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Syntoms and diagnosis

The symptoms vary from person to person. The most common are tremor (trembling or
shaking), stiffness, and slowness of movement. These symptoms lead to difficulties with daily activities such as walking, getting in and out of bed, sitting down in a chair and standing up again. People also find that they need a greater degree of concentration to do things such as walking or eating. Difficulty may be experienced in getting dressed, writing, or doing tasks such as repairs or ironing. In the long-term, difficulties in maintaining posture and balance, which can result in falls, may be experienced. Other symptoms include problems with urinating and slow bowel movements. Sometimes the symptoms are attributed to old age or depression.

The initial signs of Parkinson's are frequently vague and confusing. It often starts with a slight trembling of an arm. Other people feel tired or experience slight cramps such as pain in an arm. Symptoms often develop so gradually that it can be hard to remember when they began. Because of this, a doctor may find it difficult to discover their cause: tiredness, pain in an arm or frequent falls might suggest a number of possible illnesses. Tremor also has a number of causes and, as it is common in the elderly, can sometimes be wrongly diagnosed as Parkinson's. Sometimes the symptoms are mistakenly attributed to old age or depression. Parkinson's is always progressive, so a Parkinson's diagnosis is unlikely if there is no progression over a period of three years or more. If your doctor says that he feels you may have Parkinson's request that he refers you for an appointment to see a neurologist, with a special interest in Parkinson's for confirmation of the diagnosis.

A characteristic of Parkinson's is that symptoms can change from day to day and sometimes even from hour to hour. For example a person may find it difficult to walk to the front door and then perhaps only 30 minutes later, will be able to go for a walk. These changes are very common and are a part of Parkinson's or may also be a result of drug treatment.

Symptoms and signs

Stiffness (rigidity). In Parkinson's the muscles become stiffer because they are always a little tense. This is known as hypertonus (hyper = excessive, tonus = tension) or rigidity. Rigidity mostly begins in the neck/shoulder or in an arm. It can be felt as real stiffness in the joints (elbow, wrist or knee) but also as a tired, heavy or nagging bruised feeling in the muscles. When rigidity is present, there is usually a degree of slowness of movement (bradykinesia). Involvement of back muscles leads to postural change and to a tendency to sit, stand and walk bent forward. If the facial muscles become stiff, a person has a fixed look.

Shaking. Where tremor exists, shaking usually begins in the hands and arms on one side of the body. Often the thumb and forefinger move against each other, the so-called counting money or pill-rolling tremor. Shaking can also occur in the foot, less often in the mouth and jaw (not the whole head). It is strongest when someone is not moving, hence the term rest tremor. If a movement is made, the shaking is reduced and stops during sleep. Emotional states (sorrow, anger, joy, nervousness) or tiredness often make it worse.

Slowness (bradykinesia) and poverty of movement. In Parkinson's, movement becomes slower, so called bradykinesia (brady = slow, kinesia = movement) and reduced, so called hypokinesia. Slowness of movement often occurs together with muscle stiffness. The strength of the muscles does not actually decline, but the muscles do not react so quickly. Automatic movements that previously happened unconsciously now have to be made consciously, for example, clearing the throat, changing position, blinking, and swallowing. Doing all kinds of things, especially those involving fine movements, takes more time and effort: for example, tying shoelaces, turning pages, doing up shirt buttons. Handwriting can change, with the letters becoming unsteady and smaller. In the long term, writing can become difficult to read: micrographia (micro = small, graphia = writing). While automatic movements can become more difficult, acquired movements are less affected. For instance, it is not unusual that someone with Parkinson’s can still play the piano.

Examination and diagnosis

If diagnosed with Parkinson's it is natural to want to know how this is going to affect you. It is impossible to answer this question accurately because the condition develops differently in each individual and treatment is also individual. Parkinson's tends to begin gradually, with symptoms becoming more serious as time passes. That is why the course of the disease is referred to as progressive. Symptoms can sometimes remain slight for years and it is a mistake to suppose that everyone with Parkinson's becomes seriously disabled. With medication, most people with Parkinson's lead normal lives for many years. However, symptoms can develop rapidly in a small number of people. Parkinson's is not a directly fatal disease but mortality rates in the condition are higher than in the normal population. People can die from indirect consequences of the disease. For instance, someone might be more susceptible to pneumonia because of the deterioration in his or her general condition.

It is advisable to always consult with your GP about your symptoms if you are worried about them. Seek advice if they get worse, if they change, or if new ones appear. Remember that a symptom discussed need have nothing to do with Parkinson's; there could be another cause that should be investigated. A new symptom might, for example, be a side effect of drug treatment. You could also discuss this with a PD Nurse or practice nurse.