Think "Parkinson's disease", and noticeable tremors, struggling with walking, and dementia probably immediately come to mind. This progressive neurological condition certainly doesn't initially announce itself with these symptoms, which are more characteristic in patients with advanced Parkinson's disease.
The early signs of Parkinson's are often, in fact, pretty subtle. Combine this with the fact that Parkinson's mostly strikes people over 60, and it's no surprise that the earliest red flags are often simply attributed to aging. There isn't one single symptom that can tell a person — or one of their loved ones or carers — that "it's time to see a doctor about the possibility of Parkinson's disease". Being aware of the way in which the very first symptoms of Parkinson's can manifest may, however, enable people to receive a timely diagnosis that can help them live more comfortable, productive lives for longer.
A tremor — shaking or trembling — may be the one symptom of Parkinson's disease that immediately springs to mind for most people, but it's important to understand that tremors are unlikely to be very severe or attention-grabbing when they first show up. An ever-so-slight, uncontrollable, twitch that you're often only aware of when not otherwise engaged in some physical activity make strike your hand, foot, or even just a finger. These twitches will occur on one side of the body (unilaterally) in the very early stages of Parkinson's, though they later become more intense and go on to affect more parts of your body, as well as striking on both sides.
These kinds of slight tremors warrant a trip to your doctor all by themselves, though you should be aware that they don't have to be caused by Parkinson's — physical activity and stress can also induce them, and they may even be a side effect of a medication you're on.
2. Shrinking handwriting
Anyone with, for instance, arthritis or some other form of chronic pain, may of course notice that fine motor activities, like cutting food and handwriting, are becoming more challenging. Even vision issues can do the same. All of these things being more common in older adults (just like Parkinson's), it's not unusual for handwriting to start looking different with increasing age.
Micrographia — a fancy word for "small handwriting" — is quite characteristic in people suffering Parkinson's disease, however, and it can be one of the earliest warning signs. If you notice that your handwriting is suddenly much smaller, and you leave smaller spaces between your letters (or you observe this in a loved one's writing), pay attention. Because the neurological changes at work in Parkinson's disease make it much harder to direct your movements, this change is involuntary. Patients may start out using their previously usual "font size", only to see their letters become smaller and smaller as they continue writing.
3. Stiffness and slowed movement
Stiffness and reduced mobility are both features of aging, especially if you have arthritis or recently suffered an injury. Many older people find that they are stiff and feel uncomfortable as they wake up, but that these symptoms get better after they've been up for a while. In Parkinson's disease, the stiffness can, on the other hand, last the whole day.
Bradykinesia is the medical term for slow movement, another well-known feature of Parkinson's that is the result of neuron damage. If your movement becomes less fluid and twitchy, your arms don't naturally swing anymore, and your gait has changed to the point of shuffling with small steps, it is good to have Parkinson's disease in mind as a possibility.
4. Gradually losing your sense of smell
Your sense of smell can be affected by a wide variety of factors, including of course a common cold — but it should come back after a temporary illness has run its course. Not many people know that the loss of your sense of smell is also associated with Parkinson's disease, with research indicating that it may even the be very first symptom a patient experiences. Some people with early Parkinson's disease may, in fact, lose their sense of smell years before they notice any changes in movement or display any behavioral and cognitive changes.
5. Unusual movements during sleep
It's not uncommon for people — and indeed animals, too — to involuntarily move while sleeping, especially as they dream. Some people take this more than a few steps further without even being aware of it, however — vivid and scary dreams cause some people to be very active in their sleep, even attacking their partners. While this can be caused by various factors, extreme jerking around or physically "living your dreams" can also be one of the first symptoms of Parkinson's disease. Whether or not this ultimately proves to be the cause, anyone who does strange things while sleeping should see a doctor.
6. Changes in speech
Parkinson’s disease is well-known to affect speech, often causing monotony, hoarseness, or slurring. Another early warning sign of Parkinson's is a suddenly much more quiet volume of speech, or speech that starts off at a more normal volume but becomes increasingly softer as the conversation goes on — just as with the smaller handwriting. Patients themselves may not be aware they are doing this. If you notice this phenomenon, called hypophonia, in a loved one, it may be time for them to be checked out.
7. Masking: Unusual facial expressions
Parkinson's disease affects not just the movement of the hands, feet, arms, and legs, but also facial expression, initially usually on one side of the face. This is because the many muscles within the face don't function as they used to, and so patients can look "blank" or even displeased even during a pleasant or funny conversation. This is known as "masking", because the person looks a little like they're wearing a mask. As Parkinson's progresses, many patients also find it difficult to blink.
8. A slouched posture
Slouching can be one of the earlier signs of Parkinson's disease due to stiffness, with patients sometimes having a tendency to bend more toward one side as their sense of balance changes. They may not always be aware they are doing this. Because posture commonly changes with age anyway, this slouched or hunched posture may be missed as a possible warning sign of Parkinson's.
Parkinson's disease patients are more prone to frequent bouts of constipation, to the point this should be taken seriously as a possible symptom even though it's not at all rare to suffer from constipation. Because this symptom may appear well before any motor changes become obvious to the patient and others, it is good to seek medical attention if you notice you are often constipated.
10. Feeling dizzy and faint
People with hypotension (low blood pressure) feel dizzy, fatigued or low on energy, and can either feel like they will faint or may actually faint, especially upon standing up. Because Parkinson's is associated with hypotension, this is another possible indication that should, in the context of the presence of other warning signs on this list, be taken seriously.