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.

Early onset of Parkinson’s disease (YOPD or young onset of Parkinson’s disease) is not common but can occur as early as the teen years. It may often be missed at the onset and early stages of Parkinson’s disease may be misdiagnosed for other conditions like dystonia, multiple sclerosis and even alcohol or drug abuse. Often cases of Parkinson’s disease in teens or young adults (within their 20s) may be missed altogether for years as the sufferer attempts to hide their symptoms and cope with mild tremors and poor coordination without alerting a medical professional.

Young Onset Parkinson’s Disease Treatment

Treatment for early onset of Parkinson’s disease (teens, 20s, 30s) may not be the same as Parkinson’s disease in the more senior years. The use of levodopa is limited in young sufferers of Parkinson’s and reserved for the later years. Other treatments are usually advisable in a younger sufferer due to the side effects of levodopa, which has been shown to be higher when used in young onset of Parkinson’s disease. The higher incidence of depression in young onset of Parkison’s disease has to also be considered in the therapeutic protocol as the depression can affect the socioeconomic aspects of the sufferer.

Juvenile Parkinson’s Disease

Juvenile Parkinson’s disease is rare but has been reported to occur in children under the age of 10 years. Unlike other neurological and musculoskeletal disorders in children, juvenile Parkinson’s disease is clearly identifiable due to the changes in posture and stooped gait typical of Parkinson’s disease. These characteristic symptoms of Parkinson’s disease may not be as clearly evident in older children and young adults suffering with young onset of Parkinson’s disease (YOPD).

While there is no clear genetic link for the development of Parkinson’s disease, any person suspecting the development of this condition should seek medical attention immediately. A thorough case history, neurological and musculoskeletal examination and further diagnostic testing will allow your medical doctor to confirm or exclude Parkinson’s disease as a differential diagnosis.