Understanding Parkinson’s Disease Progression: From Early Signs to Advanced Symptoms

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By Staff
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PD progression includes both motor and nonmotor symptoms. Motor symptoms refer to those that affect mobility and movement, such as balance and walking. Nonmotor symptoms include everything else, such as sleep, mood changes, and the cognitive ability to understand, remember, and apply information.

Early Signs of Parkinson’s Disease

Parkinson’s disease often begins with subtle early signs and symptoms that can be mild and easy to overlook.

Your limbs may feel stiff, and simple movements, like getting out of a chair, take more energy than usual. Handwriting feels slow and small. If you look at a mirror, you may notice fewer facial movements and expressions, or that you’re naturally leaning forward more than usual.

Early signs include:

  • Minor Tremors For many people, the first noticeable symptom of PD is a tremor in one limb, especially at rest. It’s usually noticed in one of the hands. But not all patients will develop a tremor early on, and some never develop a tremor at all.
  • Slower Movements (Bradykinesia) Movements become slower, making everyday tasks a little more time-consuming. This affects both your voluntary motions, such as when you reach for a glass, and your automatic movements, such as blinking or moving your arms while walking.
  • Rigidity You might notice that your movements are not as smooth as they used to be. As a result, you may feel like your feet are stuck to the floor, and it takes more energy to lift them. Stiffness in your wrists and fingers can lead to slower and smaller handwriting.
  • Sleep Disturbances Movement during sleep is normal, especially in the early and light stages of sleep. But sudden movement during deep sleep or acting out dreams could indicate PD.

Samer Tabbal, MD, a board-certified neurologist and the director of the movement disorders program at Miami Neuroscience Institute in Miami, says that early diagnosis of PD doesn’t affect progression. If someone has mild symptoms, doctors may avoid giving them medications to reduce the risk of side effects. But the earlier someone with moderate to severe symptoms gets diagnosed, the better doctors can help manage symptoms.

Parkinson’s Tremor Progression

Tremors are the most common and visible sign of PD. Up to 90 percent of people with PD experience tremors, and they’re slightly more common in those who are older. People with PD who don’t have tremors tend to have a faster progression of the disease than those who have resting tremor.
In PD, the typical type of tremor is a resting tremor. This means that the tremor is noticeable when that body part is at rest and not moving, but isn’t very noticeable or even goes away completely when that limb is being used. For example, you might not have tremors when picking up a bag or shaking someone’s hand, but they start again when you’re sitting or standing still, or when holding a spoon or fork to the mouth.
In the early stages of PD, there are sometimes slight, occasional tremors on one side of the body, usually the hands. They can also appear in the leg or jaw. As the disease progresses, the tremors become more pronounced. They’re more frequent, affect both sides of the body, and look more like shaking instead of slight movements.
The tremors can become constant and intense in the late stages of PD. Most people experience shaking that interferes with their lives, especially when they try to do anything that requires fine motor skills, such as writing, tying shoelaces, or shaving.

While it may be possible to hide nonmotor symptoms, tremors can be very visible, and may push people with PD away from social situations.

Claire Henchcliffe, MD, a neurologist at UCI Health and the Stanley van den Noort Professor and Chair of the department of neurology at the University of California in Irvine, says that this, together with the inability to practice certain sports or hobbies because of the tremors — such as playing the guitar — can lead to depression and added anxiety. Around family and friends, the lack of independence can suddenly feel like a burden, which may alienate people with PD even more, she says.

Advanced Parkinson’s Symptoms

As PD progresses into the later stages, symptoms become severe.

Typical advanced motor symptoms include freezing and severe tremors. Freezing refers to the sudden inability to move. It is temporary but can greatly affect an individual’s independence. The tremors that were once mild are now constant, affecting both sides of the body.
Both freezing and severe tremors can pose a danger. It becomes much easier to lose balance and fall.
Speech and swallowing can also become more erratic. Dysphagia, or swallowing difficulty, starts mildly with the person coughing at times during a meal or taking longer than usual to eat. As PD progresses, it can become severe, leading to aspiration (accidental inhalation of food), dehydration, and malnutrition. Aspiration is the leading cause of death in people with PD.
Nonmotor symptoms also become more frequent. Mood disorders, particularly depression and anxiety, are common and have the greatest impact on overall health. Anxiety in PD is caused by both psychological and biological factors. Chemical changes in the brain caused by PD (low levels of chemicals called GABA, dopamine, serotonin, and norepinephrine) also cause anxiety and depression. The severity of the motor symptoms and dependence on family and friends also add to anxiety and depression.
Chemical changes in the brain can also worsen cognition. About 70 percent of people with PD develop dementia when PD progresses to advanced stages. Signs and symptoms include forgetting how to do simple tasks, becoming disoriented or confused, having problems with short- and long-term memory, having hallucinations or delusions, and having trouble comprehending sentences and speaking.

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