Symptoms

The symptoms of Parkinson’s disease usually develop gradually and are mild at first.

There are many different symptoms associated with Parkinson’s disease. Some of the more common symptoms are described below.

However, the order in which these develop and their severity is different for each individual. It’s unlikely that a person with Parkinson’s disease would experience all or most of these.

Main symptoms

The three main symptoms of Parkinson’s disease affect physical movement:

• tremor – shaking, which usually begins in the hand or arm and is more likely to occur when the limb is relaxed and resting
• slowness of movement (bradykinesia) – where physical movements are much slower than normal, which can make everyday tasks difficult and can result in a distinctive slow, shuffling walk with very small steps
• muscle stiffness (rigidity) – stiffness and tension in the muscles, which can make it difficult to move around and make facial expressions, and can result in painful muscle cramps (dystonia)

These main symptoms are sometimes referred to by doctors as parkinsonism as there can be causes other than Parkinson’s disease.

Other symptoms

Parkinson’s disease can also cause a range of other physical and mental symptoms.

Physical symptoms

• balance problems – these can make someone with the condition more likely to have a fall and injure themselves
• loss of sense of smell (anosmia) – sometimes occurs several years before other symptoms develop
• nerve pain – can cause unpleasant sensations, such as burning, coldness or numbness
• problems with urination – such as having to get up frequently during the night to urinate or unintentionally passing urine (urinary incontinence)
• constipation
• an inability to obtain or sustain an erection (erectile dysfunction) in men
• difficulty becoming sexually aroused and achieving an orgasm (sexual dysfunction) in women
• dizziness, blurred vision or fainting when moving from a sitting or lying position to a standing one – caused by a sudden drop in blood pressure
• excessive sweating (hyperhidrosis)
• swallowing difficulties (dysphagia) – this can lead to malnutrition and dehydration
• excessive production of saliva (drooling)
• problems sleeping (insomnia) – this can result in excessive sleepiness during the day

Cognitive and psychiatric symptoms

• depression and anxiety
• mild cognitive impairment – slight memory problems and problems with activities that require planning and organisation
• dementia – a group of symptoms, including more severe memory problems, personality changes, seeing things that aren’t there (visual hallucinations) and believing things that aren’t true (delusions)

When to seek medical advice

See your GP if you’re concerned you may have symptoms of Parkinson’s disease.

Your GP will ask about your symptoms and your medical history to help them decide whether it’s necessary to refer you to a specialist for further tests.

Diagnosis

No tests can conclusively show that you have Parkinson’s disease. Your doctor will base a diagnosis on your symptoms, medical history and a detailed physical examination.

Your GP will talk to you about the problems you’re experiencing and may ask you to perform some simple mental or physical tasks, such as moving or walking around, to help with the diagnosis.

In the early stages, your GP may find it difficult to say whether you definitely have the condition because symptoms are usually mild.

Referral to a specialist

If your GP suspects Parkinson’s disease, you’ll be referred to a specialist. This will usually be:

• a neurologist – a specialist in conditions affecting the brain and nervous system
• a geriatrician – a specialist in problems affecting elderly people

The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement.

A diagnosis of Parkinson’s disease is likely if you have at least two of the three following symptoms:

• shaking or tremor in a part of your body that usually only occurs at rest
• slowness of movement (bradykinesia)
• muscle stiffness (rigidity)

If your symptoms improve after taking a medication called levodopa, it’s more likely you have Parkinson’s disease.

Special brain scans, such as a single photon emission computed tomography (SPECT) scan, may also be carried out in some cases to try to rule out other causes of your symptoms.