The signs and symptoms of Parkinson's disease

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The symptoms of PD affect individuals differently, but some can be an early sign of the disease.

These are:

• REM sleep disorder and other sleep problems
• the loss of the sense of smell
• tremor, especially in one hand
• a smaller size of handwriting
• difficulty moving or walking or a stooping gait
• constipation
• loss of facial expression, that may make the person look emotionless
• a low or soft voice

The four main signs and symptoms include:

• slow physical movements, known as bradykinesia
• shaking, or tremor
• muscle stiffness, or rigidity
• problems with balance and coordination, known as postural instability

Symptoms often start on one side first.

Slow physical movement

The person finds it hard to start moving. Starting to get up from a chair can become more difficult, for example. It takes longer than before to do physical tasks. A lack of coordination can cause the person to fall or drop things.

The difficulty is not only with carrying out the movement itself, but also with planning and starting it.

Many people may experience slower movements and attribute these to older age, but sometimes they are a sign of PD.

Tremor

Tremor is a familiar symptom of PD to many people. The shaking often starts in one hand.

It may start in one foot, or the person may begin rubbing their forefinger and thumb together, back-and-forth. Less commonly, it starts in the jaw or face. Many people do not have a severe tremor.

It is usually more likely to happen when the affected part of the body is resting. Stress or anxiety may make it more noticeable.

Other conditions that may lead to tremor include:

• multiple sclerosis
• encephalitis, an inflammation of the brain
• alcohol use disorder

The presence of tremor is not necessarily a sign of PD.

However, according to the Parkinson’s Disease Foundation, around 70 percent of people with PD experience a slight tremor at some time during the disease.

Rigidity

The muscles feel stiff, and this can make some everyday tasks troublesome, such as getting out of a chair, rolling over in bed, using body language appropriately, or making fine finger movements.

Stiffness is most common in the limbs and neck. Severe stiffness can reduce a person’s range of movements. Sometimes there is pain.

Posture and balance

Problems with balance and coordination, especially if the person feels stiff, can increase the risk of falling.

In addition to the primary motor symptoms, a person may also:

• stoop or lean forward, as if they are walking quickly
• walk with the arms held stiffly by their side
• experience muscle cramps
• experience drool
• feel tired
• write with a small, cramped hand
• have difficulty with fine finger movements
• have difficulty coordinating movements
• make involuntary movements and have prolonged muscle contractions
• lose facial expression, which can make the person appear uninterested when speaking or cause them to stare fixedly with unblinking eyes
• experience sexual dysfunction
• speak more softly, slur or repeat words, use a monotonous voice, or speak with varying speeds, either faster or more slowly
• have difficulty swallowing
• not swing the arms when walking

PD affects the brain and the CNS, and specifically the parts that control movement.

Movement does not happen only in the hands, feet, and other parts of the body that we can see.

It is also responsible for essential functions such as digestion and the circulation.

For this reason, the following symptoms may occur:

Constipation: This is a common problem for people with PD. There may also be leakage of stool.

Changes in urinary control: The person may have some incontinence or difficulty passing urine.

Blood pressure problems: A person’s blood pressure can vary as the circulatory system cannot control the blood flow as well as it used to.

People commonly experience low blood pressure, and this can make them dizzy as they stand up, for example, or lead to fainting.

Wide variations in blood pressure are also possible. In the long term, this can have an impact on the cardiovascular system.

The main cause of symptoms in PD is a fall in dopamine production in the brain. This affects movement, but it can also affect a person’s thinking and sense of well-being.

This can lead to:

Dementia: This is common in the later stages of the disease. The person may have difficulty remembering things and thinking clearly.

If clumps of protein — Lewy bodies — form in the brain, dementia is more likely. Some people with PD also have the tangles of protein that occur with Alzheimer’s disease.

Sleep problems: These are a core feature of PD. Contributing factors include REM sleep disturbances, the use of some medications, restless leg syndrome, pain, and difficulty turning over in the night.

A person may have difficulty sleeping or staying asleep at night, and they may also be excessively sleepy during the day.

Tiredness: Fatigue and a lack of energy can happen because of sleep problems and also because of the way PD affects movement.

Depression: This is a common problem. It can result from the changes in brain activity and from how the person feels about their condition. Anxiety is another common problem.

Psychosis: This is common in the later stages, and it can affect nearly 1 in 3 people with PD. It can range from minor illusions and vivid dreams to hallucinations, confusion, and paranoia. Hallucinations are usually visual, but some people hear and feel things that are not there.

Sensory changes: People with PD often lose their sense of smell. This can happen long before other symptoms appear. Experts consider it a predictor of PD. Some people experience a numbness, tingling, and prickling in the skin.

Pain: Pain is a common problem with PD, affecting over 60 percent of people with the disease, according to one study. Some people also experience a reduced sense of pain.

A person can have PD for a long time without noticeable symptoms. In addition, many of the symptoms can also occur with other conditions.

This makes it difficult to know when something is wrong. It can also make it hard for a doctor to diagnose PD.

Anyone who notices changes in their movements, thinking, or other bodily functions should see a doctor.

If the diagnosis is PD , early treatment can help reduce most of the symptoms that occur with this condition and improve quality of life.