Symptoms of Parkinson’s disease differ from person to person. They also change as the disease progresses. Symptoms that one person gets in the early stages of the disease, another person may not get until later – or not at all.
Symptoms typically begin appearing between the ages of 50 and 60. They develop slowly and often go unnoticed by family, friends and even the person who has them.
The disease causes motor symptoms and non-motor symptoms. Motor symptoms are those that have to do with how you move. The most common one is tremor.
Tremor, or shaking, often in a hand, arm, or leg, occurs when you’re awake and sitting or standing still (resting tremor), and it gets better when you move that body part.
Tremor is often the first symptom that people with Parkinson’s disease or their family members notice.
At first the tremor may appear in just one arm or leg or only on one side of the body. The tremor also may affect the chin, lips, and tongue.
As the disease progresses, the tremor may spread to both sides of the body. But in some cases the tremor remains on just one side.
Emotional and physical stress tends to make the tremor more noticeable. Sleep, complete relaxation, and intentional movement or action usually reduces or stops the tremor.
Although tremor is one of the most common signs of Parkinson’s, not everyone with tremor has Parkinson’s. Unlike tremor caused by Parkinson’s, tremor caused by other conditions gets better when your arm or hand is not moving and gets worse when you try to move it.
The most common cause of non Parkinson’s tremor is essential tremor. It’s a treatable condition that is often wrongly diagnosed as Parkinson’s.
Other Common Symptoms
Besides tremor, the most common symptoms include:
Stiff muscles (rigidity) and aching muscles. One of the most common early signs of Parkinson’s is a reduced arm swing on one side when you walk. This is caused by rigid muscles. Rigidity can also affect the muscles of the legs, face, neck, or other parts of the body. It may cause muscles to feel tired and achy.
Slow, limited movement, especially when you try to move from a resting position. For instance, it may be hard to get out of a chair or turn over in bed.
Weakness of face and throat muscles. It may get harder to talk and swallow. You may choke, cough, or drool. Speech becomes softer and monotonous. Loss of movement in the muscles in the face can cause a fixed, vacant facial expression, often called the “Parkinson’s mask.”
Difficulty with walking and balance. A person with this disease is likely to take small steps and shuffle with his or her feet close together, bend forward slightly at the waist, and have trouble turning around. Balance and posture problems may cause frequent falls. But these problems usually don’t happen until later on.
Freezing. Freezing, a sudden, a brief inability to move. It most often affects walking.
A small number of people have symptoms on only one side of the body that never move to the other side.
Cognitive disturbances can occur in the initial stages of the disease and sometimes prior to diagnosis, and increase in prevalence with duration of the disease. The most common cognitive deficit in affected individuals is executive dysfunction, which can include problems with planning, cognitive flexibility, abstract thinking, rule acquisition, initiating appropriate actions and inhibiting inappropriate actions, and selecting relevant sensory information. Fluctuations in attention and slowed cognitive speed are among other cognitive difficulties. Memory is affected, specifically in recalling learned information. Nevertheless, improvement appears when recall is aided by cues. Visuospatial difficulties are also part of the disease, seen for example when the individual is asked to perform tests of facial recognition and perception of the orientation of drawn lines.
A person with PD has two to six times the risk of dementia compared to the general population. The prevalence of dementia increases with duration of the disease. Dementia is associated with a reduced quality of life in people with PD and their caregivers, increased mortality, and a higher probability of needing nursing home care.
Behavior and mood alterations are more common in PD without cognitive impairment than in the general population, and are usually present in PD with dementia. The most frequent mood difficulties are depression, apathy and anxiety. Establishing the diagnosis of depression is complicated by symptoms that often occur in Parkinson’s including dementia, decreased facial expression, decreased movement, a state of indifference, and quiet speech. Impulse control behaviors such as medication overuse and craving, binge eating, hypersexuality, or pathological gambling can appear in PD and have been related to the medications used to manage the disease. Psychotic symptoms—hallucinations or delusions—occur in 4% of people with PD, and it is assumed that the main precipitant of psychotic phenomena in Parkinson’s disease is dopaminergic excess secondary to treatment; it therefore becomes more common with increasing age and levodopa intake