Understanding the Early Warning Signs of Parkinson's Disease

It’s natural to be concerned about changes in your health or the health of a loved one. You may be seeking information about Parkinson’s disease because you’re wondering what the earliest signs are. The good news is that awareness is the first step, and understanding these indicators can lead to earlier conversations with a doctor and better management down the road.

What is Parkinson's Disease?

Before diving into the early signs, it’s helpful to understand what Parkinson’s disease is. It is a progressive neurodegenerative disorder, which means it affects the brain and gets worse over time. Specifically, it impacts nerve cells (neurons) in an area of the brain called the substantia nigra. These neurons produce a crucial chemical called dopamine.

Dopamine acts as a messenger between different parts of the brain and nervous system that help control and coordinate body movements. When you have Parkinson’s, these dopamine-producing cells begin to die off. As dopamine levels decrease, you start to develop the motor (movement-related) symptoms commonly associated with the disease. However, researchers now know that many subtle signs can appear years, or even decades, before the more obvious movement issues begin.

10 Early Warning Signs You Should Know

The ad you clicked mentioned that your body gives you warnings, and that’s true. These early symptoms are often subtle and can be easily mistaken for normal signs of aging or other conditions. It’s important to remember that having one or two of these signs does not mean you have Parkinson’s. However, if you notice a persistent pattern of several symptoms, it’s a good reason to speak with your doctor.

1. Loss of Smell (Hyposmia)

One of the most common and earliest signs is a reduced or complete loss of the sense of smell, known as hyposmia. You might find it difficult to smell specific foods like bananas, dill pickles, or licorice. Because it’s not a dramatic symptom, many people don’t notice it or simply attribute it to a cold or allergies. However, a persistent loss of smell that isn’t related to a stuffy nose is a significant early indicator for many people who later develop Parkinson’s.

2. Sleep Problems, Specifically REM Sleep Behavior Disorder (RBD)

Everyone has a bad night’s sleep now and then, but a specific type of sleep disorder is strongly linked to Parkinson’s. REM Sleep Behavior Disorder, or RBD, is a condition where a person acts out their dreams. This can involve vivid, often unpleasant dreams accompanied by sudden movements, flailing, kicking, punching, or even jumping out of bed. Normally, your body is paralyzed during the REM (dreaming) stage of sleep, but in RBD, that paralysis is incomplete or absent.

3. Chronic Constipation

Problems with the digestive system, particularly constipation, are another very common early sign. While occasional constipation is normal, we are talking about a chronic, long-term issue. This happens because the same brain changes that affect movement can also slow down the autonomic nervous system, which controls involuntary functions like digestion. If you are having fewer than three bowel movements a week on a consistent basis, it’s worth mentioning to your doctor.

4. Small, Cramped Handwriting (Micrographia)

Have you noticed your handwriting getting smaller and the letters more crowded together? This condition is called micrographia. It happens because of the changes in the brain that control automatic movements. You might start a sentence with normal-sized letters, but by the end, your writing becomes tiny and cramped. This isn’t just a matter of messy handwriting; it’s a specific and often noticeable change.

5. Voice Changes (Hypophonia)

Your voice might become much softer, or you may start speaking in a flat, monotone way without the usual emotion or inflection. This is called hypophonia. Others might complain that you are mumbling or speaking too quietly, even when you feel like you’re talking at a normal volume. Sometimes, the voice can also sound hoarse or breathy.

6. Masked Face (Hypomimia)

Parkinson’s can affect the small muscles in the face that control your expressions. This can lead to a “masked” look, where you have a consistently serious or blank expression even when you’re feeling happy or upset. You may blink less often than usual. This is not a conscious choice but an unconscious result of the disease affecting muscle control.

7. Stooping or Hunching Posture

You might notice that you’re not standing up as straight as you used to. A tendency to stoop, hunch over, or lean forward is a common postural change in the early stages of Parkinson’s. This can also be accompanied by stiffness in the shoulders or hips, which you might mistake for arthritis or just getting older.

8. Dizziness or Fainting

Feeling dizzy, lightheaded, or even fainting when you stand up from a chair or get out of bed can be a sign of orthostatic hypotension. This is a sharp drop in blood pressure upon standing. It’s another symptom caused by the autonomic nervous system not working as it should, and it is frequently reported by people in the early stages of Parkinson’s.

9. Reduced Arm Swing

A subtle but telling sign is a reduction in the natural swing of your arms when you walk. Typically, one arm will swing significantly less than the other. You might not notice it yourself, but a family member or friend might point it out. It’s often one of the first signs of the stiffness and slowness of movement that characterizes the disease.

10. A Subtle Tremor

While a significant tremor is the most well-known symptom of Parkinson’s, it often starts very subtly. It might begin as a slight shaking or twitching in just one finger, a thumb, or your chin when you are at rest. This is called a “pill-rolling” tremor because it can look like you are rolling a small pill between your thumb and forefinger. The tremor usually disappears when you are using your hand to perform an action.

What to Do If You're Concerned

Seeing some of these signs in yourself or a loved one can be frightening, but it’s important not to panic. Many of these symptoms can be caused by other, less serious conditions. The key is to be proactive. Keep a log of the symptoms you’re noticing and schedule an appointment with your primary care doctor. They can perform an initial evaluation and, if necessary, refer you to a neurologist, specifically a movement disorder specialist, who is an expert in diagnosing and treating conditions like Parkinson’s disease.

Frequently Asked Questions

What are the main motor symptoms of Parkinson’s? The four main motor symptoms are:

1. Tremor: Shaking that usually begins in a limb, often a hand or fingers, when at rest.
2. Bradykinesia: Slowness of movement, which can make simple tasks difficult and time-consuming.
3. Limb Rigidity: Stiffness in the arms, legs, or trunk.
4. Postural Instability: Impaired balance and coordination, which can lead to falls.

Can these early signs be caused by something else? Absolutely. This is a critical point. Constipation can be related to diet, loss of smell can be caused by sinus issues, and stiffness can be due to arthritis. That is why self-diagnosing is not recommended. A doctor is needed to evaluate the complete picture and rule out other possibilities.

How is Parkinson’s disease diagnosed? There is no single blood test or scan that can definitively diagnose Parkinson’s. A neurologist will typically make a diagnosis based on your medical history, a review of your signs and symptoms, and a thorough neurological and physical examination. They may also look for how you respond to certain Parkinson’s medications.