Early detection of Parkinson’s disease: what are the symptoms?

Early detection of Parkinson's disease: what are the symptoms?

Around 200,000 people in Germany are affected by Parkinson‘s disease. On average, the disease is diagnosed a year after the first signs appear. The reason is that the symptoms in the early stages are very unspecific and do not directly suggest Parkinson’s. However, the earlier therapy can be started, the more favourable the long-term course of the disease.

Skin test holds hope for early detection.

In February 2017, researchers were able to prove for the first time that an examination of the nerve cells in the skin can detect Parkinson’s disease. 1 In Parkinson’s disease, it is known that deposits of proteins (proteins) occur in some areas of the brain. The protein “alpha-synuclein” is not only deposited in the brain but also in the skin nerve cells. And that years before the onset of obvious motor symptoms. It is still unclear when this Parkinson’s test can be used routinely.


Transcranial ultrasound – certainty in the early stages?

Another method researchers are working on is an ultrasound of the brain, known as transcranial sonography. 2 Through a natural bone window at the temple; the doctor can determine the reflection of the sound waves from the brain region substantia nigra. An increased signal indicates cell breakdown in this area, as is typical of Parkinson’s disease.

The test could help to diagnose Parkinson’s disease in the early stages, but it also shows abnormalities in nine per cent of healthy subjects.

The first sign is that the sense of smell disappears.

Declining and eventually disappearing sense of smell (hyposmia or anosmia) is a common symptom in the early stages of Parkinson’s disease.

Those affected first notice a loss of taste, which is closely linked to the sense of smell. The essential tastes of sweet, sour, salty, umami and bitter can often still be perceived.

The causes are breakdown processes in the olfactory centre of the brain. These appear about four to six years before the motor symptoms. A smell test by a neurologist can provide information. The test persons are presented with different odour samples.


Non-specific pain as an early symptom

Pain can be an early sign of Parkinson’s disease. They often affect the shoulders, arms, or other parts of the musculoskeletal system. Burning, pulling or tingling pain is also reported. They are similar to rheumatic complaints and are rarely directly associated with Parkinson’s disease.

In the late stages, orthopaedic problems result from poor posture. Since many diseases are accompanied by pain, it is tough to diagnose Parkinson’s without other symptoms. Most patients are initially evaluated orthopedically or rheumatologically before being referred to a neurologist.

sleep disorders in the early stages

The so-called Schenck syndrome can occur in a more advanced initial stage of the disease. It is a behavioural disorder during sleep characterized by jerky, often violent movements.

The cause is the elimination of the flaccid paralysis that generally occurs during the REM sleep phase. Those affected also physically live out what they dreamed of. In addition to a neurological examination, the diagnosis is usually made in a sleep laboratory.

Depression in Parkinson’s disease

Sometimes, a depressed mood or even depression is an early symptom of Parkinson’s. Lack of drive, lack of interest and joylessness are manifestations of this. If there are no motor abnormalities, Parkinson’s is rarely suspected.

In the later stages of the disease, the depressive mood is intensified by the progression of the disease and the associated everyday limitations.


dementia and Parkinson’s disease

Parkinson’s patients in the late stages often develop additional dementia, i.e. a slowing down of memory performance up to memory loss. Personality changes, too. Those affected are disoriented, confused and often in need of care. 

This dementia caused by the degradation of dopaminergic cells must be differentiated from other dementia diseases, such as Alzheimer’s dementia.

Tremor, rigidity, akinesia – the typical Parkinson’s triad

A classic symptom of Parkinson’s disease is the trembling of body parts, most commonly the hands. Doctors speak of tremorsA tremor is typical of Parkinson’s patients, which is present when the patient is at rest and disappears when they concentrate on a movement. Parkinson’s disease should be considered whenever a new tremor occurs. However, it is usually only observed in the advanced stage of the disease.

The generally reduced mobility of those affected is also striking. Parkinson’s patients move slowly and need more time for many everyday things. It‘s called akinesia. In the future, “dyskinesia” can also occur. These are jerky, unwanted movements.

Another classic phenomenon is the so-called rigour, a muscle stiffness that makes movement even more difficult.

The role of the eyes in the early detection of Parkinson’s disease

Only in recent years have researchers found that the eyes also begin to tremble, i.e. develop a “tremor”. This can go unnoticed by the environment. Those affected rarely notice this eye tremor themselves.

If Parkinson’s disease is suspected, an eye exam by an ophthalmologist can provide information about a possible eye tremor.


Late stage symptoms

The gait pattern of a person with Parkinson’s disease is always similar: Small steps without swinging the arms, which, in the early stages, often only affects one side of the body. An apparent change in the movement pattern only occurs in later phases of the disease.

Disorders of muscle functions

In Parkinson’s patients, fine motor skills are limited as the disease progressesAccessing, opening bottles, combing hair, or buttoning pants is becoming increasingly difficult for those affected.

Due to the decreasing ability to control the hand and finger muscles, the handwriting of those affected also changes. Many people with Parkinson’s write very small and scrawled.

Since the facial muscles can also be moved less, the face appears stiff and expressionless; the facial expressions are frozen (“mask face”). Speech can also be impaired, and sound can be monotonous and slurred.

How else does Parkinson’s disease announce itself?

In addition to the motor symptoms, there are changes in the autonomic nervous system. This controls numerous involuntary processes in the body.

For example, blood pressure. Many Parkinson’s patients suffer from low blood pressure, which can result in dizziness and fainting spells. Dysfunction of the sweat glands causes them to produce too much secretion and increase sweating.

Another affected organ is the intestines, which can become sluggish and cause constipation. The bladder muscles can also be weakened, resulting in urinary incontinence.


Who Can Get Parkinson’s?

Anyone can get Parkinson’s disease. The cause is a lack of a neurotransmitter in the brain, dopamine. The result is a disruption in motor control and, thus, malfunctions in voluntary and involuntary muscle cells.

Symptoms usually appear by age 55 to 65 but can start earlier or later. Symptoms only become visible after around 50 per cent of the dopaminergic nerve cells have died.

Different forms of Parkinson’s

There are different forms of Parkinson’s disease, but most often, no cause can be identified (idiopathic Parkinson’s syndrome). However, there are also hereditary forms based on a mutation in the genes of one parent. However, these forms are much rarer than idiopathic Parkinson’s and usually appear younger. A genetic test can provide certainty.

Other forms of Parkinson’s are secondary and atypical Parkinson’s syndrome.

How do I recognize Parkinson’s disease?

The problem with the individual early symptoms of the disease is that they need to be more specific. Those around you first notice many signs, for example, the changed typeface, the reduction in facial expressions or the one-sided swinging of the arms.

If pain or depression leads to a doctor’s visit, Parkinson’s disease is suspected in the rarest of cases. In contrast, visual diagnosis is often possible in advanced stages with motor symptoms such as rigidity, tremors and akinesia.


13 possible early warning signs of Parkinson’s at a glance

  • Protein deposits in the skin (alpha-synuclein)
  • Cell degradation in the brain region substantia nigra
  • loss of sense of smell
  • Non-specific pain, especially in the musculoskeletal system
  • Sleep disorders (“Schenck syndrome”)
  • Depression
  • dementia
  • Tremor, rigidity and akinesia
  • tremor of the eyes
  • classic gait pattern
  • changed typeface
  • rigid facial expressions (mask face)
  • low blood pressure, increased sweating, constipation, urinary incontinence due to disorders of the autonomic nervous system


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