Parkinson’s disease (PD) often comes on gradually with early signs and symptoms. Physical and mental changes in the early stages of PD may go relatively unnoticed, but the condition generally becomes more noticeable over time.

Many MyParkinsonsTeam members have described their early experiences with the condition and the time it took to get a diagnosis. “My falls existed long before my diagnosis,” a member wrote. Another member said, “I’m pretty new to a PD diagnosis. I can trace symptoms back to 2005.”

PD is a disorder in the central nervous system. It is caused by low levels of dopamine due to the degeneration of nerve cells (neurons) in a part of the brain called the substantia nigra. Dopamine is a neurotransmitter that controls movement, mood, learning, and functions in other parts of the body.

PD can cause motor symptoms that create movement disorders and problems with mobility, as well as nonmotor symptoms such as depression, sensory disorders, and cognitive problems. Parkinson’s is a chronic disease and there is no cure. Treatment is aimed at managing symptoms, slowing disease progression, and improving quality of life.

Early Nonmotor Symptoms

Many early physical symptoms can be a sign of Parkinson’s, but nonmotor symptoms often appear earlier than motor symptoms. In fact, nonmotor symptoms may start years or even decades before motor symptoms. This collection of early health problems is known as premotor PD. Early nonmotor symptoms include:

• Loss of smell
• Sleep problems (specifically, REM sleep behavior disorder)
• Depression
• Constipation

One MyParkinsonsTeam member described his early loss of smell. “I lost my sense of smell six years ago, and never noticed until my wife pointed out a smell of something burning in the kitchen. I just thought I had sinus issues. All these little issues have accumulated over the past six years to finally get the diagnosis.”

Another member discussed her depression. “I was diagnosed in 2017 with PD. At the time, I was being treated for major depression. The treatment that I was placed on for PD really changed my life and livelihood.”

Neurology researchers are seeking more precise methods for identifying premotor PD to start treatment sooner. Studies show that people with premotor PD often have signs of Lewy bodies. These are abnormal protein deposits that can cause neurological disorders and a type of dementia that can be associated with PD. Early diagnosis of PD — before the onset of motor symptoms — could result in treatment that slows disease progression and results in better outcomes.

Early Motor Symptoms

Early motor symptoms that affect movement and other physical functions often begin on one side of the body. These symptoms may be mild at first. Sometimes, these issues are ignored, or a family member may notice a change. As symptoms increase and begin to affect the entire body, the side of the body that first had signs of Parkinson’s may have worse symptoms.

Common symptoms of PD that may occur early include:

• Tremor — Light shaking while at rest
• Bradykinesia — Slowness of movement that can cause abnormalities in walking, such as shuffling
• Writing changes — Difficulty writing or small handwriting (micrographia)
• Rigid posture or muscle stiffness — Decreased range of motion, which may also be painful
• Decreased automatic movement — Having trouble performing unconscious actions such as smiling and blinking

“It can be hard to tell when your movements are slowing down significantly until it becomes fairly obvious,” a MyParkinsonsTeam member said. “My husband had been slowing down for several years, but we just attributed it to age or his bad knee or just not being in a hurry. In his case, his walking slowed, and eating slowed, and finishing projects slowed, but it was very gradual.”

“Bradykinesia was one of my first symptoms,” another member wrote about their slow movement. “My family had been commenting that I was always the last person to finish dinner in a restaurant while everyone else wanted to order dessert, but I didn’t realize how much slower until I saw the specialist.”

One member described her difficulties with writing. “Micrographia was my first symptom of Parkinson’s. My writing became smaller and smaller and at the same time, my hand would cramp, with pain continuing up to my shoulder. My GP sent me to a physiotherapist for six months of treatment with no improvement until I was diagnosed with PD.”

Other Early Symptoms of Parkinson’s

Other neurological symptoms may occur early in the development of PD. Some other early signs of the condition include:

• Facial masking (hypomimia) — Facial expressions that do not express emotion (flat affect)
• Dizziness and fainting (neurogenic orthostatic hypotension) — Low blood pressure due to problems with the part of the nervous system that controls automatic body processes
• Balance problems
• Changes in voice

“Flat affect was my first symptom,” a MyParkinsonsTeam member said. “I was normally very animated with a great deal of facial expression. When it dropped off to zero facial expression, my partner couldn’t figure out why I was mad at her but denied being so.”

Another member talked about her experience with fainting. “I was making coffee, and I blacked out — the second time it happened to me within the last year,” she wrote. “I got misdiagnosed for so many years when I had low blood pressure.”

Early Signs of Parkinson’s and Diagnosis

Early symptoms are a sign that it may be time to see a neurologist to determine if the condition can be diagnosed as PD. Although doctors can test physical agility and muscle tone, there are no definitive lab tests (or biomarkers) to confirm a Parkinson’s diagnosis. Signs that may seem like PD symptoms can also be due to side effects from drugs, essential tremor, or other neurological conditions.

Doctors will look for symptoms that correlate with the condition. An MRI test and a DaTscan may be used to examine the brain and dopamine function. Sometimes, a health care provider may recommend trying a Parkinson’s medication, such as levodopa/carbidopa, to see if there is a positive response.

Talk With Others Who Understand

On MyParkinsonsTeam, the social network for people with Parkinson’s disease and their loved ones, more than 88,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s.

Do you have questions about the early signs and symptoms of Parkinson’s disease? Share your experience in the comments below, or start a conversation by posting on your Activities page.