Early symptoms of Parkinson's disease

As with many other serious conditions the early symptoms of Parkinson’s disease may seem trivial and not sufficiently inconvenient for the person experiencing them to think of asking anyone about them. Also most people know little about Parkinson’s, and what they do know is no guide to the early stages of the disease. 

Some symptoms which people experience before a definite diagnosis are very vague and non-specific. For instance several people described quite prolonged periods when they noticed that they were increasingly exhausted, or noticed that they had become physically or mentally slower, or felt somewhat depressed (also see Mental disturbances). Jean was told she probably had ME and to this day does not know whether she did indeed have this as well as early Parkinson’s disease. Elaine also persuaded herself that her exhaustion was caused by factors outside herself and failed to connect this with other symptoms as they emerged. When Brian noticed that he was increasingly exhausted he cut down his activities and at the age of 63 accepted his symptoms could be due to his ageing, as did Stephen who was only 43 at the time.

People who were particularly active physically were perhaps especially attuned to how their bodies functioned and thus became aware of a problem when running or in the gym. Rafa started having problems when his leg wouldn’t move properly after a couple of miles running: ‘You know what to do, you know you can do it, but the leg doesn’t want to cooperate’.

Quite often the next step towards diagnosis would be that someone else, a friend or family member, would comment on a symptom which the person showing it had not noticed. Shuffling was commonly noticed and often treated as a bit of a joke. Relatives noticed Fred’s shuffling and mentioned it to his wife who didn’t tell him until a doctor friend commented on the trouble he seemed to be having walking. When a friend noticed that Sharon was walking peculiarly she did her best to ignore it until further symptoms appeared.

 

 

Another symptom others noticed is the rigidity of expression described as the mask. The mask becomes a default position which can however be over-ridden during a direct social encounter, particularly in response to a joke but also when the person in question looks at their own face in a mirror. This would explain why many people have failed to recognise the symptom in themselves. Fred's consultant asked him whether he had always been so ‘po faced’ and he had no idea whether he had or not. Philip described how his GP had looked at him, and noticed that his face had lost some mobility and that the muscles in his face seemed somewhat rigid, and so referred him to a neurologist.

 

The rigid facial mask is a symptom which a partner may misinterpret until it has been explained to them. It is often misunderstood as switching off of responsiveness to them.

 

 

Change in handwriting is a common early symptom which people notice themselves. Brian had various symptoms, his right side was stiff, he was limping and walking with difficulty. He began to worry that he might have MS or a wasting disease. But most peculiar was the fact that his writing had got smaller and for some reason he found it particularly difficult to make w’s. Jean described how her handwriting would start out big and then peter down to hardly anything, and Tom’s first intimation that something was wrong was when he was writing a postcard to a friend: he found himself suddenly brought to a halt in the middle of writing the name Anthony Diacopolous and could not complete it. Helen’s GP (see Getting the diagnosis) guessed her problem when she told him that she was having problems putting a key in the lock or using her computer mouse.

 

Judie noticed that it was difficult to drive or change gear; Kevin could not keep up the necessary rhythm to control a toothbrush; when David’s tendency to fall over when running was followed by an inability to tap in time to music he decided that it really was time to see a doctor. Angela noticed pains in her shoulder, hip and knees and Ann became aware that it was hard to do the ironing.

 

One symptom which many people associate with Parkinson’s disease is tremor so it is less surprising that when Rex noticed a persistent tremor in his right hand his GP immediately referred him to a neurologist. Elisabeth on the other hand describes a sensation of having one hot and one cold leg, and sitting on a beach watching her leg shaking, but not knowing what this might mean. When Judie developed a tremor in one hand her GP obviously guessed its probable significance but though he had referred her to a neurologist she continued to attribute her tremor to a trapped nerve.

 

Lay people are not alone in misdiagnosing early symptoms of Parkinson’s disease. Many of the people we interviewed had consulted their GPs about unexplained symptoms only to be given a variety of alternative explanations. Sometimes this was frustrating because they felt that they knew something was really wrong.

 

Geraldine's GP told that the change in her handwriting at the age of 42 was caused by carpal tunnel syndrome related to her menopause.

 

 

 

The symptoms in Parkinson’s disease may begin insidiously, spread over several years. They may also not be consistently present. Mari remembered that she used to be cross when Humphrey failed to appreciate the scent of a flower she was pointing out to him or the smell of the food she had cooked. It was not till after he had died that she discovered that this was a symptom associated with Parkinson’s disease. While some people did not mention what they saw as trivial symptoms to their doctor for fear of being labelled a hypochondriac, others as we have noted thought their symptoms might all be explained by advancing age or other things in their lives.

A few guessed that their symptoms might be signs of a serious disorder and even made their own diagnosis before consulting a doctor (see Getting the diagnosis).