Early Recognition of Parkinson’s: 10 Initial Signs to Watch For

Parkinson’s starts years before diagnosis with brain changes that may impact parts of your life, but are often not noticeable until you look back on them.

Early signs of Parkinson’s can be split into two groups: motor and non-motor symptoms. Motor symptoms affect how you move – for example, you might notice a slight tremor, stiffness in your muscles, slower movements, or a shuffling walk. Non-motor symptoms are a bit different; they include things like losing your sense of smell, changes in handwriting, sleep problems (such as acting out your dreams or restless legs), constant constipation, and mood changes like anxiety, apathy or low mood.

Because there aren’t any clear tests (biomarkers), like blood tests or brain scans, to definitively detect Parkinson’s. You and your GP have to keep track of these signs over time to get a diagnosis. In other words, recognising and recording these subtle motor and non-motor changes is very important – it’s like piecing together clues. By monitoring these symptoms, your care team can reach an earlier diagnosis, which is necessary to empower you to start making those lifestyle changes and to start treatment and managing the condition as effectively as possible.

Early detection is essential for Parkinson’s

Below, we outline a dozen subtle early symptoms that may indicate the onset of Parkinson’s. By familiarising yourself with these signs, you can help ensure that people receive appropriate medical attention as soon as possible.

  1. Loss of or reduced sense of smell: You might find it harder to notice familiar scents such as bananas, dill pickles, or liquorice. This change in your sense of smell can happen many years before other symptoms appear.
  2. Sleep disturbances: Changes in your sleep could include acting out your dreams, calling out, or experiencing uncontrolled movements like twitching or jerking of your legs during sleep. Some people also have trouble falling asleep or wake up during the night.
  3. Gastrointestinal (GI) Issues: You might experience unexplained chronic constipation or bloating decades prior to changes in movement or tremors occur. These tummy troubles happen because your digestive system can slow down, which sometimes becomes worse even with a higher fibre diet.
  4. Mood fluctuations: Later on, you may notice episodes of anxiety, depression, or a loss of interest in things you once enjoyed. These changes in mood can seem to come on without a clear reason.
  5. Small handwriting (micrographia): Your handwriting might start to shrink or become cramped. This is often first spotted in your signature where the letters seem to get smaller over time.
  6. Speech changes: People close to you may begin to notice that your voice is softer, more monotone, or that your words are slightly slurred. This change can happen gradually, so you might not even notice it yourself.
  7. Facial masking & slowed blink rate: You may show fewer facial expressions, which can make you look as though you’re not interested or are tired (hypomimia aka masked face). In addition, you might blink less frequently, sometimes giving a vacant or staring look.
  8. Muscle stiffness & rigidity: or a feeling of tight muscles, especially in your back, hips, or shoulders, might start to occur. This can make everyday movements uncomfortable or even painful.
  9. Physical movement changes: You might notice tremors (a slight shaking or off and on trembling, often starting on one side, usually in the finger or hand), a general slowness when trying to move (known as bradykinesia), smaller steps when walking, less natural arm swing, or even a shuffling walk.
  10. Excessive sweating (hyperhidrosis): Sweating in situations where it would not normally be expected, such as in cool weather or without heavy exercise, is called hyperhidrosis and might be another early sign.
  11. Unexplained changes to thinking, mood, & motivation: This might show up as difficulties with concentration, multitasking, or memory. Along with these thinking changes, you might also experience shifts in mood (e.g. anxiety, depression) or feel less motivated than usual (apathy).
  12. Unexplained pain: You could experience regular pain, especially in your hips, back, or shoulders, or even muscle cramps (sometimes known as dystonia) that do not get better with regular treatment.

We know Parkinson’s is a neurodegenerative, progressive, whole-body condition resulting from the loss of dopamine-producing neurons. Being alert to the initial signs can lead to timely diagnosis and treatment, potentially improving long-term outcomes. If you recognise any of these changes, remember that symptoms can vary from person to person. These early signs sometimes go unnoticed until more obvious symptoms, like a tremor, develop. However, it’s important to note that tremor only occurs in around 70% of people diagnosed with Parkinson’s. Early identification can help you get the support and care you need.

References

Early Warning Signs, Parkinson’s Australia 

Early warning signs poster (pdf)

Armstrong, M. J., & Okun, M. S. (2020). Diagnosis and Treatment of Parkinson Disease: A Review. JAMA, 323(6), 548–560. https://doi.org/10.1001/jama.2019.22360

Chaudhuri, K. R., & Schapira, A. H. V. (2009). Non-motor symptoms of Parkinson’s disease: Diagnosis and management. The Lancet Neurology, 8(5), 464–474.

Doty, R. L. (2012). Olfactory dysfunction in Parkinson disease. Nature Reviews Neurology, 8(6), 329–339.

Fasano, A., Visanji, N. P., Liu, L. W., Lang, A. E., & Pfeiffer, R. F. (2015). Gastrointestinal dysfunction in Parkinson’s disease. The Lancet Neurology, 14(6), 625–639.

Lees, A. J., Hardy, J., & Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055–2066.

National Institute for Health and Care Excellence. (2017). Parkinson’s disease in adults: Diagnosis and management [NICE Guideline NG71]. https://www.nice.org.uk/guidance/ng71

Postuma, R. B., Berg, D., Stern, M., Poewe, W., Olanow, C. W., Oertel, W., & Bloem, B. R. (2015). MDS clinical diagnostic criteria for Parkinson’s disease. Movement Disorders, 30(12), 1591–1601.

Waller, S., Williams, L., Morales-Briceño, H., & Fung, V. S. C. (2021). The initial diagnosis and management of Parkinson’s disease. Royal Australian College of General Practitioners.

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