Symptoms of Parkinson's Disease

Parkinson's disease is characterized by a collection of uniquely distinguishing symptoms that affect movement along with a number of other aspects of daily life. These include, but are not limited to, tremors, slowed movement (bradykinesia), stiffness (postural rigidity), and imbalance. What Parkinson's looks like differs a bit from person to person, but symptoms always worsen over time. Parkinson’s disease symptoms can be managed with both medical and surgical treatment options.

Frequent Symptoms

Symptoms of Parkinson's typically start subtly and progress over years. You may not have or develop all of these, but they are commonly seen in those with the disease.

Tremors

The tremors of Parkinson’s disease, often described as “pill-rolling,” are slow frequency tremors (4-6Hz) with varying amplitude. They often occur first in one hand and subsequently spread to the other side of the body, usually remaining asymmetrical.

The tremors usually affect the hands and arms, although they can also involve the chin or the legs.

Parkinson's disease tremors are resting tremors. A hand tremor, for example, should only happen when you are not engaging your hand in any type of action. The tremor should briefly stop once you deliberately engage your hand in a task, like holding a utensil or picking something up off the floor.

Stiffness

Parkinson's disease commonly causes stiffness (postural rigidity) throughout the body. Like the tremors, the stiffness often begins in one side, typically on the same side of the tremor, but subsequently affects both sides of the body.

Parkinson's disease may also cause episodic freezing of muscles, which is more severe than typical rigidity. This usually involves the muscles that are already the most rigid, though it does not affect everyone with Parkinson's.

Masked Face

One of the telltale signs of Parkinson's disease is a lack of animated facial expression. If you have early Parkinson’s disease, you might not notice these in yourself, though others likely will because a masked face can make it appear as if you are not interested in what others are doing or saying.

Decreased Blinking 

One of the common symptoms of Parkinson's disease is decreased blinking. If you have Parkinson's disease, diminished blinking can make you look as if you are staring at someone or something. The reduced blinking may also make your eyes dry. 

Shuffling Gait

People living with Parkinson's disease often walk distinctively slowly, with a trademark sluggish shuffling of the feet and a tendency to keep the legs relatively straight, rather than bending them while walking. When someone with Parkinson’s disease walks, the feet remain closer to the ground instead of lifting with each step.

Slow Movements

Most people with Parkinson's disease move slowly—what's known as bradykinesia. This begins early in the course of the disease, but like most of the symptoms, it is often not strikingly noticeable until after a diagnosis has been made.

Speech Issues

Speech problems are common in patients with Parkinson’s disease and are characterized by a weak, sometimes nasal or monotonous voice with imprecise articulation. The speech can be slow in some patients, but fast in others.

Sleep Problems 

The majority of people living with Parkinson's disease experience trouble sleeping. This can range from trouble falling or staying asleep to sleepiness during the daytime.

Restless legs syndrome, a condition characterized by an urge to move the legs, is common, as is REM sleep disorder, a condition in which people act out their dreams while sleeping.

The sleep problems caused by Parkinson’s disease ultimately result in a sense of fatigue.

Balance Problems 

Most of the time, Parkinson's disease interferes with balance. This can make it difficult to exercise or even engage in everyday tasks, like walking up stairs. As the disease progresses, it becomes a challenge to remain standing without leaning on something for support.

Small Handwriting 

The micrographia of Parkinson’s disease is distinct. If you have micrographia as a result of Parkinson’s disease, your writing is most likely tiny, yet clear and sharp. The letters and words become smaller and smaller as you proceed to write additional sentences, and the words typically begin to curve or angle down along the page after several sentences or paragraphs.

Apathy 

Apathy is a lack of interest in anything. While most people who have Parkinson’s disease display a masked face, which gives the appearance of apathy, sometimes actually experience the feeling as well. In fact, apathy may be one of the earliest symptoms of the disease.

Dry Skin

If you have Parkinson's disease, you may have dry, flaky skin and dryness of your scalp. 

Pain 

About 60% of those living with Parkinson's disease experience pain. Persistent stiffness and muscle rigidity is often the root of the pain. The pain associated with Parkinson's disease is muscle pain that happens in the absence of any obvious injury.

Rare and Late-Stage Symptoms

There are other symptoms of Parkinson's disease that happen less commonly or in later stages of the disease.

Fluctuating Emotions 

Some people with Parkinson's disease, especially late-stage Parkinson's disease, experience emotions that change very quickly. Sadness is the emotion most prevalent among people living with Parkinson's disease. 

Unexplained Crying 

Parkinson's disease can produce bouts of tearfulness. These are usually mild and unexplained episodes of weeping that come on unexpectedly, and they can be quite embarrassing.

Stooped Posture 

A trademark hunched-over posture can affect some people living with Parkinson’s disease. Most of the time, this begins late in the course of the illness.

Low Blood Pressure/Blood Pressure Fluctuations

Often described as dysautonomia, this unsettling problem affects a small minority of people living with Parkinson's disease. Dysautonomia causes fluctuations in blood pressure, predominantly causing unexpected and sudden episodes of low blood pressure. Symptoms include lightheadedness, dizziness, and loss of balance. 

Swallowing Problems 

Sometimes, the slowing of muscle movements in Parkinson’s disease can interfere with normal action of the swallowing muscles, making it challenging to chew, swallow, and eat.

Hallucinations 

Parkinson's disease can cause hallucinations. These hallucinations are typically visual. Auditory (hearing voices), olfactory, and tactile hallucinations also can occur in Parkinson's Disease, but are less common.

Note, too, that, some of the medications used to treat Parkinson's disease are known to cause hallucinations as a side effect as well.

Forgetfulness 

Parkinson’s disease can be associated with a type of dementia called subcortical dementia. That is characterized by difficulties with decision making, multi-tasking, changes in personality, and overall slowness of thinking. Dementia tends to occur late in the course of the disease.

Constipation and Urinary Retention

The slow muscle movements typical of Parkinson's disease can cause the muscles of the bowels or bladder to slow down, resulting in constipation or urinary retention.

Similar Health Problems

There are a number of illnesses that can easily be mistaken for Parkinson's disease because they produce similar symptoms.

Benign Essential Tremor

Benign essential tremor is a common condition often confused with Parkinson’s disease. It is characterized by rapid tremors of the hands, arms, head or voice, usually affecting both sides of the body equally, that worsen with anxiety. Unlike the tremors of Parkinson's disease, the tremors of benign essential tremor do not improve with action, and in fact, typically worsen with activity. 

Parkinsonism 

Parkinsonism is a group of neurological diseases that causes motor problems similar to Parkinson’s disease. Medications such as antipsychotics, repeated head trauma, strokes, toxins as well as certain neurodegenerative disorders such as progressive supranuclear palsy and multisystem atrophy, are some of the causes of this condition. Some of these conditions tend to progress more rapidly, do not respond well to levodopa therapy and have other associated symptoms such as early falling, early dementia, more severe dysautonomia

Lewy Body Dementia 

This type of dementia is characterized by forgetfulness, lack of insight, hallucinations, and some motor symptoms that are similar to the symptoms of Parkinson’s disease. The major difference between Parkinson’s disease and Lewy body dementia is that motor symptoms and physical symptoms are more prominent in Parkinson’s disease, while memory and behavioral symptoms are much more prominent in Lewy body dementia. At the late stage of each of these conditions, the symptoms may overlap considerably.

Major Depression

Extreme depression can cause slowness of movements, a masked face, apathy, sadness, and sleep disturbances that resemble the symptoms of Parkinson’s disease. However, depression does not cause tremors, shuffling gait or muscle rigidity that are trademarks of Parkinson’s disease.

Side Effects of Antipsychotic Medications 

A few antipsychotic medications are known to cause tremors and stiffness that are very similar to the symptoms of Parkinson’s disease. These medications must be carefully adjusted in order to manage the illness for which they are intended while minimizing the Parkinsonian side effects.

Creutzfeld-Jacob Disease

This is a rare disease that causes involuntary muscle jerks called myoclonus and profound dementia. Sometimes it causes blindness. This illness can be caused by an unusual infectious agent that is transmitted through contact with the brain or spinal cord contents of an infected individual or animal. The muscle jerks are intense and erratic, in contrast to the rhythmic tremors of Parkinson’s disease. Also, differently from Parkinson's, dementia is rapidly progressive and can prevent you from being able to move and speak.

Infectious Encephalitis 

Encephalitis is inflammation or infection of the brain, and it can be fatal. Viral encephalitis has been known to cause Parkinsonism among survivors.

When to See a Doctor

If you experience any symptoms such as tremors, stiffness, trouble with balance, forgetfulness, or trouble sleeping, you should make an appointment to see your doctor. These symptoms may or may not be Parkinson’s disease, but they are manageable.

A Word From Verywell

It can be easily to come up with some other explanation for some early-stage Parkinson's symptoms. That, and trepidation about being diagnosed, often prevents people from seeking an evaluation. But know that Parkinson’s disease is treatable, and early treatment is the best way to manage your symptoms. Parkinson’s disease certainly presents some disruption to your life, but fortunately, it is not fatal and people living with it often live long, healthy, and productive lives.

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Article Sources

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