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Symptoms of Parkinson’s Disease

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Parkinson’s disease is characterised by a series of motor symptoms. The most common are:

Motor delay (bradykinesia). This is the most common and that which defines the disease. It is evident in repetitive and automated tasks (beating an egg, walking) with manual loss (fastening buttons, changes in writing such as smaller letters).

Tremor. It is present at rest typically, although it can also be while active. It usually starts in one part of the body (either in the hand or in the foot) before becoming bilateral. Around 40% of patients never have it throughout the disease.

Muscle rigidity. With symptoms associated with joint or tendon pain (tendinitis is very characteristic, for example, in the back).

Changes in gait. It is not usually a serious or disabling problem until advanced phases. However, many patients may refer to an early form in which they experiment a more dragging or slower gait compared to other people.

In the last few decades it has been seen that these characteristic motor symptoms can be preceded by other symptoms called prodromic. Some of these symptoms are non-motor, such as:

Decrease in acute sense of smell (hyposmia).

Constipation.

Sleep disorders. REM sleep disorder (vivid nightmares with vigorous movements and vocalisations during sleep), insomnia, and excessive drowsiness.

Apathy. Lack of motivation and of interest.

Pain. Besides the rigidity itself, etc.

Sometimes, it is said that these symptoms are risk factors, but they are not. They are initial symptoms that precede the development of the disease (prodromic symptoms), together with other motor symptoms, like mild-activity tremor that may be classified as non-Parkinson tremor if there is no tremor at rest, or other symptoms typical of the disease.

The non-motor symptoms may not only precede the motor disease, but in some cases during its course they can be as severe and disabling as the motor symptoms, such as dementia or autonomous nervous system dysfunction (dysautonomia).

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Signs

Motor delay (bradykinesia). Gradual decrease in the range and/or speed of repetitive movements like the opening and closing of the hand, as well as the speed of voluntary movements and limitation of their extension (hypokinesia) with poorness of general movement.

Tremor at rest. Usually in a relatively low frequency range (4-6 Hz) and a variable width that affects one side of the body in an isolated form initially, and predominantly during the course of the disease.

Rigidity. It can be a diagnostic sign, even when the patient has not noticed it symptomatically, and is detected by moving the joints of the patient.

Changes in gait. It can be demonstrated by short and dragged steps, with blocks or paralysis when walking in tight spaces or on turning round. The reduction in movement of one of the two arms when walking is also very characteristic.

Lack of facial expression (hypomimia).

Decreased font size (micrograph).

Substantiated information by:

Almudena Sánchez Gómez

Ana Cámara Lorenzo

Maria José Martí Head of the Parkinson's and Movement Disorders Unit

Yaroslau Compta Hirnyj Neurologist Neurology Service

Published: 8 July 2019
Updated: 14 November 2019

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