Parkinson’s disease – symptoms and diagnosis

What is Parkinson’s disease and how is it diagnose?

Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease (De Lau et al., 2006). It is characterized by progressive loss of muscle control, due to loss of dopamine-producing brain cells.

Still the causes of Parkinson’s remain unknown. Many experts think that the disease is caused by a combination of genetic and environmental factors. Parkinson’s in industrialised countries is generally estimated at 0,3% of the entire population and about 1% in people over 60 years of age but early-onset Parkinson’s disease also occurs (De Lau et al., 2006).

Progression of symptoms

As symptoms worsen, it may become difficult to walk, talk, and do simple daily activities. The primary symptoms of Parkinson’s disease are all related to voluntary and involuntary motor function and usually start on one side of the body. Symptoms are mild at first and will progress over time. Some individuals are more affected than others. Secondary symptoms vary in severity, and not every individual will experience all of them.

From 1990 to 2050 the number of people having Parkinsons disease will increase from 2,5 Millions to about 12 Millions.

Not all Parkinson’s is the same

The progression of Parkinson’s disease and the degree of impairment vary from individual to individual. Many people with Parkinson’s disease live long lives without major progression, whereas others become disabled much more quickly. To differentiate the various types of Parkinson’s, it is necessary to know the symptoms in detail. Whilst treatment is constantly improving, researchers have not yet been able to find a way to prevent or cure Parkinson’s. For all stages of Parkinson’s, the available therapies will help to ease symptoms. Since Parkinson´s is a progressive disease it will worsen with age. Unfortunately, no one has anyone recovered from Parkinson’s disease.

The daily challenges when having Parkinsons disease.

Symptoms of Parkinson’s disease

The early symptoms of Parkinson’s disease usually develop gradually and are mild at first. Movement symptoms may be inconvenient, but do not affect daily activities. In Parkinson´s motoric symptoms like tremor, slowed movement (bradykinesia), rigid muscles, impaired posture and balance or loss of automatic movements can occur. In addition, speech may become more softly and monotone and it may become hard to write.

Essential tremor is a neurological disorder that causes involuntary and rhythmic shaking most often of hands. In comparison to Parkinson´s, it is still present when doing simple activities such as taking a cup of coffee and the tremor often stops during movement.

Speech may be affected in Parkinson´s disease either with a very low voice volume, hesitation before speaking or slurring. Difficulties with swallowing may occur during progression of Parkinson´s and may have an effect on the willingness to eat. Also, the changed ability to smell may influence appetite.

Gastroparesis in Parkinson’s is a delayed ability of the stomach and interferes with normal digestion which may affect the absorption of oral medication. Some people with Parkinson’s disease experience an overwhelming urge to move legs. This condition is called “Restless Legs Syndrome”.

The progression of Parkinson’s disease and the degree of impairment vary from individual to individual. Many people with Parkinson’s disease live long lives without major progression, whereas others become disabled much more quickly.

Overview about symptoms of Parkinson’s



Shaking or tremor at rest


Slowness of movement, called bradykinesia


Stiffness or rigidity of the arms, legs or trunk

Postural instability

Trouble with balance and falls, also called postural instability

Note: Postural instability usually appears later with disease progression and may not be present with initial diagnosis.

What are the physical symptoms of Parkinson’s?

(= secondary symptoms)

  • Small, cramped handwriting, called micrographia
  • Reduced arm swing on the affected side
  • Slight foot drag on affected side creating a shuffled walk
  • “Freezing” – a term used to describe the phenomenon of being “stuck in place” when attempting to walk
  • Loss of facial expression due to rigidity of facial muscles, called hypomimia
  • Low voice volume, called hypophonia
  • Tendency to fall backwards, called retropulsion
  • Decrease ability in automatic reflexes such as blinking and swallowing

What are the non-motor symptoms of Parkinson’s?

  • Mood (depression, anxiety, irritability)
  • Cognitive changes (attention, visuo-spatial problems, memory problems, personality changes, psychosis/hallucinations)
  • Lightheaded and low blood pressure upon standing
  • Feeling of fullness after eating small amounts
  • Excessive sweating, especially of hands and feet
  • Dry skin
  • Urinary urgency, frequency and incontinence
  • Loss of sense and smell
  • Sleep disorders
  • Sensory (pain, tightness, tingling, burning)

Diagnosis of Parkinson‘s

Making an accurate diagnosis of Parkinson’s, especially in its early stages, is difficult. Affected patients seek an additional opinion from a neurologist with experience and specific training in the assessment and treatment of Parkinson’s disease. To diagnose Parkinson’s, the physician usually takes a careful neurological history and performs an examination. In addition, the best objective testing for Parkinson’s consists of specialized brain scanning techniques that can measure the dopamine system and brain metabolism. There is no blood test, that can give a conclusive result if a person has Parkinson´s disease. The main role of additional testing is to exclude other diseases that have similar symptoms like Parkinson’s disease.

Therefore, basis for the diagnose of neurologists are the symptoms, the medical history and a detailed physical examination. There are also self-assessments for Parkinson´s disease available, which are evaluating based on the provided answers, but they are often lacking in validation.

A reliable and easily applicable diagnostic test or marker for Parkinson’s disease is not yet available (De Lau et al., 2006).

Stages & Treatment Options

Learn more about rating scales, progression and treatment of Parkinson’s disease.

David Ashford Jones, having Parkinsons disease.

What it feels like

The personal story of David Ashford Jones, a successful and engaged man, having Parkinson’s disease.