10 early signs of Parkinson’s Disease

NEW DELHI, APRIL 7 : While the focus remains on the pandemic its easy to forget that there are many other illnesses which patients are struggling with.

Parkinson’s disease and related disorders is common in people above 60 years of age. Parkinson’s disease is a disorder where most tests including MRI Brain are not very helpful in diagnosis or non-contributory (except dopamine scans). So, an understanding of its clinical symptoms and signs is as vital as a diagnosis.

Dr. Praveen Gupta, Director & HOD, Fortis Memorial Research Institute, Gurugram shares some early signs to keep a look out for.

1. A pill rolling type of tremor visible in the resting position usually in one hand which improves intruding to move the hand.

2. There is change in handwriting with the writing becoming small and cramped called micrographia.

3. There is sudden quickening of steps which the patient cannot control called shuffling; it is also accompanied by difficulty in maintaining posture.

4. There is shortening of steps leading to short stepped walk and overall time to cover a small distance increases significantly.

5. There is decreased movement of arms while walking and the arm swing is reduced, a sign of slowing.

6. There are sleep problems with increased dreaming and enacting dreams called REM Sleep Behaviour disorder.

7. There are abnormal limb movements in sleep called PLMS and current like pain in legs called restless legs syndrome.

8. A gradual loss of smell and difficulty detecting or identifying doors called hyposmia during conversation
9. There is a clear lack of expression on face with significant lack of emotive expressions called mask-like face.

10. There is a forward bending of posture leading to early stooping and bending forward.

These early signs are a feature of decreased dopamine in the brain which interferes with sleep and changes in motor function leading to slowness of activities (Bradykinesia medically), stiffness of muscles (rigidity), loss of posture sense and trembling. These features usually affect one side of the body initially and respond very well to levodopa replacing treatments. There may also be some mental and behaviour changes and some patients there is an unexplained loss of weight.

If the patient walks in the clinic the physician can often start diagnosing based on these early symptoms. Tests are done to rule out other disorders mimicking Parkinson’s disease. Parkinson disease responds very well to treatment and response may last up to more than a decade, so it is very useful to diagnose it early to restore a patient’s quality of life.