“I am in the early stages of Parkinson’s and have a hard time when my hand shakes. I have learned that my dominant hand shakes at rest, and when my hand and arm begin to ache, I know the shaking is about to begin. It doesn’t always happen when it’s almost time for medication. I embroider, work on a quilt, or play with a rubber ball, lightly squeezing and releasing it. Anything to keep my hand busy to lessen the shaking or stop it entirely.”
—ANONYMOUS, PWP
Symptoms of Parkinson’s vary from person to person. Not everyone will experience all of them, or in the same degree. Some may experience more motor symptoms while others more nonmotor symptoms. Young-onset patients may notice only one or two of the motor symptoms, especially in the early stages. Also, not all symptoms have to be present for a doctor to diagnose you with PD, so make sure you seek a neurologist if you think you might have Parkinson’s.
You may have heard that there are cardinal signs of Parkinson’s. This is true, and while some doctors identify three primary motor symptoms, others include up to five, which you will find listed below. The first three symptoms are the most common, while the last two tend to show up as the disease progresses.
Tremor, a rhythmic muscle contraction, is very common in Parkinson’s, affecting about 80 percent of people with the disease.33 Some will experience a slight tremor in the hand or foot on one side of the body, or sometimes in the jaw or face.
Because tremor in Parkinson’s usually appears when the muscles are relaxed, it’s called “resting tremor.” This means that the affected body part trembles when it is at rest and not doing work and often stops when the person starts using (or working) that part of the body.
The tremor often spreads to the other side of the body as the disease progresses, but it will remain most obvious on the side of the body where it first appeared.
It’s important to note that not everyone with Parkinson’s has a tremor and having a tremor does not necessarily mean a person has Parkinson’s.
Below are a few more points on tremors in PD.
• They usually occur at rest but may occur at any time.
• They may become severe enough to interfere with activities.
• They may be worse when the person is tired, excited, or stressed.
• Index finger to thumb circular rubbing (pill-rolling tremor) may be present.
Note: Pill-rolling tremor is seen especially in the hands and is fairly unique to PD. The term “pill-rolling” refers to the motion a pharmacist uses to align a handful of pills before placing them in a bottle or, possibly, the motion used to roll a marble between the thumb and forefinger. Eventually the tremor becomes more generalized.
Rigidity is stiffness or inflexibility of the muscles. Normally muscles contract when they move, then relax when they are at rest. In rigidity, the muscle tone of an affected body part is stiff. Rigidity can also cause pain and cramps at the muscle site. Sometimes people mistakenly attribute the stiffness to an old sports injury (e.g., rotator cuff) or arthritis.
Bradykinesia is a slowing of voluntary movement. Bradykinesia and rigidity can occur in the facial muscles, causing a mask-like expression with little or no movement of the face. The slowness and incompleteness of movement can also affect speaking and swallowing.
Balance problems are common in Parkinson’s, and they tend to get worse as the disease progresses. You may be unable to keep a steady, upright posture or prevent yourself from falling. Falling backward can also be an issue, and you may find that it doesn’t take much of a push to get you to continue stepping backward or to fall down.
Bradykinesia, rigidity, and postural instability can all contribute to problems with walking. Early on you may notice that your left and right arms do not naturally swing the same when you walk. As the disease progresses, you may begin to walk with short, shuffling steps, which, combined with other symptoms such as loss of balance, increases your risk of falling.
You may also experience difficulty making turns or abrupt movements. Some people (especially those with advanced PD) may go through periods of freezing, which is when your feet feel stuck to the floor and you find it difficult to start moving again.
Changes in speech/voice
• Slow speech
• Low-volume voice
• Monotone voice
• Difficulty speaking
Changes in facial expression
• Reduced ability to show facial expressions
• Mask-like appearance
• Staring
• May be unable to close mouth
• Reduced rate of blinking
Loss of fine motor skills
• Difficulty writing; writing may be small and illegible (micrographia)
• Difficulty eating
• Difficulty with any activity that requires small movements
• Movement is slow and uncontrolled
Changes in mood and thinking
• Depression
• Apathy (lack of motivation)
• Fear, stress, or anxiety
• Dementia or confusion
• Memory difficulties and slowed thinking
• Paranoia and hallucinations
Involuntary functions changes
• Constipation
• Weight loss (mild to moderate)
• Low blood pressure (when changing positions, such as from sitting to standing)
• Sexual difficulties (decreased libido in women; erectile dysfunction in men)
• Urinary problems (need to urinate more often or feel urgent need to urinate)
• Changes in body temperature control system (excessive sweating)
Physical changes
• Fatigue and/or loss of energy
• Sleep disturbances (inability to stay asleep; acting out dreams; restless legs syndrome)
• Pain, including muscle aches and pains (myalgia)
• Skin problems (oily or dry; increased risk of melanoma)
• Difficulty swallowing
• Drooling (resulting from decreased swallowing)
• Loss of sense of smell (reduced ability to detect odors)
Some symptoms of Parkinson’s may show up years before a diagnosis. Constipation, loss of sense of smell, anxiety, and depression are some examples.