Could my symptoms be indicative of Parkinson's disease?

Could Your Symptoms Be Parkinson's Disease?

Your symptoms could indicate Parkinson's disease if you have bradykinesia (slowness of movement) combined with either resting tremor, rigidity, or both—these are the essential diagnostic criteria that should prompt immediate neurological evaluation. 1, 2

Essential Diagnostic Features to Assess

The diagnosis of Parkinson's disease is primarily clinical and requires specific motor signs 1:

• Bradykinesia is mandatory - This means slowness of movement with progressive reduction in speed and amplitude when you repeat actions (like tapping fingers or opening/closing your hand) 3
• Plus at least one of the following:
  • Resting tremor (shaking that occurs when your limb is relaxed, not during movement)
  • Rigidity (stiffness when someone else moves your limbs)
  • Both tremor and rigidity 1, 2

Postural instability (balance problems) is no longer considered a cardinal diagnostic feature and typically appears later in disease progression, not at onset 3, 4

Specific Motor Signs to Look For

Bradykinesia manifestations 3:

• Difficulty with fine motor tasks (buttoning clothes, writing)
• Slowness with gross motor activities (walking, turning in bed)
• Reduced facial expressions (masked face)
• Soft or slurred speech
• Decreased arm swing when walking

Tremor characteristics 1, 2:

• Occurs at rest (when your hand is relaxed in your lap)
• Often starts on one side
• May have a "pill-rolling" quality
• Typically improves with purposeful movement

Rigidity features 1:

• Constant resistance throughout passive movement (not just at the beginning)
• May feel like a "lead pipe" or have a "cogwheel" ratcheting quality
• Often asymmetric (worse on one side)

Red Flags That Suggest Something Other Than Parkinson's Disease

Seek alternative diagnoses if you have 1:

• Vertical gaze palsy (difficulty looking up or especially down) → suggests Progressive Supranuclear Palsy
• Asymmetric rigidity with alien hand phenomenon (hand moves involuntarily as if it has a mind of its own) → suggests Corticobasal Syndrome
• Ataxia (uncoordinated movements, stumbling)
• Early severe dementia or hallucinations (within first year)
• Poor or no response to levodopa medication

Non-Motor Symptoms That May Precede Motor Signs

These prodromal symptoms can appear years before motor symptoms 2, 5:

• Constipation (at least doubles your risk) 2
• Loss of sense of smell (hyposmia)
• REM sleep behavior disorder (acting out dreams, thrashing in sleep)
• Depression or anxiety
• Urinary problems

When to Pursue Diagnostic Testing

MRI brain imaging is indicated when 1:

• Your clinical presentation is unclear or atypical
• You need to rule out structural causes (stroke, tumor, hydrocephalus)
• Note: MRI is often normal in early Parkinson's disease 1

I-123 ioflupane SPECT/CT (DaTscan) is valuable when 1:

• Differentiating Parkinson's disease from essential tremor or medication-induced tremor
• The scan shows decreased uptake in the striatum in Parkinson's disease
• A normal scan essentially excludes Parkinsonian syndromes 1

Critical Context About Timing

Symptoms typically appear only after approximately 40-50% of dopaminergic neurons in the substantia nigra have already been lost, usually about 5 years after neurodegeneration begins 1, 3. This means by the time you notice symptoms, significant brain changes have already occurred.

Age and Risk Factors

• Peak onset is between 60-70 years of age 3
• Male sex and advancing age are independent risk factors 6
• Having a relative with Parkinson's disease or tremor at least doubles your risk 2
• Being a non-smoker increases risk 2

Common Pitfalls to Avoid

Do not confuse drug-induced parkinsonism with Parkinson's disease 1. Certain medications can cause similar symptoms, particularly:

• Antipsychotics
• Metoclopramide (for nausea)
• Valproate (for seizures)

Do not wait for all four "classic" signs to appear—you only need bradykinesia plus one other cardinal sign for diagnosis 1, 2

Do not assume tremor is required—some patients have Parkinson's disease without tremor (akinetic-rigid subtype) 2, 5

Immediate Next Steps

If you have bradykinesia plus resting tremor or rigidity, you need neurological evaluation now 1, 2. The diagnosis is clinical, made by a physician examining you, not by lab tests or scans alone 1, 7. Early diagnosis matters because effective symptomatic treatments exist that significantly improve quality of life, and there is no reason to postpone treatment once disability develops 6, 2.