The ABCs of Parkinson’s Disease: The Letter E

The ABCs of Parkinson’s Disease: The Letter E; Early Signs 

Although Parkinson’s Awareness Month has passed, WWS Physical Therapy and Vestibular Staff feel it is important to continue sharing information about PD.

Parkinson’s is a disease characterized by changes in the basal ganglia, an area of the brain that produces dopamine. Dopamine helps drive our movements; without it, the quality and amplitude of our movements change. Though many signs of the disease are not recognized for years after developing the initial symptoms, the signs listed below are some of the first to occur in Parkinson’s Disease. Each of these signs independently is not necessarily an indicator of the disease, but if multiple are present, additional follow-up may be warranted.

1. Tremor – Uncontrolled movement commonly seen in the thumb, fingers, and hand that occurs while at rest.
2. Small Handwriting – Smaller letter sizes, more crowded word spacing, or changes in the orientation of words on the page. A change in handwriting size is known as micrographia.
3. Loss of Smell – Inability to detect scents well. You can test this by trying to smell strong foods like garlic, pickles, or coffee. This is one of the earliest signs and can be present up to 10 years before diagnosis.
4. Trouble Sleeping is difficulty staying asleep, excessive movement, or trashing while asleep. It is commonly associated with acting out dreams or night terrors, which can also be present many years before diagnosis.
5. Trouble Moving or Walking  – This is commonly noticed by a spouse or family member first. It often begins with a slower walking speed or a reduced swing of one arm, though it can progress to stiffness with movement or the sensation of feet being stuck to the floor.
6. Constipation – Straining to move the bowels and GI changes are common early signs of Parkinson’s Disease
7. Soft Voice – changes in volume, projection, or even annunciation of words
8. Masked Face – Inability to show expression or reduced facial expression. Others can perceive this as a persistent serious, depressed, or mad look.
9. Dizziness—Dizziness or fainting commonly occurs upon rising from a chair. It can be a sign of low blood pressure, which is common with Parkinson’s Disease.
10. Stooping or Bending Forward – Family or friends may notice you leaning or slouching forward when standing. Postural changes such as this are a common early sign of Parkinson’s Disease.

Though these signs and symptoms are not exhaustive, in combination, they are good predictors of Parkinson’s Disease. If you notice these symptoms, it is important to follow up with your primary care physician and a neurologist who specializes in Parkinson’s Disease. Additionally, early occupational, speech, and physical therapy are key in managing disease progression and improving function and quality of life. You may contact WWSPT to learn more.

Dr. Cassie Z. Newnan, PT, DPT,
WWS Physical Therapy and Vestibular Rehabilitation
Doylestown, PA.
(215) 489-3234