How do early symptoms of Parkinson's disease (PD) come on?

Early symptoms of Parkinson’s disease (PD) are usually mild and generally occur gradually. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing. Some may notice that their speech has become softer or that their handwriting has changed (written letters/words are smaller). You may forget a word or thought and have feelings of depression or anxiety. Generally, friends and family may begin to notice the changes before you do. They often notice the stiffening or lack of movement in the body (no arm swing when walking) or the absence of facial expression (“masked face”).

As the disease goes on, it begins to interrupt daily activities. It is important to note that not all patients experience the full range of symptoms. In fact, most patients have mild, non-intrusive symptoms.

What are the symptoms of Parkinson's disease?

Muscle rigidity. Rigidity is the inability for the muscles to relax normally. Most patients with PD develop some degree of rigidity, or stiffness of limbs. This rigidity is caused by uncontrolled tensing of muscles and results in the patient being unable to move freely. Also, patients may experience aches or pains in the affected muscles.

Tremor. In general, tremor (shaking) begins in the hands and arms. It can also occur in the jaw or foot. Tremor usually involves the rubbing of the thumb against the forefinger. It is more apparent when the hand is at rest or the patient is under stress. In the early stages of the disease, usually only one side of the body or one limb is affected. As PD progresses, tremor may become more generalized. Tremor usually worsens with stress. Tremor rarely disables a patient and often disappears during sleep and when the arm or leg is being moved. Not every patient with PD has tremor.

Bradykinesia. Bradykinesia is the slowing down of movement and the gradual loss of spontaneous activity. It is caused by the brain’s slowness in transmitting the necessary instructions to the appropriate parts of the body. This symptom is especially stressful for PD patients, given that it is unpredictable and can be quickly disabling. One moment a patient is moving easily, the next they need help moving at all. This makes accomplishing simple tasks and participating in daily routines extremely difficult. Bradykinesia affecting the facial muscles may cause a mask-like appearance.

Changes in walking pattern (gait). This commonly includes the inability of a patient to swing their arms naturally while walking, taking short shuffling steps, “freezing spells” (difficulty starting to walk and difficulty stopping), bend forward (stooped posture), and difficulty in maneuvering turns and corners.

Other symptoms of PD

  • Loss of balance and falls
  • Forward or backward lean that makes them more likely to fall
  • Stooped posture (when the head is bowed and the shoulders are slumped)
  • Shaking of the head
  • Voice and speech changes; voice will become softer, with poor enunciation
  • Loss of motor skills
  • Memory problems
  • Constipation
  • Depression
  • Feelings of fear and anxiety
  • Confusion
  • Dementia
  • Fatigue
  • Drooling
  • Skin problems, such as dandruff
  • Difficulty swallowing and chewing
  • Stress and tension
  • Sleep disturbance
  • Urinary problems
  • Sexual dysfunction

It is important for you to visit your doctor if you are experiencing any of these symptoms so you can receive the proper evaluation and diagnosis. There are other conditions that appear similar to PD, including:

  • Parkinson’s plus, like progressive supranuclear plasy (PSP), corticobasal degeneration (CBD), multiple system atrophy (MSA), and vascular Parkinson’s.
  • Depression
  • Aging
  • Use of anti-psychotic drugs
  • Other degenerative disorders of the brain

If you have questions about the possibility of PD with you or someone close to you, talk with your doctor as soon as possible.

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