Parkinson's disease - Symptoms 

The symptoms of Parkinson's disease usually begin slowly and develop gradually, often in no particular order.

Parkinson's disease affects people in many different ways with a variety of symptoms and responses to treatment. Severity of the symptoms also varies between people.

It would be unlikely for a person to experience all or most of the symptoms listed in this section.

Types of symptoms

Potential symptoms can vary widely but are within three broad categories:

• symptoms that affect physical movement – known as motor symptoms
• symptoms that affect mood, thinking and behaviour – known as neuropsychiatric symptoms
• symptoms that affect your autonomic nervous system (the nervous system that controls your autonomic functions such as breathing and urination) known as autonomic dysfunction – see below for more details

Common motor symptoms

These three are the most common motor symptoms:

Tremor

The most common initial symptom is uncontrollable shaking, known as tremor. Shaking usually begins in the hand or arm. It is more likely to occur when the limb is at rest and can be more noticeable when the patient is stressed, anxious or tired. Shaking usually decreases when the limb is being used.

The presence of a tremor does not necessarily mean that you have Parkinson's disease. Tremor is also a symptom of other conditions and is usually due to a harmless condition called essential tremor.

Slowness of movement (bradykinesia)

Parkinson's disease can make your physical movements much slower than normal, particularly when you try to start moving. The medical term for slowness of movement is bradykinesia.

People have reported that they try to move the affected body part at a normal speed but ‘the messages just seem not to get through’.

Often the first sign of bradykinesia is that you no longer swing one of your arms when walking.

Everyday tasks, such as buttoning clothes, writing with a pen and opening jars, can become difficult and time consuming.

Bradykinesia can affect your legs resulting in a distinctive slow and shuffling kind of walk with very small steps. And occasionally, in more advanced cases, a person can temporarily lose the ability to walk and their feet become ‘frozen to the floor’.

Bradykinesia can also affect the face and voice leading to a loss of normal facial expressions. A person also blinks less than usual.

Stiffness of muscles (rigidity)

People with Parkinson's disease also experience stiffness and tension in their arm and leg muscles. This is known as rigidity.

When examining people with Parkinson’s disease, doctors can feel two different types of rigidity:

• ‘lead-pipe rigidity’ – where there is a feeling of constant resistance in the affected muscles
• ‘cogwheel rigidity’ – where there is resistance in affected muscles followed by relaxation; as if you were rotating a cogwheel

Other motor symptoms

Dystonia

Some people with Parkinson’s disease can experience involuntary muscle cramps, spasms and contractions. These can occur independently but can also be a response to the dopaminergic drugs.

In cases of Parkinson’s disease dystonia usually affects the muscles in the calves and feet, though occasionally other parts of the body can be affected, such as:

• hands
• head
• neck
• eyelids

Read more about dystonia.

Postural instability

In some cases of more advanced Parkinson’s disease a person loses much of their natural sense of balance. This is known as postural instability and can be a leading cause of falls and injuries.

Neuropsychiatric symptoms

Depression

Depression is thought to affect up to half of people with Parkinson’s disease and is thought to arise from a number of complex and inter-related factors, such as:

• the reduction of dopamine and other chemicals inside the brain (dopamine can have a powerful influence on mood)
• the stress of living with Parkinson’s disease
• the impact that Parkinson’s disease can have on your relationship with others

Signs you may be depressed include:

• feeling down, depressed, or hopeless during the past month
• having little interest or pleasure in things you used to enjoy during the past month

Depression can seriously impact on your quality of life; if it occurs discuss treatment with your GP.

Read more about depression.

Anxiety

Anxiety can also affect people with Parkinson’s disease especially once treatment with levodopa becomes less effective and they start to experience ‘off-episodes’ (a sudden return of their motor symptoms).

The sudden return of symptoms can make people feel anxious, and in the most serious cases, trigger a panic attack.

Read more about anxiety.

Mild cognitive impairment and dementia

If you are in the early stages of Parkinson’s disease you may experience what is known as mild cognitive impairment.

This means your pattern of thinking can become disrupted and you have problems with activities that require planning and organisation.

Around 40% of people with advanced Parkinson’s disease go on to develop a more severe form of cognitive impairment known as dementia.

Symptoms of dementia in people with Parkinson’s disease include:

• significant problems with memory, learning new information and understanding written and spoken language
• sudden outburst of emotions such as anger, excitement and frustration
• difficulties recognising previously familiar people and places
• poor concentration and low attention span
• visual hallucinations (seeing things that are not real)
• delusions (believing in things that are not true)

Having both hallucinations and delusions and being unable to tell the difference between your imagination and reality is known as psychosis.

Read more about dementia.

Sleep disturbances

Insomnia (problems sleeping) is thought to affect around half of those with Parkinson’s disease.

Periods of insomnia often come and go over the course of the disease.

Causes of insomnia are often complex. They can include changes to the brain, side-effects of some of the medications used to treat Parkinson’s disease, breathing difficulties during sleep, abnormal movement during sleep and the natural effects of aging.

Read more about insomnia.

This in turn can cause excessive daytime sleepiness and sudden dozing during the day. Some medications used to treat Parkinson’s disease can also make you feel drowsy during the day.

Automatic dysfunction

Your automatic nervous system is the part of your brain and nervous system that regulates functions of your body that you do not have to think about, such as breathing, swallowing, digesting food and passing urine.

The changes in brain chemistry that occur in Parkinson’s disease can disrupt many of these functions and cause the following:

• problems with urination – such as having to get up frequently during the night to urinate and, or separately from, urinary incontinence (the unintentional passing of urine)
• constipation
• in men – inability to obtain or sustain an erection (erectile dysfunction)
• in women – difficulties in becoming sexually aroused and achieving an orgasm
• a sudden drop in blood pressure when moving from a sitting or lying position to a standing one (orthostatic hypotension) – this can cause dizziness, blurred vision and in some cases fainting
• excessive sweating (hyperhidrosis)
• difficulties swallowing (dysphagia) – which in turn can lead to malnutrition (not having enough nutrients in your diet) and dehydration (not drinking enough fluids)
• excessive production of saliva (drooling)