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10 Early Signs of Parkinson’s Disease That Doctors Often Miss

By Melanie Haiken, Caring.com

Medications can slow the course of Parkinson’s. Know how to recognize early symptoms of Parkinson’s, so you or a loved one can get medical help.

Let’s be honest: A diagnosis of Parkinson’s disease can be pretty unnerving. In fact, an April 2011 survey by the National Parkinson’s Foundation revealed that people will avoid visiting the doctor to discuss Parkinson’s even when experiencing worrisome symptoms, such as a tremor.

The problem, however, is that waiting prevents you from beginning treatment that — although it can’t cure Parkinson’s — can buy you time. “We now have medications with the potential to slow progression of the disease, and you want to get those on board as soon as possible,” says Illinois neurologist Michael Rezak, M.D., who directs the American Parkinson’s Disease Association National Young Onset Center.

Parkinson’s disease (PD) occurs when nerve cells in the brain that produce the neurotransmitter dopamine begin to die off. When early signs go unnoticed, people don’t discover they have Parkinson’s until the disease has progressed. “By the time you experience the main symptoms of Parkinson’s, such as tremor and stiffness, you’ve already lost 40 to 50 percent of your dopamine-producing neurons. Starting medication early allows you to preserve the greatest possible number of them,” Rezak explains.

Here, 10 often-missed signs that can help you identify and get early treatment for Parkinson’s.

1. Loss of sense of smell

This is one of the oddest, least-known, and often earliest signs of Parkinson’s disease, but it almost always goes unrecognized until later. “Patients say they were at a party and everyone was remarking on how strong a woman’s perfume was, and they couldn’t smell it,” says Rezak.

Along with loss of smell may come loss of taste, because the two senses overlap so much. “Patients notice that their favorite foods don’t taste right,” Rezak says.

Dopamine is a chemical messenger that carries signals between the brain and muscles and nerves throughout the body. As dopamine-producing cells die off, the sense of smell becomes impaired, and messages such as odor cues don’t get through. Some researchers consider this change so revealing that they’re working to develop a screening test for smell function.

2. Trouble sleeping

Neurologists stay on the alert for a sleep condition known as rapid eye-movement behavior disorder (RBD), in which people essentially act out their dreams during REM sleep, the deepest stage of sleep. People with RBD may shout, kick, or grind their teeth. They may even attack their bed partners. As many as 40 percent of people who have RBD eventually develop Parkinson’s, Rezak says, often as much as ten years later, making this a warning sign worth taking seriously.

Two other sleep problems commonly associated with Parkinson’s are restless leg syndrome (a tingling or prickling sensation in the legs and the feeling that you have to move them) and sleep apnea (the sudden momentary halt of breathing during sleep). Not all patients with these conditions have Parkinson’s, of course, but a significant number of Parkinson’s patients — up to 40 percent in the case of sleep apnea — have these conditions. So they can provide a tip-off to be alert for other signs and symptoms.

3. Constipation and other bowel and bladder problems

One of the most common early signs of Parkinson’s — and most overlooked, since there are many possible causes — is constipation and gas. This results because Parkinson’s can affect the autonomic nervous system, which regulates the activity of smooth muscles such as those that work the bowels and bladder. Both bowel and bladder can become less sensitive and efficient, slowing down the entire digestive process.

One way to recognize the difference between ordinary constipation and constipation caused by Parkinson’s is that the latter is often accompanied by a feeling of fullness, even after eating very little, and it can last over a long period of time. When the urinary tract is affected, some people have trouble urinating while others begin having episodes of incontinence. The medications used to treat Parkinson’s are effective for this and other symptoms.

4. Lack of facial expression

Loss of dopamine can affect the facial muscles, making them stiff and slow and resulting in a characteristic lack of expression. “Some people refer to it as ‘stone face’ or ‘poker face,’” says neurologist Pam Santamaria, a Parkinson’s expert at the Nebraska Medical Center in Omaha. “But it’s really more like a flattening — the face isn’t expressing the emotions the person’s feeling.”

The term “Parkinson’s mask” is used to describe the extreme form of this condition, but that doesn’t come until later. As an early symptom, the changes are subtle: It’s easiest to recognize by a slowness to smile or frown, or staring off into the distance, Santamaria says. Another sign is less frequent blinking.

5. Persistent neck pain

This sign is particularly common in women, who have reported it as the third most-common warning sign they noticed (after tremor and stiffness) in surveys about how they first became aware of the disease.

Parkinson’s-related neck pain differs from common neck pain mainly in that it persists, unlike a pulled muscle or cramp, which should go away after a day or two. In some people, this symptom shows up less as pain and more as numbness and tingling. Or it might feel like an achiness or discomfort that reaches down the shoulder and arm and leads to frequent attempts to stretch the neck.

Read the rest of the article here.

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