Early signs of Parkinson’s disease can be easy to miss. They may include tremors, small handwriting, voice changes and a rigid facial expression.

Parkinson’s disease (PD) is a neurological movement disorder that, according to the National Institutes of Health, affects approximately 500,000 people in the United States.

Some early symptoms include:

  • cramped handwriting or other writing changes
  • tremor, especially in the finger, hand or foot
  • uncontrollable movements during sleep
  • limb stiffness or slow movement (bradykinesia)
  • voice changes
  • rigid facial expression or masking
  • stooped posture

PD starts with the brain cells, called neurons, which control movement. The neurons affected by Parkinson’s disease produce a substance called dopamine. PD sets in when the neurons die and the levels of dopamine in the brain decrease. The lack of dopamine is thought to result in the symptoms that affect the way you move.

Early signs of Parkinson’s disease can be easy to miss, especially if they occur sporadically. It may be time to see a doctor if you are noticing symptoms that keep appearing.

A change in the size of your handwriting may be an early indicator of Parkinson’s disease. People with PD have a hard time controlling movement because of the changes in the brain. This can affect many different motor skills, including writing.

Micrographia is the medical term for “small handwriting.” Parkinson’s patients often have handwriting that looks cramped. Individual letters tend to be smaller than normal, and words are spaced closely. A person with PD may begin writing a letter in their regular handwriting but gradually start writing in smaller font.

Tremor is perhaps the most recognizable sign of Parkinson’s disease. A slight twitching or shaking of a finger, hand, or foot is common. The person experiencing the tremor is likely to be the only person who notices them in early stages of PD.

The shaking will worsen and become noticeable to others, however, as the condition progresses. The tremor is usually most noticeable at rest.

Parkinson’s disease is associated with many different types of sleep problems, including insomnia, vivid dreams, and trouble regulating sleep times.

Additionally, another movement disorder, restless leg syndrome (RLS), is more common among people who have Parkinson’s disease. RLS causes urges to move the extremities, particularly when it’s time to sleep. This condition makes it very difficult to fall asleep and stay asleep.

New sleep problems can be an early sign of Parkinson’s disease.

Parkinson’s disease mainly affects adults older than 60. You may feel stiff and a little slow to get going in the morning at this stage of your life. This is a completely normal development in many healthy people. The difference with PD is that the stiffness and slowness it causes don’t go away as you get up and start your day.

Stiffness of the limbs (rigidity) and slow movement (bradykinesia) appear early on with PD. These symptoms are caused by the degeneration of some of the neurons in the brain that help control movement. A person with PD will notice jerkier motions and move in a more uncoordinated pattern than before. Eventually, a person may develop the characteristic “shuffling gait.”

Another characteristic is slow walking that then rapidly speeds with fast, small steps.

Parkinson’s disease affects movement in different ways, including how you speak. You might be familiar with the slurred speech of advanced PD patients. Less dramatic voice changes can occur in early stages of the disease.

Your enunciation will most likely remain crystal clear early on in PD. You may, however, unintentionally be speaking more quietly. People in early stages of PD often speak in low tones, a hoarse voice, or with little inflection.

Parkinson’s disease may also cause people to speak very fast.

Parkinson’s can affect the natural facial expressions in addition to gross motor skills. People often comment that some individuals with PD have a blank stare.

This phenomenon, called masking, is a common sign of early PD. The disease can make movement and control of small muscles in the face difficult. Patients may have a very serious look on their face even when the conversation is lighthearted and lively. People with PD often blink less often as well.

Parkinson’s may also cause some people to feel less emotional, however they may also be more emotional at times (though this is rare).

Posture will change in small ways at first, and will gradually worsen.

A stooped posture that can also be described as leaning and slouching is an early indicator of PD. This posture has to do with the loss of coordination and balance affecting the body.

This stooped posture may sometimes make it look like a person is going to fall over. It is possible to straighten the back, but when a person is relaxed the stooped posture can return.

Parkinson’s disease is a serious and chronic condition. PD treatment is more successful when the disease is caught in its earliest stages. Diagnosis can be difficult, as many of the early signs are similar to those in other health conditions.

You know your body better than anyone else. Talk to your doctor if you have any concerns about your physical movement or behavior, or if something doesn’t feel right.

Early signs of Parkinson’s disease can sometimes be easy to miss. Small handwriting, tremors, a rigid facial expression and changes to the voice are just some of the signs that could indicate Parkinson’s disease.

If you are concerned about any symptoms you or a loved one may be experiencing, speak with your doctor.