These symptoms can be the first signs of Parkinson’s

The typical tremor is not the only Parkinson's symptom.

The typical tremor is not the only Parkinson’s symptom. (Source: Astrid860/getty-images-bilder)
Many people associate Parkinson’s with one particular symptom in particular: tremors. However, this does not have to be the first sign.

Parkinson’s syndrome is one of the most common neurological diseases. This causes certain nerve cells in the brain that produce the neurotransmitter dopamine to die. This process gradually affects the entire body, causing numerous symptoms to appear. The characteristic tremor is just one of them.

In most cases, the cause of the death of nerve cells in the brain remains unknown. Then experts speak of Parkinson’s disease (also: idiopathic Parkinson’s syndrome). Parkinson’s syndrome is rarely due to another disease or medication.In addition to tremors, three other symptoms are typical of Parkinson’s: These include muscle stiffness, movement disorders and impaired postural stability. In the early stages of the disease, however, it is not uncommon for completely different signs to appear that are not initially associated with Parkinson’s.

First signs of Parkinson’s in the early stages

Parkinson’s disease develops gradually. As a rule, the disease does not progress in episodes, but rather progresses continuously.

The first clear sign of Parkinson’s is tremors. In the early stages, however, the disease often manifests itself through rather unspecific symptoms that can also occur as part of the normal aging process. In addition, the possible early symptoms vary greatly from person to person. It may take years before a doctor makes a diagnosis.

Parkinson’s: A variety of early symptoms possible

Pain or feelings of stiffness can be the first sign years before diagnosis. The symptoms occur in the neck, shoulder, back or in the arms or legs. A rheumatic disease is often initially suspected as the cause of the pain.

An increased tendency to fall can also be an early symptom of Parkinson’s. In addition, sufferers often have a reduced ability to smell. Other, rather unspecific early symptoms include fatigue, fatigue, reduced performance, circulatory problems , forgetfulness , sleep disorders or constipation .

Even in the early stages of Parkinson’s, a deterioration in fine motor skills can be noticeable. For example, those affected have difficulty tying their shoes. The typeface can change: The font becomes smaller, especially at the end of the line.

Older man takes notes
A change in writing can be a symptom of Parkinson’s. (Source: KucherAV/getty-images-bilder)

Sometimes relatives notice the first signs of the disease even if those affected do not even notice them. For example, speech can appear changed and become quieter even in the early stages. A depressed mood with loss of interest or irritable behavior can also be the first sign.

As you progress, other signs may become apparent, such as:

  • slowed movements, so everyday tasks like washing or eating take longer
  • a feeling of stiffness in your arms or legs
  • Difficulty getting up from an armchair/chair
  • social withdrawal, for example because those affected have the feeling that they are too slow
  • a changed, rigid facial expression

Main symptoms of Parkinson’s disease

As Parkinson’s progresses, the main characteristic symptoms of the disease become apparent. These include

  • slowed movements/lack of movement (akinesia),
  • muscle stiffness,
  • Trembling at rest and
  • a disturbance in postural stability.

The first three symptoms are sometimes referred to as the Parkinson’s triad. If these signs occur together, the disease is usually already advanced. Often one side of the body is initially more affected by the symptoms than the other.

Akinesia: lack of movement in Parkinson’s disease

People with advanced Parkinson’s suffer from movement disorders in the form of a lack of movement (akinesia). You can only carry out movements very slowly or to a limited extent.

Sick people are noticeable with short, increasingly smaller steps and a shuffling gait. It is typical that the arms do not swing when walking. Activities that require good fine motor skills are becoming increasingly difficult – for example, tying a bow or threading a thread.

People with Parkinson’s have problems making or stopping voluntary movements. When running, for example, they find it difficult to take the first step and are hardly able to stop a movement abruptly. Their posture is often stooped.

The lack of mobility affects not only the muscles of the arms and legs, but those of the entire body. For example, the facial muscles: Over time, facial expressions appear mask-like and rigid (so-called hypomimia). Swallowing becomes increasingly difficult. The voice becomes quieter and monotonous. Another sign: As the disease progresses, the writing becomes less clear and smaller.

Muscle stiffness in Parkinson’s disease

People with Parkinson’s suffer from permanent muscle stiffness (so-called rigidity). The arms, legs and neck are particularly affected: they feel stiff and tense, which can lead to muscle pain . If other people try to move the stiff part of the body, they can hardly do so or only do so against significant resistance.

Tremors in Parkinson’s

Tremors – known in technical terms as tremors – are also a typical symptom of Parkinson’s, occurring in around three quarters of those affected. The tremor is particularly noticeable at rest. Experts then speak of a resting tremor. A frequency of around four to seven tremors per second is typical. The wrists and finger joints are particularly affected. The involuntary trembling movements can be reminiscent of “counting money” or “rolling a pill” movements.

Disturbance of postural stability in Parkinson’s disease

As the disease progresses, another symptom becomes visible: an unstable posture (so-called postural instability). It arises because the reflexes that keep the body in balance during movements are increasingly disturbed.

Sick people have to repeatedly correct their upright sitting or standing posture. They cannot cope well with abrupt movements, such as a push: instead of taking a big step backwards, they take many small steps – or they fall.

Other symptoms of Parkinson’s

Parkinson’s disease can lead to numerous other complaints. Possible signs include:

  • Concentration problems
  • slowed mental functions and thinking processes
  • depressions
  • excessive sweating
  • Increased sebum production in the skin, for example on the face
  • excessive salivation
  • Bladder function disorders
  • impotence
  • constipation
  • Disturbances in blood pressure and temperature regulation
  • Olfactory disorders
  • sleep disorders
  • Balance disorders
  • Uneven sensations or pain, for example in the back

As the disease progresses, around 3 out of 10 of those affected develop dementia, which is known as Parkinson’s dementia.

Elderly woman in front of the laptop
Concentration problems can have many causes, but can also occur as part of Parkinson’s disease. (Source: fizkes/getty-images-bilder)

Dementia in Parkinson’s

The progressive lack of dopamine in the brain can become noticeable on a cognitive level. The symptoms are initially only mild, so family members may not notice them at first. However, symptoms increase over time.

If the cognitive impairment is so severe that the person can no longer cope with everyday life independently, this is Parkinson’s dementia. It usually occurs at an older age and when the disease is already advanced.

Parkinson’s dementia is characterized by severe mental decline (dementia). Men get sick more often than women. Possible symptoms of dementia in Parkinson’s disease are:

  • Concentration and memory problems
  • slower thinking, slower reactions
  • Changes in mood
  • Changes in personality
  • Change in behavior
  • Problems with spatial vision
  • Language disorders
  • indifference
  • Accompanying: other psychological complaints such as depression, anxiety, hallucinations

Sick people can usually remember new things, but have difficulty recalling what they have learned later.

Parkinson’s dementia is not curable. The main aim of treatment is to maintain the person’s independence for as long as possible, for example through cognitive training, regular exercise and a balanced diet. The symptoms can be alleviated somewhat with medication. So-called acetylcholine esterase inhibitors such as rivastigmine are often used. Relatives can also be of support.

Symptoms such as tremors or movement disorders can have many causes and do not necessarily have to be symptoms of Parkinson’s. Anyone who notices possible early signs of Parkinson’s should consult a doctor to be sure. A first point of contact can be your family doctor’s office.

Medications, among other things, play a role in the treatment of Parkinson’s disease. These include levodopa (L-dopa) and active ingredients from the group of dopamine agonists. The symptoms can be easily treated with L-dopa or dopamine agonists, especially at the beginning of drug treatment. As it progresses, the effect often wears off


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