sensitivity: Contrast sensitivity refers to your ability to see the outlines of small objects and make out subtle differences in patterns and textures. Parkinson’s disease can impair the ability to perceive details.Impaired vestibulo-ocular reflex: This is the ability to maintain a gaze and focus during head movements. Parkinson’s disease’s impact on motor function reduces the eyes’ ability to compensate for motion.Impaired convergence: Convergence is the ability of the eyes to work together to focus on objects nearby, and this can also be impacted by Parkinson’s disease. In addition, patients may experience an inability to gaze upward.Lid-opening apraxia: Another effect of disease progression is the inability to voluntarily open your eyes after they’ve been closed. Musculoskeletal Alongside the cardinal signs of Parkinson’s disease are other impacts on the muscular and skeletal systems. These include: Micrographia: An inability to make fine movements, which affects handwriting and speechDystonia: Involuntary muscle contractions cause repetitive and twisting movements, which can affect postureMyoclonus: A recurrent period of involuntary muscle twitching and jerkingKyphosis and/or scoliosis: Different types of curving or bending of the spineCamptocormia, or “bent spine syndrome”: An abnormal forward bending of the spine while upright or walking, potentially resulting in a stooped posturePisa syndrome: A sideways bend in the spine while upright or walking Gait Largely as the result of Parkinson’s disease’s effects on muscle and motor control, changes can occur in your pattern and manner of walking. This can lead to a distinctive “Parkinsonian gait,” characterized by shuffling or very short steps, sudden stops or freezing when walking, and festination, which is a tendency to speed up and shorten repetitive movements. Festination can cause muttering or inaudible speech. Cognitive Symptoms Many people with Parkinson’s disease—between 24% and 31% of patients—experience cognitive decline, or dementia. This is characterized by problems with memory, difficulty concentrating or completing tasks, and trouble paying attention. It can develop gradually or rapidly. Parkinson’s dementia is a type of Lewy body dementia, meaning it is caused by deposits of the protein alpha-synuclein in the brain. Over time, it can severely impact your quality of life and your ability to live independently. In addition, Parkinson’s disease is also associated with psychosis and the development of visual hallucinations. This has been found to arise in 20–40% of patients who are taking medications for the condition. It can increase in severity over time. This psychosis has been linked both to the development of Parkinson’s dementia and the medications taken to treat the condition. Other Non-Motor Symptoms A range of other symptoms can also arise with Parkinson’s disease, affecting mental health, sleep, digestion and other bodily functions, and sense of smell. In many cases, these non-motor symptoms come before the onset of the condition itself. Mental Health Impact Parkinson's disease can have a significant effect on mental health, as is the case for many chronic and debilitating disorders. The most common of these are: Depression: The most common mental health impact of this disease is depression, a feeling of persistent sadness, loss of interest in activities, and melancholy mood that affects daily living.Anxiety: Anxiety is a severe and constant feeling of worry and fear that is often associated with depression.Apathy: This is a persistent lack of interest or excitement in activities and motivation. It can lead to a loss of impulse or will and reduced speech or expression of emotions. Sleep Disorders Disturbances in the quality and quantity of sleep represent another common hallmark of Parkinson’s disease. Researchers have found approximately 64% of patients with the condition experience this issue. Often linked to the other symptoms of Parkinson’s disease, associated sleep disorders include: Excessive daytime sleepiness: Characterized by difficulty staying awake during the dayInsomnia: An inability to fall or stay asleepRestless legs syndrome (RLS): Characterized by an uncontrollable urge to move the legs, especially at night, which can impact sleepREM sleep behavior disorder (RBD): Excessive body movement during the rapid eye movement (REM) or dreaming stage of sleep As a result of the above, fatigue is a common sign of Parkinson’s disease. In turn, sleep disturbances can also impact other aspects of mental and physical health. Autonomic Function Parkinson’s disease can also affect a range of autonomic (involuntary) bodily functions. These impacts on autonomic function include: Constipation: Difficulty defecating or completely emptying your bowelsOrthostasis: Low blood pressure upon standing up; this can lead to faintingDysphagia: An inability to properly chew foodUrinary incontinence: Bed wetting or lacking control of urinationDiaphoresis: Excessive sweatingSexual dysfunction: This can include sexual over- or under-activity, erectile dysfunction, vaginal tightness or dryness, or lack of sexual desire Other Symptoms Additional symptoms of Parkinson’s disease include problems with sense of smell. Patients may be unable to distinguish odors or lose their sense of smell completely. Aches and pains are another common feature and have been found to affect about 46% of those with the condition. The quality of this pain may be tingling, burning, or sharp and pointed. It can occur throughout the body or affect specific joints, the genitals, the abdomen, or the face. When to See a Healthcare Provider In general, if you suspect you have Parkinson’s disease and are experiencing typical symptoms, such as tremors, rigidity, and difficulty with motion or staying upright, you should call your healthcare provider. Seek out emergency care if you are experiencing any of the following symptoms (even after diagnosis): Sudden onset of or changes to the pattern of your symptoms Severe reactions or lack of response to medications Any cognitive symptoms, such as difficulty remembering or concentrating Worsening pain After a fall Difficulties eating, including choking or coughing Signs of bladder infection, such as burning during urination, frequent urination, or fever Best Medical Alert Systems With Fall Detection A Quick Review Parkinson’s disease is a progressive neurodegenerative disorder that primarily impacts motor skills and function. Its primary symptoms are tremors, slow or interrupted movements, muscle stiffness and rigidity, and difficulty maintaining an upright posture. In addition, this progressive disease can impact mental health, control of bodily functions, gait, and sleep. Signs of the condition warrant medical attention, with cognitive symptoms, worsening pain, and falls among reasons to seek emergency help. Was this page helpful? Thanks for your feedback! Tell us why! Other Submit Sources Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Chou KL. Clinical manifestations of Parkinson disease. In: Post TW. UpToDate. UpToDate; 2022. National Institute of Aging. Parkinson’s disease: causes, symptoms, and treatments. Poewe W, Seppi K, Tanner CM, et al. Parkinson disease. 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