11 Symptoms That Could Be Early Signs of Parkinson’s Disease

Parkinson’s disease is a condition that affects the brain and nervous system. Some of the most recognizable symptoms include tremors, slow and rigid movements, and difficulty walking. But these symptoms tend to develop in the later stages of the disease. 

Parkinson’s disease is a progressive disorder, meaning that it steadily gets worse over time. This also means that the earliest symptoms can be subtle. And so many people are not diagnosed with the condition until the later stages of the disease.

If you’re worried that you or someone you know has Parkinson’s disease, you’re not alone. It can be hard to know if someone’s symptoms are truly Parkinson’s or if they’re something else. But it helps to know some of the early symptoms. That way, you can know when it’s time to see a provider. The earlier someone is diagnosed with Parkinson’s, the earlier they can start treatment to help slow down the disease.

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Prescribing Information I Important Safety Information 3355-V2 (v 2.1)

Important Safety Information

DHIVY is contraindicated in patients

•Currently taking a nonselective monoamine oxidase (MAO) inhibitor (e.g., phenelzine, linezolid, and tranylcypromine) or have recently (within 2 weeks) taken a nonselective MAO inhibitor. Hypertension can occur if these drugs are used concurrently.

•With known hypersensitivity to any component of DHIVY.

Taking DHIVY may result in falling asleep while engaged in normal activities, even without warning and as late as 1 year or later after starting DHIVY. This may affect your ability to drive or operate machinery, resulting in accidents. Do not do anything that requires alertness until you know how DHIVY affects you. Tell your healthcare provider about any sleep medicines you take or if you have a sleep disorder, and discuss any episodes of drowsiness or sleepiness you experience while taking DHIVY.

Talk to your healthcare provider before you change the dose or stop taking DHIVY, as this may result in serious side effects. Call your healthcare provider immediately if you develop withdrawal symptoms such as fever, confusion, or severe muscle stiffness.

Tell your healthcare provider if you have any heart conditions, especially if you have had a heart attack or irregular heartbeats. Your heart function should be monitored during the time period your DHIVY dose is first adjusted.

Treatment with DHIVY may cause hallucinations or abnormal thoughts and behaviors. Be sure to tell your healthcare provider if you experience excessive suspicion; seeing, hearing, or feeling things that are not real; confusion; agitation; aggressive behavior; and disorganized thinking.

Treatment with DHIVY may also cause intense urges to gamble, increased sexual urges, intense urges to spend money, binge eating, and other intense urges, as well as the inability to control those urges. Uncontrolled sudden movements of the face, arms, legs, or trunk may appear or get worse during treatment with DHIVY. This may mean your dosage of DHIVY or other Parkinson’s medications needs to be adjusted.

Tell your healthcare provider if you have ever had a peptic ulcer or glaucoma, as treatment with DHIVY may worsen these conditions. DHIVY also may cause abnormal blood or urine test results.

Some patients taking DHIVY may experience depression or suicidal thoughts. Tell your healthcare provider if you have thoughts of suicide.

The most common side effects that may appear with DHIVY include uncontrolled sudden movements and nausea.

Tell your healthcare provider about all the medications you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Using DHIVY with certain other medicines, including MAO inhibitors, isoniazid, iron supplements, medicines for high blood pressure or those that increase or decrease dopamine levels, or metoclopramide, may cause serious side effects.

Notify your healthcare provider if you become pregnant or intend to become pregnant during DHIVY therapy or if you intend to breastfeed or are breastfeeding an infant.

Please see full Prescribing Information.

11 early signs and symptoms of Parkinson’s disease

Early symptoms of Parkinson’s disease aren’t always easy to notice. They are usually more vague symptoms that start before the more obvious ones that affect someone’s movement. 

The following list starts with some of the earliest symptoms, then walks through a typical progression of some of the later symptoms. These later symptoms are included because the condition can develop differently from person to person. Also, some people may start to notice very subtle changes that are the first signs of the later symptoms, so it helps to know what those are.

It’s also helpful to remember that if someone develops the symptoms listed below, it does not necessarily mean they have Parkinson’s. Some of these are very common symptoms of other conditions, with much more likely causes. 

1. Loss of smell

Experts believe that loss of smell may be one of the earliest signs of Parkinson’s. And it can start years before any of the more recognizable movement symptoms start. At the time of diagnosis, the majority of people with Parkinson’s report a noticeable loss of smell.

2. Constipation

Constipation is a very common issue for many Americans — and for many different reasons. But one of the early symptoms of Parkinson’s is difficulty moving your bowels or needing to strain to pass a bowel movement. This is because of the way Parkinson’s affects the nervous system, which is an important part of digestion. 

3. Bladder problems

Like constipation, changes in bladder function are common problems among adults. And the nervous system plays an important role in bladder function too. People with Parkinson’s often feel like they have an overactive bladder. They may have to get up frequently to pee, or they may experience urinary urgency (suddenly needing to pee).

4. Trouble sleeping

Parkinson’s can disrupt someone’s sleep for a few different reasons. This can be due to: 

• The bladder problems described above, causing someone to use the bathroom more frequently 

• Sudden movements — like jerking — when a person is in deep sleep 

• Pain or restlessness in their legs that improves if they move around

These sleep disruptions may also lead to increased daytime sleepiness or more frequent naps in the middle of the day.

5. Dizziness

A condition called orthostatic hypotension can cause dizziness when someone changes position. It is relatively common in early Parkinson’s disease. This is related to the way Parkinson’s affects the nerves that control blood pressure. When someone with orthostatic hypotension stands up, their blood pressure drops temporarily. This can cause them to feel dizzy or potentially even pass out. 

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6. Slow movements 

One of the first movement symptoms in Parkinson’s is a general slowness. This is called “bradykinesia.” This may be difficult for someone to describe when it first starts. It may just feel like weakness or tiredness. Or someone may notice it just becomes harder to initiate movement.

In the arms, someone may first notice it is hard to coordinate movement in the hands. They may have difficulty with:

• Buttoning shirts or zippering jackets

• Tying shoelaces

• Typing on a phone or computer

• Writing by hand, including handwriting that may start to appear smaller 

In the legs, someone may notice:

• Difficulty getting out of a chair

• A shorter stride when walking

• A feeling of unsteadiness

7. Stiffness and rigidity

Muscle and joint stiffness can also be early movement signs of Parkinson’s. Some people may experience this as inflexibility. Or it may even feel like muscle cramps or tightness. But this will become more noticeable with time. This may be particularly apparent when someone is walking. 

For example, it can lead to:

• Decreased arm swing when walking

• A “shuffling gait,” meaning it is hard to lift their feet off the ground or take full steps 

• A stooped-over appearance when walking

Later in Parkinson’s, the change in posture will become more apparent. It can look like stooping, slouching, or leaning when standing. This may also lead to trouble balancing and increased falls.

8. Tremor

Shaking is one of the hallmark movement symptoms of Parkinson’s. This shaking can be in the:

• Hand

• Arm

• Foot

• Leg

The classic Parkinson’s tremor is described as a “pill rolling” tremor in the hand. It is a small, circular tremor that looks like someone is drawing small circles with their hand. It’s usually more noticeable when someone is at rest, and it gets better with movement. 

Most Parkinson’s tremors start on just one side of the body, but over time it can affect both sides. And not everyone with Parkinson’s will develop the classic pill rolling tremor. Most people with the condition have some type of tremor, but it can look different from person to person.

9. Changes in voice

Parkinson’s disease affects many different muscles in the body, including ones that help you speak. Someone with Parkinson’s may start to speak in a softer or lower voice. They may also mumble, stutter, or have trouble articulating their words.

10. Masked face or inability to make facial expressions

Parkinson’s also affects the muscles in the face. This can make it harder for people to form facial expressions, sometimes referred to as “masked face.” It describes the way some people with Parkinson’s have a harder time expressing joy or laughter. They may look like they are upset, mad, or serious even when they’re in a good mood. 

11. Depression and anxiety

Changes in mood can happen in both early or late stages of Parkinson’s. Depression in particular can be underdiagnosed and undertreated in people with the condition. But about a third of people with Parkinson’s experience depression. 

Other common mental health symptoms include:

• Decreased interest in activities

• Decreased motivation

• Low mood

• Anxiety

• Difficulty concentrating

• Difficulty with planning

In the later stages of the condition, people can also develop hallucinations and delusions. Others can start to develop dementia, but memory changes tend to come later in the disease.

Who is at risk for Parkinson’s disease?

Scientists are still trying to understand what increases someone’s risk for Parkinson’s disease. But they know that the following factors play a role:

• Age: In most cases, Parkinson’s is diagnosed when someone is over 65 years old. But people younger than 50 can still develop it. Experts think that when a younger person develops Parkinson’s disease, it’s more likely because of their genetics.

• Genetics: Scientists believe that up to 15% of Parkinson’s cases are caused by genes that someone inherits from their parents. And a smaller number of those are due to specific genetic mutations. But even though genetics plays a role, most cases of Parkinson’s do not run in the family. And even when they do, genetics probably isn’t the only reason that someone develops the condition.

• Environment: Exposure to toxins in the environment may also play a role in Parkinson’s risk. These include pesticides, cyanide, herbicides, methanol, and carbon disulfide. People are more likely to be exposed to these chemicals if they live in a rural area, drink well water, or work in agriculture. But just like genetics, toxin exposure is likely a contributor rather than the main cause.

• Lifestyle: Research shows that cigarette smoking and caffeine intake may actually protect someone against developing Parkinson’s. But other health risks associated with these may outweigh the potential benefits. 

Researchers are still trying to figure out how these risk factors interact with each other. But it’s clear that no one develops Parkinson’s from one factor alone. Instead, a combination of these factors likely increases or decreases the likelihood that a person develops the condition. 

Diagnosing Parkinson’s disease

Many people live with Parkinson’s symptoms for several years before they see a provider. And by this time, many of the symptoms are more severe. But an earlier diagnosis can help get you on the right treatment sooner.

If you or a loved one is experiencing one or more of the above symptoms, it’s never too early to talk to your provider. This is especially true if your symptoms are causing worry or interfering with your daily life. 

If you do have Parkinson’s disease, the diagnosis can take time. This is because there is no single test for the condition. The diagnosis is based on your symptoms and a physical exam. If it seems that your symptoms could be due to Parkinson’s, your provider will likely:

• Recommend blood tests and imaging tests: These tests will rule out other potential causes of your symptoms. This is because many other conditions can cause symptoms that look like Parkinson’s disease.

• Refer you to a neurologist for evaluation: These are providers who specialize in the brain and nerves. They have experience in diagnosing and treating conditions like Parkinson’s.

There’s no cure for Parkinson’s. But there are many treatments that can help improve symptoms and decrease the chances of complications from the disease. These can include:

• Medications that reduce the movement symptoms

• Medications to help with the other symptoms, like depression or constipation

• Physical therapy to improve strength, coordination, and balance

• Occupational therapy to help you stay independent and perform daily activities

• Some procedures that can help with Parkinson’s symptoms

It may feel scary to talk to your provider about the possibility of Parkinson’s. But an earlier diagnosis can help get you the right support and treatment for your symptoms. 

Why trust our experts?

Written by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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