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What is the number one symptom of Parkinson’s disease?

Parkinson’s disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.

What Are the Main Parkinson’s Disease Symptoms?

The four main symptoms of Parkinson’s disease are:

  • Tremor. A tremor, or shaking, usually begins in a limb, often the hand or fingers. You may rub your thumb and forefinger back and forth, known as a pill-rolling tremor. Your hand may tremble when it’s at rest.
  • Slowed motion (bradykinesia). Over time, Parkinson’s disease may slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk.
  • Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion.
  • Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson’s disease. Balance problems may also increase your risk of falls.

Tremors are considered the number one symptom and hallmark of Parkinson’s disease, occurring in about 70% of people with Parkinson’s. Typically, a tremor in the hand or fingers on one side of the body is an early symptom for many people.

More Details on Tremor as the Primary Symptom

Here are some more details on tremor as the primary and most common symptom of Parkinson’s disease:

  • Tremor often begins in a hand, although sometimes a foot or the jaw is affected first.
  • The tremor associated with Parkinson’s usually appears when a limb is at rest, unlike essential tremor which usually occurs when making a movement.
  • The tremor may initially only occur or be more pronounced when you are under stress or tired.
  • The tremor often starts out subtle and gradually worsens over time.
  • Typically the tremor begins on one side of the body, commonly the dominant hand side.
  • The pill-rolling tremor occurs when the thumb rubs against the index or middle finger.
  • The tremor usually disappears during sleep.

While not everyone with Parkinson’s disease experiences a tremor, it is the most well-known and common early sign. If you notice a slight, rhythmic, back-and-forth tremor in one hand, see your doctor. The sooner Parkinson’s disease is diagnosed, the better the outcomes.

Other Early Symptoms

In addition to tremors, here are some other early symptoms that may occur before or along with tremors:

  • Subtle slowness and stiffness – You may notice that regular activities like rising from a chair, walking, or bathing take longer.
  • Stooped posture – You may begin standing with your head or shoulders slumped forward.
  • Shuffling gait – Your usual walking pace and stride length may decrease.
  • Loss of facial expression – Your face may appear more “mask-like”, with less blinking.
  • Speech changes – Your speech may become softer or have a monotone quality.
  • Writing changes – Your handwriting may appear smaller or less fluid.

Paying attention to subtle early symptoms like these can lead to an earlier Parkinson’s diagnosis. However, a slight hand tremor is the most common initial symptom.

What Causes the Tremor Symptom?

Parkinson’s disease is linked to loss of the brain cells that produce dopamine. Dopamine acts as a messenger between the substantia nigra and corpus striatum areas of the brain to produce smooth, controlled movements. As Parkinson’s disease develops and dopamine production drops, communication between these brain areas becomes impaired.

When dopamine levels fall below about 80% of normal, movement-related symptoms like tremor and stiffness can begin. Researchers believe the lack of dopamine causes abnormal brain activity that leads to the involuntary muscle movements seen as tremors.

Factors That Can Increase Tremor

While tremors may be a constant symptom for some with Parkinson’s, certain factors can cause tremor to worsen temporarily:

  • Stress or anxiety – Increased stress hormones like adrenaline are linked with worsened tremor.
  • Low blood sugar – Hypoglycemia can trigger episodes of increased tremor.
  • Fatigue – Tremor often worsens with increased tiredness as dopamine function declines.
  • Caffeine – Caffeine acts as a stimulant that can amplify tremor.
  • Certain medications – Drugs like amphetamines, some asthma medications, and dopamine antagonists may increase tremor.

Understanding these tremor triggers can help you manage fluctuations in symptom severity. Coping strategies like stress management and avoiding caffeine may help.

How Parkinson’s Tremor Differs from Essential Tremor

Essential tremor is another common tremor disorder. While essential tremor may resemble Parkinson’s tremor, there are some differences:

Parkinson’s Tremor Essential Tremor
Usually occurs at rest Usually occurs with movement
Affects hands, arms, legs, jaw Primarily affects hands, arms, head
Rarely occurs in legs May occur in legs
Associated with muscle rigidity No associated rigidity

Diagnosing which type of tremor you have is important, since treatments differ. If you have a resting tremor along with rigidity, it likely indicates Parkinson’s disease rather than essential tremor.

When to See a Doctor

Consult your doctor if you notice any of the following:

  • A slight shaking or tremor in one hand, arm, leg, foot, or jaw that persists when relaxed
  • Stiffness or reduced arm swing when walking
  • Changes in gait like shuffling steps or balance problems
  • Handwriting that has become smaller, slower, or less uniform
  • Soft or slurred speech
  • Stooped posture or reduced facial expressions

Seeing your doctor promptly when symptoms first appear gives the greatest chance for effective treatment. Parkinson’s disease has no cure yet, but medications and therapies can improve symptoms and quality of life.

Diagnosing Parkinson’s Disease

To diagnose Parkinson’s disease, the doctor takes a full medical history and performs a neurological exam. Diagnosis is based on clinical symptoms – there are no blood or imaging tests that can definitively diagnose Parkinson’s. The exam may include assessments of:

  • Muscle rigidity
  • Bradykinesia (slow movements)
  • Postural instability
  • Gait abnormalities
  • Tremor at rest

Your doctor may also order lab tests or brain imaging to rule out conditions that mimic Parkinson’s symptoms, like stroke, brain tumors, or side effects of certain medications. A positive response to carbidopa-levodopa therapy also helps confirm a Parkinson’s diagnosis.

Conclusion

In summary, the most common initial symptom of Parkinson’s disease is a slight tremor or shaking in one hand, arm, leg or jaw that is present at rest. This is caused by degeneration of dopamine-producing neurons in the brain that control coordinated movement. Tremor often begins on one side of the body and is described as a “pill-rolling” tremor of the fingers or hand. While not all with Parkinson’s have tremor, it occurs in around 70% of people, making it the cardinal symptom.

Other early symptoms like stiffness, slow movements, balance issues, and gait changes may accompany tremor. Recognizing and promptly reporting the onset of symptoms like tremor to your doctor can lead to earlier diagnosis and treatment to alleviate symptoms. While there is no Parkinson’s cure yet, early treatment can significantly improve quality of life and daily functioning.