When singer Carly Simon shared her Parkinson’s disease diagnosis, many fans were surprised. Her symptoms did not begin with the shaking hands often associated with Parkinson’s, but with difficulty walking and standing up from a chair. Her story highlights an important fact: the early signs of Parkinson’s disease are often subtle and easy to miss.
Many people think a hand tremor is always the first symptom of Parkinson’s disease, but early symptoms often have little to do with tremors. In fact, some people with Parkinson’s disease never develop a tremor at all. Because these changes can seem small, they are often blamed on aging or other health problems.
In this article, you’ll learn:
- The early signs of Parkinson’s disease that often show up before a tremor
- What causes Parkinson’s disease and how it’s diagnosed
- Why early evaluation can make a difference
What Is Parkinson’s Disease?
Parkinson’s disease is a progressive neurological disorder that affects the brain and nervous system over time. It occurs when certain brain cells that produce dopamine, a chemical that helps control movement, stop working properly.
Parkinson’s disease affects more than 1.1 million people in the United States, and nearly 90,000 people are diagnosed each year. It’s the second-most common neurodegenerative disease after Alzheimer’s disease.
Although often recognized by movement changes, Parkinson’s can also affect sleep, digestion, mood and sense of smell. Most people are diagnosed around age 60 or older, but symptoms and progression vary.
What Causes Parkinson’s Disease?
The exact cause of Parkinson’s disease is not known. Researchers believe it develops from a combination of genetic and environmental factors.
Early Signs of Parkinson’s Disease That Often Go Unnoticed
A tremor is one of the most recognized Parkinson’s disease symptoms, but it’s not always the first, or even the most noticeable, sign. In fact, some symptoms can appear years before movement problems develop. Doctors call this the prodromal stage, when subtle changes may be the earliest clues to Parkinson’s disease.
Early Non-Movement Symptoms (Prodromal Stage)
These symptoms may develop years before changes in movement. On their own, they are common and usually have other causes, but together they can provide important clues.
Loss of Smell
A reduced sense of smell may occur years before movement symptoms appear in some people with Parkinson’s disease. However, changes in smell are common and can also be caused by allergies, sinus problems, viral infections and many other conditions.
Acting Out Dreams During Sleep (REM Sleep Behavior Disorder)
During normal REM sleep, the body stays mostly still while dreaming. REM sleep behavior disorder (RBD) causes people to physically act out their dreams, such as talking, shouting, kicking or making sudden movements during sleep. RBD can appear years before movement symptoms of Parkinson’s disease and is one of the earliest non-movement symptoms associated with the disease.
Constipation
Constipation is very common and is often related to diet, hydration, medications or other health conditions. In some people with Parkinson’s disease, constipation may occur before movement symptoms begin.
Depression, Anxiety or Apathy
Changes in mood or losing interest in things you once enjoyed can be early symptoms too. These feelings have many causes, so they always deserve care and attention on their own.
Early Movement Symptoms
As Parkinson’s disease progresses, changes in movement often become more noticeable. These symptoms may begin gradually and are sometimes mistaken for normal aging or other conditions.
Smaller Handwriting
A person’s handwriting may gradually become smaller and more difficult to read before other symptoms appear. This change, called “micrographia,” is related to changes in fine motor control and is one of the movement changes doctors may look for when evaluating Parkinson’s disease.
Softer or Quieter Voice
Some people begin to speak more softly without realizing it. Family members may notice before the person does.
One Arm Doesn’t Swing While Walking
Normally both arms swing when you walk. In early Parkinson’s, one arm may stop swinging as much. This one-sided change can be an important clue.
Shoulder Stiffness or Frozen Shoulder
A stiff, painful shoulder is often blamed on injury, arthritis or for older women, menopause. Sometimes, though, it shows up early in Parkinson’s on one side of the body.
Slower Movement (Bradykinesia)
Everyday tasks like buttoning a shirt, tying shoes or getting out of a chair may gradually take longer than they used to. Doctors call this slowed movement “bradykinesia.”
Reduced Facial Expression
Sometimes the face shows less expression, so a person may look serious even when they feel happy. Doctors call this a “facial masking.”
Do These Symptoms Mean You’ll Get Parkinson’s Disease?
No symptom, or group of symptoms, can predict for certain that someone will develop Parkinson’s disease. Many of the symptoms discussed are common and can have many other causes.
Doctors look at the overall pattern, how symptoms change over time and the results of a neurological evaluation when making a diagnosis.
How Is Parkinson’s Disease Diagnosed?
Diagnosing Parkinson’s disease is like putting together a puzzle. There is no single blood test or scan that confirms the disease.
Diagnosis usually includes:
- Reviewing your medical history
- A neurological examination
- Assessing movement and non-movement symptoms
- Reviewing your medications and other possible causes
- Imaging tests, sometimes used to rule out other conditions
Understanding Parkinson’s Disease Stages
Parkinson’s disease progresses differently for everyone. Doctors may refer to Parkinson’s disease stages to explain how symptoms can change over time, but not everyone follows the same path or progresses at the same pace.
- Early stage: Symptoms are mild and often affect only one side of the body. Daily activities usually continue with little or no assistance.
- Mid-stage: Balance, movement and daily activities become more challenging, and some people may need additional support.
- Advanced stage: Movement symptoms become more limiting, and people may need more help with daily activities.
- Late stage: Many people require significant assistance with daily care, mobility and other activities. Some may use a wheelchair or spend more time in bed.
Although Parkinson’s disease is a progressive condition, many people continue to live active, meaningful lives for years after diagnosis with appropriate treatment and support.
Why Early Diagnosis Matters
While there is no cure for Parkinson’s disease, early diagnosis can make a meaningful difference. Treatments can help manage symptoms, improve quality of life and support independence. Depending on a patient’s needs, a care plan may include:
- Medications that help replace or mimic dopamine
- Physical therapy
- Occupational therapy
- Speech therapy
- Regular exercise
For some people with more advanced Parkinson’s disease, advanced therapies such as deep brain stimulation or focused ultrasound may also be treatment options.
Working closely with a neurologist — especially one who specializes in movement disorders — can help ensure you receive the right treatment at the right time.
When Should You See a Doctor?
Many people with Parkinson’s disease first notice subtle changes. If you experience persistent symptoms, worsening changes or several symptoms occurring together, talk with your healthcare provider.
An evaluation does not necessarily mean you have Parkinson’s disease, but it can help identify the cause of your symptoms and determine the right next steps.
Frequently Asked Questions
Can Parkinson’s disease be prevented?
There is no proven way to prevent Parkinson’s disease, since the exact cause isn’t fully understood. Staying active and healthy is good for your brain, but it can’t guarantee prevention.
Is Parkinson’s disease hereditary?
Most cases are not directly inherited. A small number of people have gene changes linked to Parkinson’s, but having a relative with the disease does not mean you will get it.
Can Parkinson’s disease progress without a tremor?
Yes. Not everyone with Parkinson’s has a tremor. Some people mainly experience stiffness, slowness, or balance problems instead.
