Symptoms and signs may begin gradually and become more apparent over time as they increase in frequency.
Tremors
One of the more defining symptoms of Parkinson's is the presence of tremors, though it is important to note that one third of Parkinson's cases do not involve tremors as an initial symptom while others do not develop tremors at all. In addition, tremors alone may indicate an entirely different disorder.
If a tremor is present, it usually begins in one hand when at rest. This particular tremor diminishes when the hand is intentionally moved and can also completely stop when at rest. Over time, tremours will progress to the other hand, arms, and legs, in that order. The eyelids, forehead, jaw, and/or tongue may also be affected. The voice is not. As mentioned, you may also be symptom free when at rest, but experiences shakes or tremors when emotionally distressed or experiencing stress. Tremors are absent during sleep and decrease as the disease progresses.
Additional Symptoms
In addition to tremors, you will likely experience difficulty initiating movement (akinesia), slow movement (bradycardia), decreased movement (hypokinesia), arm, leg, and general muscle rigidity and stiffness, and a feeling of aching or cramped muscles (due to rigidity and hypokinesia). Steps are generally short and sluggish and there is a lack of arm motion when moving. You may also fatigue quickly.
Posture is often stooped and a loss of balance and stability occurs when walking where you may fall forward (propulsion) or backward (retropulsion) due to a loss of postural reflexes. Speech is often slurred, stuttered, of low volume, and monotone. Handwriting is small and cramped.
There are reduced facial expressions due to facial-muscle impairment and decreased blinking. Muscle stiffness in the face and throat can also make swallowing difficult and cause drooling or choking. Within seven to ten years, a lack of mental acuity can also occur.
At a chemical level, those with Parkinson's are seriously deficient in the neurotransmitter dopamine. For more information, see Causes, below.
NOTE: As there is no definitive test for Parkinson's, all other conditions associated with the above symptoms (other degenerative brain conditions, side effects of antipsychotic drugs, et cetera) must be ruled out before an accurate diagnosis can be made. Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) tests can be conducted to rule out disorders that mimic Parkinson's. Reflex, coordination, muscle strength, and mental function tests can also be performed to ensure an accurate diagnosis.
