By Ezekiel Sachs, M.D.

Parkinson’s disease is a neurodegenerative disorder, meaning it progressively affects the nervous system. The condition is caused by nerve cells in the brain breaking down or dying, which results in a loss of dopamine. Dopamine is a neurotransmitter that works as a messenger between nerve cells, and plays a pivotal role in how we move, think, sleep, and feel. When dopamine levels are low, it causes abnormal brain activity and can lead to Parkinson’s disease.

Early Signs of Parkinson’s Disease

Parkinson’s disease is diverse and can develop differently from person to person, but in most cases symptoms appear gradually over several years. The earliest signs are typically mild and may even go unnoticed for some time.

Having just one of the following symptoms doesn’t necessarily signal Parkinson’s disease, but anyone experiencing more than one of these signs should consider talking to a doctor.

  1. Tremors or Shaking. This is possibly the most well-known symptom of Parkinson’s. The first tremors usually begin in the fingers or hands, and often happen when at rest. While there are various types of tremors, a “pill rolling tremor,” which looks like someone is rolling a pill or small ball between their thumb and forefinger, is most common with Parkinson’s.
  2. Smaller Handwriting. Although handwriting can change as we get older due to stiff joints or vision loss, if it gets particularly small with letters and words written too closely together, this can be a sign of Parkinson’s called micrographia.
  3. Slower or Difficult Movement. Over time, Parkinson’s can cause slower movement called bradykinesia. Steps become shorter, feet can drag when walking, and simple everyday tasks can be difficult and time-consuming. Additionally, muscles can become stiff and rigid, particularly in the shoulders and hips, causing arms to not swing as usual or the feeling that feet are stuck to the floor.
  1. Loss of Smell. Temporary loss of smell is common with a cold or other illness, but if it continues over a long period of time without congestion it could be a sign of Parkinson’s, especially if strong smells can no longer be detected.
  2. Difficulty Sleeping. Many people have trouble sleeping and there are numerous reasons for it, but thrashing around, kicking, or sudden exaggerated body movements during sleep can be a sign of Parkinson’s disease.
  3. Constipation. Not being able to have a bowel movement is extremely common and happens to just about everyone, but if the constipation is prolonged it can be a sign of Parkinson’s, particularly if it happens in conjunction with other symptoms.
  4. Dizziness or Fainting. Because Parkinson’s disease can cause low blood pressure, an early sign of the condition is repeatedly feeling dizzy or fainting after standing up.
  5. Masked Face. This term doesn’t refer to wearing a mask, but to having an unusually expressionless face or appearing to be in a depressed or angry mood at all times, even when happy, which is a common sign of Parkinson’s.
  6. Stooping or Hunching Over. Other conditions, like arthritis and osteoporosis, can cause slouching, but if these have been ruled out and if hunching over happens along with other signs of Parkinson’s, it could be reason for concern.
  7. Lower or Softer Voice. Some people naturally speak softly or have a hoarse voice, but if a change in the softness or tone of voice happens for no apparent reason and continues over a long period of time, it could be a sign of Parkinson’s.

It’s important to note that these are not the only signs of Parkinson’s disease. Everyone’s experience is different and other symptoms can occur, such as depression, bladder control issues, and difficulty chewing, but these don’t usually present until the condition has significantly progressed.

It should also be noted that, although Parkinson’s typically affects people over 50, anyone can have the disorder so the above signs and symptoms shouldn’t be ignored just because the person experiencing them is younger.


Dr. Sachs is a board-certified neurologist at Kelsey-Seybold’s Berthelsen Main Campus, Spring Medical and Diagnostic Center, The Woodlands Clinic, and Conroe Family Medicine. His clinical interests include Parkinson’s disease, carpal tunnel syndrome, myasthenia gravis, progressive supranuclear palsy (PSP), transient ischemic attack (TIA), vascular disease, and vertigo.

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