Physical therapist helping a man with Parkinson's disease
Physical Therapy for Parkinson’s

What Are the First Signs of Parkinson’s?

It was a long time ago (1817) that London doctor James Parkinson wrote “An Essay on the Shaking Palsy.” Doctors have been talking about this medical condition for several thousand years. Of course, the disorder itself is just the same as ever. The first change people feel is a bit of a tremor, a mild shakiness, usually of one hand. Or, the shakiness might be in an arm or a leg. In the hand, the Parkinson’s tremor is called a “tremor at rest”. The relaxed hand shakes. The shaking stops if the person uses his hand. When his hand is once again resting and relaxed, the tremor comes back. The hand tremor is sometimes called a “pill-rolling” tremor. When the hand is relaxed the thumb and forefinger move as though the person is rolling a pill between them.

Beyond That Early Parkinson’s Tremor

Gradually things change. The way a person takes the steps while walking changes. His posture when he just stands still is different. The way his face looks changes because his face muscles move less.

Parkinson’s Gait – How He Walks

When a person get Parkinson’s his walk changes, It can change in a few different ways. One is called a “shuffling gait”, where he seems to drag his feet when he walks, taking smaller steps and not swinging his arms much. Another type of walking is the “freezing gait”, where he starts to take a step but then stops. It’s like his foot is stuck to the floor. After a step or two he walks more normally. Finally, there’s the “festinating gait”, taking quick, short little steps. (Festinate means to hurry.) But it’s a slow walk because, though the steps are quick, they’re so small, there’s not much progress across the room.

Parkinson’s Posture – How He Stands

Maybe the best word to describe the way a person with Parkinson’s stands is “stooped”. The brain doesn’t send the right “stand up straight” signals. The result is rounded shoulders with his head and upper body leaning forward. The stiff muscles that come with Parkinson’s don’t help the situation. (Good news: Physical therapy can help a person overcome Parkinson’s posture. You can read more about it on our Parkinson’s Treatment page.)

The Frozen Face of Parkinson’s

It’s the stiff muscles problem again. With Parkinson’s a person’s face muscles are less able to move to show emotions on his face. It becomes hard to smile or frown. It’s as though he’s wearing a mask of his own face, and it’s called “facial masking”. Without smiling, frowning, or other facial expressions of emotion it makes it look as though he doesn’t have any emotions.

What Happens and How Fast It Gets Worse is Unpredictable

What happens, when it happens, and how quickly things get worse is different for each person. Your doctor doesn’t have the ability to predict what will happen next and how fast everything will move along. Some people are lucky in that they have only minor signs like a bit of a tremor. Medicines, regular exercise, physical therapy, and occupational therapy can slow it down. However, it’s important to understand that It’s an ongoing condition that can be treated but cannot be cured. Sadly, there’s just no way to completely stop it. Once Parkinson’s starts it continues for the rest of the person’s life. And it does gradually change over time, continually even if slowly getting worse.

The 5 Stages of Parkinson’s

As time goes by more signs appear. His arms don’t swing in quite the same relaxed way when he walks. His voice gets quieter. Doctors who treat Parkinson’s have divided the changes in Parkinson’s disease over time into 5 stages.

Stage 1 of Parkinson’s – No Problems

In this earliest Stage 1 of Parkinson’s the movements are only affected on one side of the body. The symptoms are mild and the person can do anything he wants to do. He can move as he needs for tasks and jobs, hobbies and sports. Often at this stage he doesn’t don’t realize a medical problem has started. And if he did, the signs are so minimal that his doctor might not be able to make the right diagnosis. The doctor would not want to guess wrong and have him feel that he has Parkinson’s if that’s not what’s wrong. There might be a bit of a tremor now and then in one hand. Or just a bit of not-quite-right feeling or movement in an arm or a leg. He might feel his muscles are just a bit stiff.

Stage 2 of Parkinson’s – First Hints of Things to Come

Months, or even years, after Stage 1 has appeared, the person might start having the signs of Stage 2. This second stage is still early and mild Parkinson’s but it’s getting more noticeable. In Stage 2 his doctor might be able to make the diagnosis, especially if there’s a tremor. Both sides of his body might be involved. There might not be any difficulties with balance but his trunk muscles might feel stiff. There might be neck or back pain with a start of the stooped posture of Parkinson’s. It’s in Stage 2 that the changes in his face might start, with his face appearing stiff, with less blinking. His voice might get softer, quieter, as he talks, and what he says might be slurred at times. While all his movements are slowed he can still get everything done, all the usual tasks of daily life.

More on Stages 1 & 2 – Parkinson’s Signs You Don’t See

In addition to the changes you can see in these early stages there are changes with the individual that you can’t see.  For example, he might lose some or all of his sense of smell. His thinking might slow down. He might have been quick-minded before Parkinson’s, but no longer. Though previously a strong person, he might start to feel physically weak. He used to be a vigorous, robust individual but now he starts to feel just a bit sick all the time. Life might slowly drift toward being a burden, with no fun at all, which then could slide into a depression.

Stage 3 of Parkinson’s – Here Comes Trouble

Stage 3 is when the diagnosis becomes clear and the feeling of disability really starts. The individual can still do everything even though disability is starting. He can do all the tasks of daily living like taking showers, brushing his teeth, getting dressed, and eating. So, in Stage 3 the individual can still live alone. However, at this point all the signs of Parkinson’s are there. A doctor can make the diagnosis without a doubt. His movements are obviously slowed and there are problems with keeping his balance. The balance problem is there because, without knowing it or thinking about it, we all keep our balance with little muscle and position changes all the time, moment to moment. As Parkinson’s gets worse these little balance fixes are slower or not there at all. Because of this, falling is more common.

Stage 4 of Parkinson’s- Trouble Is Here

Stage 4 is when the bad stuff starts to happen. He can no longer live an independent life by himself. For some of those tasks, like bathing, dressing, and eating, he needs someone’s help. This need for help is what marks him as in Stage 4. The Parkinson’s had become really disabling. Even if he can stand by himself and walk along alone it’s clearly a struggle. A walker can help.

Stage 5 of Parkinson’s – Some Never Make It This Far

Stage 5 is the worst. In fact, some people never make it to Stage 5. In Stage 5 he can’t stand up from a chair or get out of bed by himself. He might fall just with standing. Even when walking with a walker he might freeze in place or stumble as he tries to walk. As you can imagine, at this point he needs 7/24, around-the-clock assistance so he doesn’t fall, and, to help him eat, bathe, and dress. He might even start to test reality poorly, having hallucinations (seeing or hearing what’s not there) and delusions (believing something that’s just plain not true).

Parkinson’s Disease is a Really Common Condition

Parkinson disease is a really common medical condition. It’s so common that each of us probably knows someone who had it or has it now. Worldwide, it’s one of the most common disorders of the nervous system. About 1 out of every 100 people over age 60 will eventually get it.

Younger People, Under Age 50, Can Get Parkinson’s

Parkinson’s is usually viewed as a condition of the elderly. And while this is true for the most part, younger individuals can get it. For every 20 people who have Parkinson’s it’s likely that one will be under age 50. To put it another way, about 5% of people with Parkinson’s had it start before age 50.

The Intense International Push for Research on Parkinson’s Treatments and Cures

The push is on. People with Parkinson’s (including some well-known celebrities like Michael J. Fox), their families, and the doctors who treat them are all pushing public opinion supporting more research on Parkinson’s. Everyone wants answers. And a lot of public interest helps drive fund raising for research and patient care. The result is a major, worldwide push to beat Parkinson’s. The research is across many areas, like the types of exercise one can do to slow it so that it gets worse much more slowly. Drug companies and universities search for new medicines. Medical tech companies want to invent new non-drug devices and treatments. To help speed research along, genetically-modified animals have been made that behave as people do when they have Parkinson’s. The animals allow researchers to test trial medicines to see if they are safe and might help people.

Helpful links:

Clinical Trials for Parkinson’s Treatments –

Parkinson’s Information Page – National Institutes of Health

More on Parkinson’s – National Institute on Aging

Parkinson’s – MedlinePlus – U.S. National Library of Medicine

Understanding Parkinson’s – Parkinson’s Foundation

About Parkinson’s – The Michael J. Fox Foundation

Parkinson’s – The Mayo Clinic

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