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The main symptoms of Parkinson’s disease were mentioned earlier. They are: trembling (tremor), stiffness (rigidity), slowness (bradykinesia/akinesia), problems with posture and problems with balance. In this section we will go into more depth about each of these symptoms and also touch on some others.

Tremor
This is the commonest problem that leads people to seek medical advice. It affects around 70 per cent of people with Parkinson’s disease. One hand or leg alone may shake, or it may even be just the thumb. The shake is most noticeable when relaxing and usually disappears when sleeping. This symptom also tends to disappear when the limb is being used, for example while eating a meal or exercising the hand. Tremor can be very embarrassing to sufferers, but it is rarely disabling. Sometimes it is not noticeable to others but can be felt inside. It is very important to note that tremor is not unique to Parkinson’s disease. There is another condition called Benign Essential Tremor which also causes the shakes. However, in Benign Essential Tremor the shake is at its worst when the limb is being used, making this condition very disabling. No other symptoms of Parkinson’s disease are present in people with Benign Essential Tremor.

Rigidity
The doctor may notice rigidity or stiffness when he or she moves your arm around at the elbow or wrist. This is described as ‘lead-pipe’ rigidity when the limb is just generally difficult to bend or straighten - as if it were a metal pipe. Where tremor is also present it is referred to as ‘cog-wheel’ rigidity, as movement in the joints feels like a ratchet. The latter can be especially noticeable at the wrist joint. This rigidity may cause the limbs to feel clumsy, weak or heavy and if severe may result in the affected person losing the use of one or more limbs.

Slowness
Technically, this is described as ‘akinesia’ or ‘bradykinesia’. These words mean ‘no movement’ and ‘slow movement’ respectively. In real terms the affected person will notice that they take longer to start and carry out tasks; they will walk more slowly and without swinging their arms; they may experience difficulty getting up out of chairs and they will also get tired easily when carrying out repetitive tasks. In addition to moving slowly, they may have particular problems with starting or controlling movements. For example, they may be able to stride out quite well, but find taking the first step very hard.

Problems with posture
People with Parkinson’s disease tend to stoop forwards. They also hold their arms in a flexed position at the elbows and at the wrists. The knees sometimes become permanently bent. Because Parkinson’s disease usually affects one side of the body more than the other, they may lean over to one side. Poor posture puts stress and strain on different areas of the body, and this leads to pain.

Loss of balance
Poor posture often leads to poor balance. It alters the centre of gravity in the body, giving the affected person a tendency to fall. Even when standing still they may have a tendency to stumble forwards or backwards if nudged. When they try to walk they may find that they are constantly trying to compensate for this alteration in the centre of gravity. They walk with small, fast shuffling steps (called festination) and constantly look as if they are about to topple forwards.

Loss of facial expression
Parkinson’s disease slows all movements, and the muscles of the face are also affected. A person with Parkinson’s may look depressed or sad; they won’t blink as much as before and they sometimes appear to be staring; they also may not appear to smile or laugh as readily as before. People who see them every day may not notice the difference since this all happens so gradually, but photographs taken five years earlier may be useful in highlighting the change.

Speech problems
Parkinson’s disease can cause the voice to become much softer, and the affected person may lose their ability to speak to a room full of people. Sometimes the voice becomes hoarse and the words a little slurred. Often words seem to tumble out on top of each other much too quickly. Swallowing becomes slower, and in advanced cases the person cannot deal with their own saliva. Drooling can become a problem.

Small writing
This is technically termed micrographia. An example is shown below. This is very common. In many cases it can be shown that Parkinson’s disease has been developing for many years by the fact that handwriting in diaries or on cheque book stubs has become progressively smaller. Treatment helps to reverse this problem.

Bowel and bladder problems
Parkinson’s disease itself causes constipation and the drugs used to treat it can make the problem worse. It is important to drink plenty of water and eat enough fibre in your diet. If the problem continues, consult your doctor or specialist. Passing water can also become problematic. There is a tendency to pass water more frequently and with a little urgency. Sometimes there is difficulty starting the stream. These symptoms usually respond quite well to drug treatment. Parkinson’s disease does not usually cause incontinence. Consult your doctor or specialist if you are having problems. For men, the bladder problems that occur in Parkinson’s disease can sometimes be confused with prostate problems.

Freezing
This does not refer to temperature, although it does seem common that people with Parkinson’s disease or Parkinsonism complain of unusually cold hands or feet. It actually refers to the situation where they stop walking abruptly and feel as if they were suddenly stuck to the floor with glue. This happens most frequently in confined spaces e.g. doorways. Getting out of a lift can be a real problem.Stepping over an imaginary line on the floor or thinking of a marching tune can sometimes help start up the movement. Different specialists and therapists have different tips to help overcome this problem.

Night-time/sleep problems
People often have problems with turning over in bed, and night-time visits to the toilet can be a nuisance. Cramp is common, and people sometimes suffer from something called ‘Dystonia’, a cramp-like symptom that causes them to hold themselves or part of their body in an unnatural posture. What this amounts to is that sleep can often be disrupted. Drug treatment can help, so discuss these problems with your doctor or specialist. At the other end of the scale, Parkinson’s disease can cause extreme tiredness and the drugs used to treat it can make the affected person feel very sleepy.

Greasy skin and sweating
The skin can become very greasy, even in people who previously had a very good complexion. It is important to pay particular attention to personal hygiene so that other problems do not develop. Unfortunately, the combination of Parkinson’s disease and its treatments can cause excessive sweating, so much so that a bed can become completely drenched. This can be a frightening experience. Again, balancing the drug treatments properly can help, so discuss these symptoms with your doctor or specialist.

Memory problems
Contrary to what was first thought, it is now accepted that Parkinson’s disease can cause some memory problems, even in the early stages. Small things like forgetting where you put your keys are typical. Patients may also be a little slow to respond to questions, or not be able to add up a column of figures as quickly as before. These symptoms should not to be confused with the early signs of dementia that occur in Alzheimer’s disease. In Parkinson’s disease the irritating little symptoms that do develop do not usually get much worse. Only a minority of people go on to develop severe mental problems.

Pain
Pain is not a common feature of Parkinson’s disease. It does sometimes occur, as do other sensory symptoms that are difficult to explain, such as pins and needles or numbness. These symptoms usually respond better to adjusting the Parkinson’s disease drug treatment than to pain-killers. Sometimes, other groups of drugs such as tricyclic anti-depressants can be useful. Consult your doctor or specialist if you are experiencing persistent or frequent onsets of pain.

Sexual difficulties
In a survey carried out by the Parkinson’s Disease Society UK, it was found that a significant proportion of people with Parkinson’s disease complained of sexual difficulties. It was by no means a problem that affected everyone, so having the disease does not mean that difficulties will definitely follow. Having a chronic disease of any kind can cause problems of both a physical and an emotional nature, which can put considerable stress on a relationship, and the sexual relationship is often the first to suffer. This is particularly true for people affected by Parkinson’s disease because of the actual symptoms of the disease and the drugs used to treat it. A specific type of Parkinsonism can cause complete impotence in men. Sexual problems can affect any couple, not just those where one of the partners has Parkinson’s disease, and standard therapies and counselling will help. You should seek expert advice if you are having problems in this area.

Depression and anxiety
About a third of all people with Parkinson’s disease will experience depression during their illness and it seems to be that the nearer they are to the time of diagnosis the more likely they are to be affected by depression. The chemical imbalance in the brain itself which is present in Parkinson’s disease can lead to depression, and this together with having to cope with a long-term disease makes this symptom understandably common. The good news is that this depression responds well to anti-depressant drugs.

Parkinson’s disease seems to make people more likely to be anxious, but we now know that anxiety and stress do not cause the disease. Tasks such as going to the hospital can cause severe anxiety in affected people, and this may make the signs and symptoms of the disease appear much worse. Just paying for the shopping at the supermarket can become severely distressing. It is important to recognise this and to try to ease the problem, for example by learning relaxation techniques. Speak to your doctor or specialist if anxiety attacks are a problem.

It is very important to remember that no two people with Parkinson’s disease will ever show exactly the same symptoms. Those listed above are some of the more common problems. The disease is very unpredictable, which means that it is normal to have good days and bad days. This unpredictability makes it very difficult to live with, not just for the affected person themselves but also for their friends and relatives. People with Parkinson’s disease need extra time and understanding so that they can maintain their independence.

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Last updated 25 June 2009