The first sign of Parkinson's may be as slight as a tremor in one finger. Over time, the movement disorder may grow more pronounced, involving the hand and then the arm, usually on just one side of the body. Facial muscles may be affected, making the face appear less expressive than before. As the illness progresses, walking may slow and the gait may become unsteady. Episodes of "freezing," where the legs are difficult to move, may occur. Swallowing and digestion may be slowed, and the voice may lose strength and range. Depression is common among those who have the illness, although not all people have the full range of symptoms.
Slowness of movement
This is the most disabling symptom. Initially, it often begins in one arm with a loss of manual dexterity. The slowness makes it difficult to get out of a chair or turn in bed. Fine movements such as buttoning clothing, handwriting, and using a fork or knife may become difficult. Later, the person appears to be in slow motion and if not treated may become virtually frozen like a statue. Because of the enormous energy it takes to overcome slowness the person with Parkinson's often complains of being "weak" although there is not true muscular weakness.
Tremor
Tremor occurs in about two-thirds of people with Parkinson's and is often the most visible and obvious sign of the disease. While the Parkinson's tremor usually affects the hands and feet it sometimes involves the lips, tongue, and jaw. The tremor is more visible while at rest or while walking and will usually stop during movement of the hand.
Muscle stiffness
Stiffness combined with slowness may cause aching muscles and joints, especially in the shoulders. This is sometimes misinterpreted as "arthritis" or "bursitis."
Masked face
An often confusing characteristic of the disease is the presence of a "masked face," showing little or no emotion. Blinking and spontaneous eye movements are less frequent, giving rise to a staring expression. This can be misinterpreted as lack of interest or depression.
Walking difficulties
The gait may be slow with short steps. A person with Parkinson's may also intermittently freeze as if the feet were stuck to the floor. Freezing occurs especially when approaching doorways or if forced to hurry. There is a propensity to bend the trunk forward and to walk with out swinging the arms. It is common to have difficulties with balance.
Speech problems
About one half of all individuals with Parkinson's Disease develop difficulty with their speech. The most common problem is a soft or fading voice. Communication can be complicated further by a fast mumbling speech with uncontrollable repetitions of the first syllable.
Swallowing difficulties
Some individuals experience difficulty eating because their ability to swallow has become impaired. Food may collect in the mouth or the back of the throat resulting in choking or coughing. Friends and family members may wish to become familiar with the Heimlich Maneuver in the event of a choking episode. A physician or other health professional can explain this procedure.
Troubling inconsistencies
It is important to note that an individual's symptoms may vary from moment-to-moment and day-to-day. Symptoms may be nonexistent one minute only to suddenly reappear for no clear reason. These variations can be due to the disease or medications. Such fluctuations will often confuse or frustrate caregiver, family, and friends who are unaware of the fickle nature of this disease.
