Parkinson’s disease is difficult to diagnose in the early stages. The first signs and symptoms of the disease are so subtle that its often missed. Often an observant family member or friend will notice the beginning of the changes in a person, which may be so vague that it is often dismissed as occurring due to old age. Diagnosis is frequently missed in younger people since the first signs and symptoms, even when noticed earlier, may be attributed to other conditions instead of Parkinson’s disease.

Early Signs and Symptoms of Parkinson’s Disease

Although tremor, rigidity, bradykinesia (slowness of movement), and loss of postural reflex are considered to be the characteristic features of Parkinson’s. However, not all these symptoms are likely to be present in all patients in the early stages of Parkinson’s disease. Symptoms vary from person to person, and the onset may be so slow as to remain unnoticed for several years.

Some of the very first signs and symptoms likely to be observed are :

• A change in facial expression may be one of the earliest signs. Others may notice the expressionless face and fixed staring gaze without blinking of the eyes (“masked face”). Loss of animation is sometimes mistaken for depression.

• A barely noticeable tremor, usually on one hand, when the hand is at rest is among the first sign noticed by a person or their loved ones. It is also the first symptom which prompts many patients to seek medical help. The tremor may get worse when the person is agitated or stressed. Tremor of the lips, tongue, or chin may also be present. The typical “pill-rolling” tremor of Parkinson’s disease (repeated rolling of the thumb over the fingers) may be observed.

However, some PD patients may not suffer from tremor, which may cause a delay in diagnosis or even misdiagnosis of the condition. Other features that may be noticed include :

• The symptoms are initially present on one side of the body.
• A feeling of internal trembling.
• A general feeling of fatigue and ill-health.
• Loss of arm swing while walking.
• Walking with short shuffling steps and a tendency to lean forwards or backwards while walking.
• Unsteady gait.
• Frequent falls.
• Unnatural posture.
• Walking in a stooped position.
• Slowness of movement, especially in initiating a movement, such as getting up from a chair and walking.
• Sudden freezing of movement while walking, with the person being unable to go forward without assistance.
• Soft, hesitant, slurred speech. The person may speak in a monotone.
• The handwriting may gradually become smaller and end off in a scrawl (micrographia).
• Muscle stiffness, often leading to pain, which may be mistaken for arthritis.
• Irritability, depression, or decreased concentration level may be noticed.
• Memory problems.
• Evidence shows that mood disorders and sleeping problems can start many years before the typical symptoms of PD become evident.

Detection of early symptoms of Parkinson’s disease can help to slow progression of the disease by starting treatment as soon as possible. However, many Parkinson’s patients are either embarrassed or in denial about the first signs and symptoms and often wait till they are unable to cope or pressurized by a loved one to seek medical help.