What are the symptoms of Parkinson’s disease?

Parkinson's disease (PD) is a progressive neurological disorder that affects the nervous system and the parts of the body controlled by the nerves. The symptoms of PD are usually mild at first and develop gradually. Symptoms often begin on one side of the body and as the disease progresses, eventually affect both sides. However, the symptoms may still be more severe on one side of the body than on the other.

There are many different symptoms associated with PD and the order in which these develop and their severity is different for each individual. It's however unlikely that a person with PD would experience all or most of these.

There are two types of PD symptoms, motor symptoms and non-motor symptoms.

Motor symptoms

The primary symptoms of PD revolve around motor function impairment and include tremors, slowness of movement, rigidity, and impaired balance and coordination.

Tremor

Tremor is a rhythmic, involuntary shaking that occurs in a finger, hand or limb when at rest. The shaking usually decreases during voluntary movement. In addition to fingers and hands, tremor can appear in the arms, legs, jaw, or head. Tremor is often one of the first symptoms people notice and it affects up to 70% of people with Parkinson’s.

Slowness of movement

Slowed movement, known as bradykinesia, describes a decrease in spontaneous and voluntary movement. PD slows physical movement, making simple tasks difficult and time-consuming. Slowed movement may include slower walking with shorter steps or shuffling feet, or decreased blinking. Slowness of movement affects up to 98% of people with Parkinson’s and is one of the key symptoms looked for to make a diagnosis.

Rigidity

Rigidity, meaning stiff or inflexible muscles, may occur in any part of the body. It can limit the range of motion and reduce facial expressions, arm swing when walking and cause pain or muscle cramps. Rigidity affects between 90-99% of people with Parkinson’s.

Impaired balance and coordination

As a result of PD, many people develop a stooped posture, known as degenerative scoliosis. This bending of the spine is a normal part of aging, but it can be more exaggerated in people with Parkinson’s leading to impaired balance and an increased risk of tripping and falling.

Other motor symptoms of PD include freezing, dyskinesia, and restless legs.

Non-motor symptoms

Non-motor symptoms describe symptoms not related to movement. These common symptoms can affect almost every body system, occur at any time in the course of the disease – even before motor symptoms appear, and differ in severity from person to person.

Non-motor symptoms can significantly impact the quality of life for people with PD and their families.

PD can affect the automatic and involuntary functions that our bodies perform, impact how people feel and think, and cause other physical changes.

Autonomic dysfunction

Bowel problems: Bowel problems are more likely in people with PD. The most common bowel issue, affecting up to 65% of people with Parkinson’s, is constipation.

Bladder problems: Bladder problems including frequent urination, incontinence, or difficulty emptying the bladder, can affect people with PD, especially in the later stages of the condition.

Low blood pressure: Low blood pressure is a frequent problem in people with PD, either as a symptom of the disease or as a side effect of Parkinson’s medications. It can cause dizziness, loss of balance, or fainting.

Other autonomic dysfunctions include sweating and sexual problems.

Mood and thinking changes

Apathy: People with PD can show no or very low feelings of motivation, making it less likely to become involved in hobbies and social activities.

Cognitive impairment: PD can cause changes to people’s memory or thinking processes ranging from multitasking and concentration difficulties that don’t interfere with daily activities (mild cognitive impairment) to significant problems that impact a job and daily and social activities (dementia).

Anxiety and depression: Challenging or stressful situations, including being diagnosed with PD, can cause anxiety or low mood. However, some people with PD feel anxious, fearful, or depressed for longer periods of time, affecting their daily life and well-being.

Other mood and thinking changes include psychosis.

Other physical changes

Swallowing problems: Eating and swallowing problems, known as dysphagia, are very common in Parkinson’s, affecting up to 90% of people with the condition. This includes hesitation before swallowing, choking on or regurgitating food, and frequent coughing or throat clearing.

Sleep problems: PD can cause changes to sleep patterns and behaviors, including difficulty falling or staying asleep, excessive daytime sleepiness, acting out in dreams or experiencing restless legs, an uncomfortable feeling in the legs that is resolved only by moving them.

Speech changes: Parkinson’s can affect speech in different ways. Many people with PD speak quietly and with a monotonous voice. Some people might slur words, mumble or trail off at the end of a sentence.

Other physical changes include fatigue, pain, and drooling.

Sources:

Parkinson's Europe, Symptoms of Parkinson’s, https://parkinsonseurope.org/signs-and-symptoms/symptoms/

The Michael J. Fox Foundation for Parkinson's Research, About Parkinson's Symptoms, https://www.michaeljfox.org/symptoms