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Parkinson’s disease usually starts very slowly and subtly. Some people notice a tremor in just a single finger. (Michael J. Fox discovered his Parkinson's disease this way.) Over time, this tremor begins to affect the whole hand, and then the entire arm. Other symptoms may also begin gradually, becoming more severe over time. Not everybody with Parkinson’s disease develops every single symptom. In addition, some of these symptoms (specifically depression , sleep disturbance, and loss of smell) may start years before any tremor is noticed.

Symptoms of Parkinson’s disease may include:

  • Shakes or tremors
    • Usually occurs at rest, may disappear while you are purposely moving
    • Usually absent during sleep
    • May worsen when you’re under emotional stress
    • May take the form of “pill rolling” (a rubbing movement of the index finger and thumb)
    • Tremors tend to start in a single finger on one hand, but may progress to the entire arm, head, lips, feet
  • Slowed movements (bradykinesia)
    • Walking and other movement becomes very slow
    • You may begin to shuffle when walking
    • Your steps become shorter and shorter
  • Muscle stiffness or rigidity
    • If someone takes your arm and tries to move it, it will seem as if you are purposely tightening up your muscles and resisting, although this is happening completely involuntarily.
    • Your handwriting may become very small and cramped, as it becomes more difficult to initiate movement.
    • You’ll lose the ability to participate in automatic movement, such as blinking and swinging your arms while walking.
    • Because swallowing becomes increasingly difficult, you may begin to drool and have an increased risk of choking on food.
    • Stiffened facial muscles may take on an expression called the “Parkinson’s face,” an unblinking, unsmiling, mask-like stare.
    • You may have difficulty initiating movement and difficulty rising from a seated position.
  • Problems with speech
    • Your voice may become softer.
    • You may speak in a flat, monotone voice.
    • You may begin to stutter.
  • Problems with balance and coordination
    • You may start to walk in a very unsteady fashion.
    • You have an increased risk of falling.
    • Writing, dressing, and eating all become more difficult.
  • Stooped, bent-over posture
  • Fatigue
  • Depression
  • Confusion
  • Difficulty sleeping
  • Cramping, burning pain in the legs
  • Restless leg syndrome (inability to stop moving the legs at night, resulting in extreme difficulty sleeping)
  • Personality changes
  • Sexual problems
  • Loss of bladder control
  • Loss of the sense of smell
  • Decreased eye blinking
  • Changes in body temperature
  • Heavy sweating
  • Memory problems
  • Dementia
  • Constipation due to slowing of the intestinal muscles that aid digestion
  • Sudden, large drops in blood pressure upon first standing up, which can result in fainting or falling
  • Seborrhea (which causes the skin to look oily)
  • Nocturia, increased urine frequency and urgency
  • Freezing in advanced stages
  • Stooped posture


American Association of Neurological Surgeons website. Available at:

Conn HF, Rakel RE. Conn’s Current Therapy 2002. 54th ed. Philadelphia, PA: WB Saunders Company; 2002.

Fox M. Lucky Man: A Memoir. New York, NY: Hyperion; 2002.

National Institute of Neurological Disorders and Stroke website. Available at:

Parkinson’s Disease Foundation website. Available at:

Last reviewed May 2015 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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