Parkinson’s disease is a progressive neurological disorder primarily impacting movement, caused by damage or death of neurons in the brain region responsible for muscle control.
When assessing Parkinson’s disease, doctors distinguish between two phases: the prodromal and clinical phases. The prodromal phase is characterized by patients noticing symptoms that raise concern, while the clinical phase involves health care providers conducting tests to diagnose the disease, Dr. Guy Schwartz, co-director of the Stony Brook Parkinson’s and Movement Disorders Center at Stony Brook Medicine, told The Epoch Times.
Understanding this progressive neurological disorder is crucial due to its impact on movement caused by neuron damage. Recognizing the different phases helps patients identify concerning symptoms while enabling doctors to diagnose the disease accurately.
Some of the most common early signs of Parkinson’s disease include tremors or shaking, primarily in the hands, arms, legs, jaw, or face, according to Schwartz. These tremors may occur at rest or during tasks and can initially be mild but tend to worsen over time.
Parkinson’s disease can lead to changes in movement, including limb stiffness or rigidity, which can impede daily activities like dressing and turning in bed, Schwartz said. Additionally, individuals may experience bradykinesia, a slowing of movement, making simple tasks more time-consuming.
Parkinson’s disease can disrupt an individual’s balance and coordination, increasing the likelihood of falls and related injuries. Common manifestations include a stooped posture, shuffling gait, and challenges in turning or changing direction during walking, according to Schwartz.
Anosmia, the loss of sense of smell, is a notable early symptom of Parkinson’s disease. Individuals may struggle to detect specific odors like those from food or flowers and may face difficulties in identifying familiar smells.
Schwartz stressed that a clinician must identify these four cardinal signs, particularly bradykinesia, to diagnose Parkinson’s disease or a Parkinsonian symptom accurately. “The slowness is an obligatory sign; there has to be bradykinesia. Without it, one cannot conclude that, cannot be certain about the diagnosis,” he said.
However, early nonmotor symptoms can suggest the onset of Parkinson’s disease, preceding noticeable motor symptoms by several years or even decades. While there is currently no cure or therapy to slow the disease’s progression, initiating treatment early can significantly enhance a patient’s function and quality of life.
Some of the earliest signs of Parkinson’s disease may not be noticed by the person experiencing them but rather by friends or family members.
Schwartz explained that one of the most established early symptoms is rapid eye movement (REM) sleep behavior disorder, a sleep disorder characterized by physically acting out vivid dreams and sudden and sometimes violent arm and leg movements during REM sleep.
However, in some cases, Schwartz added, the full account of symptoms may not be obtained due to incomplete patient history, such as when a bedmate sleeps in a separate room or is a deep sleeper.
Another particular symptom of Parkinson’s disease is multiple symptom atrophy. This rare degenerative neurological disorder affects the body’s autonomic functions, such as blood pressure, breathing, digestion, and motor control.
Multiple symptom atrophy and REM sleep behavior disorder typically appear about 10 years before the onset of Parkinson’s disease, Schwartz said.
Handwriting changes, such as progressively getting smaller and cramped writing, may be an early indicator of Parkinson’s disease.
This is due to a condition called micrographia. Characterized by the gradual reduction in the size and legibility of handwriting, the condition occurs due to the disease’s impact on motor control and coordination, particularly the fine motor skills required for writing.
Constipation is another early sign to watch for due to the impact of the disease on the autonomic nervous system, which controls various involuntary bodily functions, including digestion.
Parkinson’s disease can affect the digestive system’s muscles, leading to a slowing of bowel movements and decreased muscle contractions needed for proper digestion and elimination.
One symptom that may not be commonly associated with a neurodegenerative condition is sweating.
“There could be some problems with sweat, regulating sweat, and a rash. These are what we call nonmotor precursors of Parkinson’s disease,” Schwartz said.
Some people may experience changes in sweat regulation due to autonomic dysfunction associated with the disease.
It is important to note that experiencing one or more of these symptoms does not necessarily indicate Parkinson’s disease. Still, they could serve as early indicators, prompting the decision to consult a doctor.
A 2013 study of over 23,000 people found that individuals diagnosed with depression had over three times the risk of developing Parkinson’s disease than those without it.
Another study published in 2015 observed over 140,000 people diagnosed with depression. The condition was found to potentially serve as a prodromal symptom, a very early sign, or a contributing factor to the risk of developing Parkinson’s disease.
Anxiety disorders are also known to co-occur with Parkinson’s, with an estimated 40 percent of patients experiencing “substantial anxiety.”
Researchers also found that anxiety often emerges before the typical movement disorders associated with Parkinson’s, indicating a link to disease-related brain changes rather than psychological or social factors.
Delayed treatment may cause people to miss the opportunity to start medication when it is most effective. Untreated Parkinson’s can lead to decreased mobility and difficulties in daily activities, significantly affecting quality of life.
Research published in the American Journal of Managed Care highlights the importance of early intervention for optimal outcomes in Parkinson’s disease. Clinical trials suggest that early treatment may slow disease progression and alleviate symptoms, greatly improving patient quality of life.
Schwartz, too, emphasizes the significance of early diagnosis, acknowledging that it marks the beginning of a challenging neurodegenerative journey. “On the downside, [some] early-onset people would rather not know,” he added.
A Parkinson’s diagnosis can have a significant psychological impact on them and their social circle.
“Some patients are in denial, and that’s OK,” Schwartz said. “I’ve often got a kind of respect for that,” he added. “Sometimes ignorance is bliss. Some people have a burning desire to know, and it’s only fair. Some of them, you can sense that they can wait. They’ll come back in a year and revisit the diagnosis if something changes.”