Parkinson’s disease is the fastest-growing neurological condition in the world – yet apart from its trademark tremors, many people have no idea what its symptoms are.
About 10 million people worldwide have it, as well as a host of famous names including comedian Billy Connolly, actor Michael J Fox, singers Neil Diamond and Linda Ronstadt, and rock star Ozzy Osbourne.
The condition develops when brain cells that produce dopamine, a neurotransmitter which plays a crucial role in motor control, stop working.
World Parkinson’s Day was marked on April 11.
“Parkinson’s is a complex, progressive and incurable condition,” Jennifer Taylor, helpline service manager at Parkinson’s UK, says. “We don’t yet know exactly why dopamine-producing cells die, but factors such as genetics, environment and lifestyle may all contribute to someone’s likelihood of developing Parkinson’s.”
The condition’s many symptoms range from tremors to anxiety, and Taylor points out: “While the more well-known symptoms are related to movement, early signs can be much subtler, and people might notice changes like a loss of sense of smell, trouble sleeping, or increased feelings of depression years before any movement issues are noticed.”
And Dr Bal Athwal, a consultant neurologist at The Wellington Hospital in UK adds: “As a progressive condition, Parkinson’s can significantly impact the quality of life and may reduce life expectancy, but with treatment, the likelihood of it impacting life expectancy can be reduced.”
He says that although the majority of people with Parkinson’s are aged more than 70, a diagnosis can come at any age. It can be managed effectively through medication, lifestyle changes, rehabilitation and, in some cases, surgery.
But what are the early symptoms of the condition? Here’s what the experts say…
1. Pain
A wide variety of pain can be an early symptom of Parkinson’s, including musculoskeletal pain affecting bones, muscles, ligaments, tendons or nerves; neuropathic pain from nerve damage; dystonic pain causing sustained muscle spasms or cramps; and central pain, when pathways controlling sensation and pain in the brain, brainstem, and spinal cord aren’t working properly.
2. Anxiety
Feelings of constant worry can lead to social avoidance and sometimes anxiety attacks in the early stage of the disease, says Taylor. Evidence suggests mindfulness, meditation and exercise can help manage anxiety.
3. Trouble with balance
Postural instability or difficulty balancing, can be a challenging movement symptom associated with the condition. “It can cause falls and people may lose their confidence as a result, with worries about going out in public,” says Taylor.
4. Stiffness
People with Parkinson’s often report tightness in their limbs, says Taylor, who explains this stiffness can occur on one or both sides of the body, contributing to a decreased range of motion. “This can lead to problems with aching or pain in the affected muscles and/or joints and other more visible signs, such as your arm not swinging as you walk,” she points out.
5. Losing your sense of smell
A reduced sense of smell is often an early sign of Parkinson’s, and Taylor says you might lose your sense of smell several years, or even decades, before a Parkinson’s diagnosis.
6. Trouble sleeping and fatigue
The brain changes associated with Parkinson’s can cause sleep issues, and some people have problems sleeping long before movement symptoms develop.
Dr Athwal says: “There can be problems with sleep such as insomnia, restless leg syndrome, and REM sleep behaviour disorder – a condition in which an individual seems to act out dreams by making movements or noises.”
Fatigue also affects up to half of people with Parkinson’s and Taylor says: “You may feel quite energised one day and then too fatigued to do much the next, regardless of how much you rest.”
7. Tremor
Dr Athwal says tremor is one of the most common symptoms, and is usually seen in upper limbs, when at rest. Tremor usually starts asymmetrically and tends to occur in the hands, but can also appear in other parts of the body, including the lower lip, jaw or leg. Taylor adds: “Some people report an internal tremor, an invisible shaking sensation inside the chest, abdomen or limbs.”
8. Depression
A person with Parkinson’s may experience depression at any time, even before diagnosis.
9. Smaller handwriting and slowness of movement
Micrographia – small, cramped handwriting – is often an early symptom of Parkinson’s, say the experts. “Words can become crowded together while the size of your handwriting might get progressively smaller as you continue to write,” explains Taylor.
And Dr Athwal adds: “There is also slowness of movement – this can be quite subtle at first, but people might complain of their handwriting becoming smaller, or might find it harder to do small fine tasks such as fastening buttons and zips.”
10. Diminished facial expressions
Facial masking, also called hypomimia, is an early Parkinson’s symptom that can make it hard for others to interpret your mood. “People might assume you’re depressed or upset and it can be frustrating to constantly be asked what’s wrong when you’re feeling fine,” says Taylor. “Stiff or slow facial muscles make it hard to smile, raise your eyebrows or otherwise express your feelings, an important part of how we communicate.”