Parkinson’s Disease: Do You Know These Early Warning Signs?

Symptoms can occur long before tremors

Most people recognize the later stages of Parkinson’s disease — tremors and a shuffling walk are the most common signs. But the condition is difficult to diagnose early on; doctors don’t pinpoint most cases until they’re well past the initial stages. So is there a way to spot signs and seek treatment earlier?

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Yes, but you need to know what to look for.

The vague symptoms of Parkinson’s could point to many problems. That’s what makes early specific diagnosis difficult. And that’s what frustrates those who search for reasons behind your movement problems.

But, there are recognizable signs that could at least put you and your doctor on alert, says neurologist Hubert Fernandez, MD, Director of Cleveland Clinic’s Center for Neurological Restoration. And getting a neurologist involved earlier is the key, he says.

“It’s not uncommon for patients to see a rheumatologist or orthopedist for six months to a year for pain in the right shoulder or dragging the right leg. They might even get steroid injections that don’t work,” he says. “But, only a neurologist can diagnose Parkinson’s.”

Symptoms follow stages of the disease

Parkinson’s motor problems are quickly recognizable, Dr. Fernandez says. The tremors — rhythmic movement of lips, chin, hands and legs; rigidity; stiffness and slowness are hallmark signs. Balance and gait problems are also common.

But, Parkinson’s symptoms start long before these problems emerge. As a progressive disease, Parkinson’s destroys the brain’s nerves from the bottom up, he says.

Stage 1: Parkinson’s attacks the base of the brain stem — the medulla — initially. This may cause constipation and can cause people to lose their sense of smell. These symptoms could strike decades before you see your first tell-tale tremor, Dr. Fernandez says.

Stage 2: Nerve deterioration in the pons (the brain’s message center) is next. Damage at this stage may lead to depression and REM sleep disorder. A person may “act out” their dreams while they sleep, potentially hurting themselves or others.

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Stage 3: The tremor and shuffle appear here because the disease is attacking the part of the brain largely responsible for movement.

Stage 4 and 5: These are the most advanced Parkinson’s stages. Dementia and hallucinations often occur at this point.

When should you consult a neurologist?

Of course, not everyone who experiences constipation or depression, or who loses the sense of smell is at risk for developing Parkinson’s disease, Dr. Fernandez says. But, if you have those problems along with any of these factors, make an appointment with a neurologist:

  • First-degree relative with Parkinson’s with onset before age 60
  • One of the four motor features: resting tremor, stiffness, slowness, gait/balance problems
  • Repeated head trauma
  • REM sleep disorder

4 things you should know about Parkinson’s

In addition to learning what symptoms to watch for, there are four things you should know, Dr. Fernandez says:

1. It’s a progressive disease. Parkinson’s disease worsens over time, but each patient progresses differently. Doctors will treat the symptoms to limit how much they impact your daily life.

2. The cause is largely unknown. In 95 percent of cases, doctors don’t know why patients develop Parkinson’s. Often, a combination of factors are involved, including genetic susceptibility and environmental factors (such as having multiple head injuries). Research shows that genetic mutations are responsible for the rest of cases.

“We don’t know what factors contribute to Parkinson’s,” he says. “And, we’re just beginning to uncover the susceptibility genes.”

3. Treatment is symptom-dependent. How bothersome your symptoms are will determine how aggressively your doctor treats your disease. If your symptoms don’t disrupt your daily functioning, he or she likely will postpone prescribing medication.

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Dopamine, a chemical found naturally in the brain, is lacking or not produced in high enough quantities in people with Parkinson’s disease. Patients may take levodopa, a pill that is converted to dopamine when it reaches the brain. This helps manage Parkinson’s symptoms.

It is often prescribed with a second drug called carbidopa, which prevents the nausea that can be caused by levodopa alone.

Doctors also may use deep brain stimulation to treat you if you don’t get relief with levodopa, Dr. Fernandez says.

4. Stroke, infection or other neurological conditions can mimic Parkinson’s. Don’t make any assumptions about your condition before you see a neurologist or Parkinson’s expert for a proper diagnosis.

Ultimately, remember that your journey with Parkinson’s is unique — so work closely with your doctor, Dr. Fernandez says.

“It’s important to remember that everyone’s experience with Parkinson’s is different, and treating it is about targeting the symptoms,” he says. “The most important thing is getting a good evaluation by a neurologist or Parkinson’s expert to make sure you’re on the right path.”

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