One day, you’re relaxing on the couch and notice your hand is shaking. Has it always done that, or is it new? But when you go to pick something up, you notice the shaking stops. You may have noticed other minor changes like your movement is slowing down or your limbs feel unusually stiff. You could pass all of these instances off as being dehydrated or needing more sleep, but these symptoms put together could be early indicators of Parkinson’s disease.
What is Parkinson’s disease?
Parkinson’s disease is a chronic neurodegenerative condition that is caused by damage to nerve cells in the substantia nigra, the area of the brain that controls movement. The disease is progressive, meaning the symptoms generally develop slowly over the course of several years. Because the disease is so diverse, not every person with Parkinson’s will experience the same progression of symptoms as others. Scientists believe that Parkinson’s is caused by certain genetic and environmental factors.
Symptoms of Parkinson’s usually start appearing in middle or late life. Because a diagnosis can take months, or even years, it’s not usually diagnosed until age 60. A diagnosis younger than 50 is called young-onset Parkinson’s. Nearly one million people in the United States have Parkinson’s disease, and about 60,000 Americans are diagnosed each year, according to the Parkinson’s Foundation. Men are 1.5 times more likely to be diagnosed with Parkinson’s than women.
Although Parkinson’s disease cannot be cured, it can be effectively managed with medication and lifestyle changes.
What are the early motor symptoms of Parkinson’s disease?
There are four main symptoms of Parkinson’s disease that affect movement to be aware of.
The most common early sign of Parkinson’s disease is the tell-tale tremor that usually starts on one side of the body – usually in one hand, foot, or leg – before eventually affecting both sides of the body. The tremors usually happen at rest and go away when there is movement. About 80% of people with Parkinson’s experience tremors.
Tremors associated with Parkinson’s disease are caused by decreased dopamine production in the brain. Dopamine is a hormone and neurotransmitter, which means it carries signals between brain cells. It is produced in the nerve cells (neurons) in the substantia nigra and plays a critical role in body functions like coordination and movement. As the nerve cells in the brain that produce dopamine die or become impaired, they produce less dopamine. The loss of dopamine disrupts the transmission of signals from the substantia nigra to other parts of the brain that produce smooth, coordinated movement. As the disease progresses, movement symptoms like tremors become more noticeable.
Research has found that when the movement symptoms of Parkinson’s appear, about 60% to 80% of the nerve cells that generate dopamine have died or been impaired.
Another common early sign of Parkinson’s disease is rigidity or stiffness or tightness of the limbs. Similar to tremors, rigidity may affect one side of the body or both sides. It’s first notice when walking – the arms don’t swing as much, especially if there is one side that is more affected than the other. Rigidity can also occur in the torso or in the face, resulting in “facial masking” that can make it difficult to express emotions or use the facial muscles. Similar to tremors, rigidity is caused by reduced dopamine levels.
Slow movement (bradykinesia)
Bradykinesia, as well as rigidity or tremors, are required to receive a Parkinson’s diagnosis. Similar to rigidity, bradykinesia can often be noticed when walking because the arms swing slowly. However, it can also be identified through general slowness during any physical activity, like getting out of a chair or buttoning a shirt. When this happens, patients with Parkinson’s may need to concentrate very carefully in order to complete or initiate the action. Patients with bradykinesia may also have slower reactions to things that are going on around them.
Approximately 98% of patients with Parkinson’s disease experience bradykinesia.
Balance problems (postural instability)
Balance issues are one of the earliest signs of Parkinson’s disease. If someone has postural instability, they may be unstable when standing or have an increased chance of falls. Postural instability can make it difficult to perform everyday activities, such as:
- Getting up from a chair or bed
- Turning around
- Standing upright
As with many symptoms of Parkinson’s, postural instability can get worse as the disease progresses. Unlike the other motor impairments, postural instability isn’t linked to dopamine reductions. Instead, it is believed to be a result of damage to nerve endings that produce and release norepinephrine, called noradrenergic neurons. Norepinephrine is a hormone and neurotransmitter responsible for controlling various functions in the body, like heart rate, blood pressure, and preparing the brain for action. The loss of norepinephrine can cause a sudden change in blood pressure when going from a seated to a standing position, increasing the likelihood of a fall.
What are the early non-motor symptoms of Parkinson’s disease?
Although motor changes are often the earliest and most noticeable symptoms of Parkinson’s disease, there are non-motor signs to be aware of as well.
Changes in sleep
One symptom many people with Parkinson’s notice is that their sleep patterns change. It may be harder to fall asleep or stay asleep. But those aren’t the only changes in sleep that can occur with Parkinson’s. Other sleep changes include:
- Excessive daytime sleepiness
According to the Parkinson’s Foundation, about 30 to 50% of people with Parkinson’s experience excessive sleepiness during the day, which becomes more noticeable as the disease progresses. This can be caused by a poor night’s sleep or by certain medications.
- REM sleep behavior disorder
REM (rapid eye movement) sleep is the deepest stage of sleep during which time the irises move rapidly. It’s the stage of sleep where dreaming happens. But people with REM sleep behavior disorder (RBD) do not have the normal muscle relaxation that happens during REM, which can cause them to act out their dreams. People with RBD often experience sudden body movements and vocalizations during REM sleep. About half of people with Parkinson’s experience RBD.
- Vivid dreams
Vivid dreams can go hand in hand with RBD and Parkinson’s Disease. It’s believed that damage to brain cells that released dopamine can occur in the parts of the brain that also control sleep. Damage is what causes vivid dreams. Like all dreams, they can range from pleasant to nightmarish. If the dreams are very disturbing, it may be difficult to go back to sleep.
- Restless leg syndrome
As suggested by the name, restless leg syndrome (RLS) is a feeling of restlessness in the legs. It may also feel like there is a tingling sensation in the legs. RLS is often worse at rest, which can make it difficult to fall asleep or can interrupt sleep. In most cases, the cause of restless leg syndrome is unknown, but it may be due to disruptions in the basal ganglia. The basal ganglia is a cluster of neurons deep within the brain that is responsible for motor function.
Some people with Parkinson’s might have some mild cognitive impairment, such as being easily distracted or disorganized. It may be more difficult to plan and finish tasks, or to focus on different parts of a conversation. Some other cognitive changes include memory or thinking problems, or even hallucinations.
Both brain chemistry and brain cell changes play a role in cognitive issues with Parkinson’s. The disease not only affects dopamine but other neurotransmitters as well.
About half of people with Parkinson’s experience mood changes due to the changes in brain chemistry that are caused by the disease. Mood is a temporary state of mind or a general feeling, like happy, sad, joyful, or frustrated, that can last for a few minutes or a few weeks based on what’s going on in your daily life. It’s normal for mood to change based on external situations, but in people with Parkinson’s, mood can become disordered and changes may be extreme or inappropriate to the circumstance. A person’s mood can be affected by the diagnosis of the disease, changes in lifestyle, biological or in response to medication.
Fatigue is a common early sign of Parkinson’s, but can also occur at any stage of the disease. Fatigue is different from sleepiness or being tired—fatigue can feel more like exhaustion, but not necessarily needing to sleep. Fatigue can also be either physical or mental. There isn’t a specific cause of fatigue and it can be either physical or mental.
Small or cramped handwriting
Although handwriting can change as you get older, it can also be an early sign of Parkinson’s. About half of people with Parkinson’s have small handwriting, called micrographia, as one of their symptoms. It can be a result of bradykinesia, which causes movements to slow down, but it may also appear when bradykinesia isn’t present. Micrographia can also be a result of tremors.
Loss of smell
Another early sign of Parkinson’s is loss of smell, although not everyone who experiences a reduced sense of smell will develop the disease. However, more than 90% of patients with Parkinson’s disease will experience some reduced sense of smell. The loss of smell can occur years before a Parkinson’s diagnosis since many people don’t think to tell their doctor about it, and it can also appear before any of the motor symptoms.
It isn’t currently known why loss of smell occurs with Parkinson’s. One theory is that the process of developing the disease may begin in the olfactory bulb—the part of the brain that controls smell—and the gut. It is believed that clumps of the protein alpha-synuclein (Lewy bodies) may form in the olfactory bulb first before moving to other parts of the brain.
What to do if you’re experiencing symptoms?
If you are experiencing any of these early signs of Parkinson’s, talk to your doctor. There is no definitive test to diagnose Parkinson’s so your primary care doctor will likely refer you to a neurologist who specializes in identifying different nervous system conditions.
After walking through your current symptoms and medical history, the doctor will examine your muscle tone and movement. They will want to see how you perform certain movements like getting in and out of a chair and shifting your weight from one foot to the other.
Your doctor may also perform additional lab and diagnostic imaging tests to rule out other conditions. This could include assessing your dopamine levels through blood analysis, DaTscan, and single-photon emission computed tomography (SPECT) brain scans.
Get the support you need
If you are diagnosed with Parkinson’s diagnosis, remember that you are not alone. There are over 31,000 patients like you who also have Parkinson’s disease. Join them today at PatientsLikeMe to learn more about the disease, what to expect and how to manage day-to-day living with the illness.