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8 Early Warning Signs of Parkinson’s Disease

Initial symptoms can be mistaken for other illnesses

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Some signs of Parkinson’s disease are ones most of us recognize, such as tremor and trouble walking. But very early signs of the disease, which can appear a decade or more before the disease presents in more obvious physical forms, are often mistaken for something else. They can also be mistaken for regular signs of aging.

Common problems such as trouble sleeping, constipation and muscle stiffness, or such symptoms of living in a COVID-19 world as loss of smell and increased anxiety and depression, also are all related to early-stage Parkinson’s. Many of these conditions are very common in older adults. Experiencing them doesn’t mean you have Parkinson’s disease, but they are certainly worth discussing with your doctor, especially if you are having several of them at the same time.

“The early signs are normally not problems that bring anybody to the doctor,” says Michele Tagliati, M.D., director of the Movement Disorders Program and vice chair of the department of neurology at Cedars-Sinai Medical Center.

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That’s because the effects of Parkinson’s, a neurodegenerative order, are far reaching, and often lead to changes long before a tremor appears. While there currently is no medicine to slow the progression of Parkinson’s, lifestyle changes can help manage the disease and an early diagnoses can help with planning. Here are eight things to look for.

1. Restless sleeping

Talking in your sleep, sleep walking and/or acting out your dreams, also known as REM sleep behavior disorder, can be early warning signs of Parkinson’s. “We are supposed to be completely still and paralyzed” during sleep, says Tagliati. But for someone with Parkinson’s, the “mechanism in the brain that oversees this phase of sleep is somewhat defective.”

In fact, a 2014 study found that 33 percent of patients with REM sleep disorder had developed a neurodegenerative disease, such as Parkinson’s or Lewy body dementia, after five years. That number jumped to 91 percent after 14 years.

One sign of this problem is falling out of bed. If you live with someone else, they will most likely see or hear you acting out your dreams. Sometimes people even kick or punch in their sleep or jump out of bed suddenly. If you live alone, you may wake up with twisted sheets, or wake yourself up yelling, says Camilla Kilbane, M.D., interim director of the Parkinson’s and Movement Disorder Center at University Hospitals Cleveland Medical Center.

2. Loss of smell

Losing your sense of smell, or hyposmia, has been in the news as a side effect of COVID-19.

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Researchers aren’t quite sure why it’s also associated with Parkinson’s, says Tagliati, but there’s a clear link between the two, with this symptom appearing in 90 percent of early stage Parkinson’s cases.

Like sleep problems, issues with smell are easy to brush off and attribute to something else, like allergies, a sinus infection, a previous COVID infection, or just aging. But loss of smell shouldn’t be ignored, especially in the presence of other symptoms.

3. Constipation

Parkinson’s affects the automatic nervous system, which controls bodily functions we don’t normally think about, like going to the bathroom. Parkinson’s might also affect the gut microbiome, according to a recent study from the journal, which in turn affects how your digestion system functions — or doesn’t.

Parkinson’s doesn’t hit each GI system the same way. But a change in how often you have a bowel movement — or other digestion changes like bloating, nausea and general discomfort — could be an early warning sign, and worth investigating. Because a third of adults over age 60 in the United States report having constipation, according to the National Institutes of Health, this condition is certainly worth mentioning to your doctor but not a reason to panic.

4. Anxiety/Depression

Parkinson’s harms the brain’s ability to create serotonin and dopamine, two brain chemicals that affect mood. Changes in the levels of neurotransmitters can lead to increased anxiety and depression. According to the Parkinson’s Foundation, patients can experience depression or anxiety for two to five years before diagnosis.

Parkinson’s-induced mood disorder isn’t typically drastic, like major depression, says Kilbane. But the change might be noticed by a spouse or family member — for example, when a normally happy person starts to become a worrier.

“It’s so subtle that people may not go to the doctor,” she says, especially given the stresses associated with the pandemic, when a lot of people have been worrying more than usual.

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5. Soft Voice

According to the Parkinson’s Foundation, 89 percent of people with Parkinson’s will have speech and voice disorders. That often shows up first in volume of the voice, meaning that people may speak more softly — even if they don’t realize it, says Kilbane. This is often noticed by a spouse, friend or family member who has to ask the person to speak up and/or repeat himself.

6. Masked Face

The muscles in the face are also affected by Parkinson’s, as they experience the same gradual stiffening as in the rest of the body. People with Parkinson’s will have “less facial mimicry, and less spontaneous smiling,” says Kilbane, which is why she also calls this condition “poker face.”

People might think you’re angry or upset because your positive emotions are less likely to translate into facial cues that show joy or appreciation, like a smile.

7. Stiffness and gait problems

It’s common for undiagnosed Parkinson’s patients to view signs like stiffness and gait problems as part of aging, says Kilbane. “You anticipate as you get older that you may slow down a bit in your movements, you might be a little stiffer, and might shuffle a bit,” she says.

Stiffness from Parkinson’s can be mistaken for arthritis, but it will appear in the muscles, not the joints. It’s a distinction that can be hard for a person to make without medical guidance, she says. Gait problems can first show up in someone who has trouble keeping up with their peers on a walk or someone who is having trouble with regular activities like getting in and out of a car — again, something that might be attributed to old age. But both are signs of a potential Parkinson’s diagnosis.

8. Resting Tremors

Shaking in the hand, foot or leg is often the first obvious visual sign for Parkinson’s, says Tagliati. By the time Parkinson’s affects muscles in this way, most patients have already been experiencing early signals like sleep, smell and digestion problems — sometimes for years.

Movements are typically on one side of the body — not necessarily the dominant side — and occur when the limb is at rest. “Normally when you use the hand, the tremor goes away,” he says. “Many people put hand in pocket and nothing really happens.” A tremor in the chin is also common in Parkinson’s and should be investigated.

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