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Know the Early Signs Which Occur Long Before Tremors

Parkinson’s disease is well-known for causing tremors and other muscle-related problems. What’s not commonly known, however, is that muscle symptoms aren’t always the first signs of Parkinson’s disease. 

It takes an experienced neurologist like William Shankle, MD at Shankle Clinic to determine if your early signs may signal the onset of Parkinson’s. The only way to know if you should come to see us for a neurological assessment is by learning the signs that occur long before tremors.

Parkinson’s disease is recognized by muscle symptoms

Parkinson’s is a neurodegenerative disease that occurs when certain nerves in the brain deteriorate. The nerves that die produce a neurotransmitter called dopamine, which controls muscle movement.

As the disease progresses and more nerves are damaged, declining levels of dopamine gradually lead to the muscle problems that are the hallmark of Parkinson’s: tremors, muscle stiffness, and slow movement.

The tremors or shaking often begin on one side of your body in your fingers or hand. The uncontrollable shaking most often appears while your arm or hand are at rest. You may also notice facial tremors in your chin.

Stiffness when you walk is another one of the earliest motor signs of Parkinson’s. You may notice stiffness that doesn’t get better as you move. Shuffling your feet and not swinging your arms like you normally would while walking are also two red flags of Parkinson’s.

These motor symptoms define Parkinson’s, but by the time they appear, 60-80% of the dopamine-producing neurons have degenerated. The earliest signs of Parkinson’s occur many years before tremors appear.

Early signs of Parkinson’s

The nerve damage that leads to Parkinson’s disease occurs as a protein called alpha-synuclein builds up around the nerves. These same protein clumps develop in other areas of your brain before they reach the area that causes the primary Parkinson’s symptoms. As a result, you can develop early signs such as:

Loss of smell

Loss of smell, called anosmia, often occurs long before tremors. If you develop anosmia that’s not due to another type of disease, you have a 50% or greater chance of developing Parkinson’s disease in the next 5-10 years.

Keep in mind that it’s common to lose your sense of smell due to problems such as a cold or flu. However, you should regain the ability to smell when you feel better. If the problem persists, and especially if you can’t smell foods such as pickles or bananas, contact us for a Parkinson’s evaluation.

REM sleep behavior disorder

REM (rapid eye movement) sleep is the stage of sleep when you dream. Normally, your muscles stay relaxed and don’t move while dreaming. 

If you have REM sleep behavior disorder, you physically act out your dreams. You may flail, kick, twitch, make vocal sounds, or sit up and leave the bed. If you have this condition without another underlying cause, it’s an early warning sign of Parkinson’s disease.

Small handwriting

You may notice that your handwriting changes as you get older, whether due to arthritis, stiff fingers, or poor vision. Small handwriting, however, is an early sign of Parkinson’s. 

This condition, called micrographia, is identified by changes in the size and spacing of your handwriting. If you have micrographia, your handwriting gets progressively smaller and you tend to crowd letters and words together.


Constipation is such a common problem that it’s often hard to associate it with Parkinson’s, especially if you haven’t developed tremors. However, changes in muscle movement may affect your digestive tract before other parts of your body, making constipation one of the early signs.

If you have problems with constipation even after medical treatment, it’s worth considering that it may be a sign of Parkinson’s. Additionally, if you have constipation together with REM sleep behavior disorder and/or loss of smell, your risks for Parkinson’s are higher.


It’s common to experience depression after you’re diagnosed with Parkinson’s, but in some cases, depression is an early symptom. Dopamine is also an important mood regulator. As you lose dopamine-producing neurons, you’re more likely to become depressed before you have enough nerve damage to cause muscle symptoms.

If you have any questions about motor or nonmotor symptoms, call our office in Newport Beach, California, or schedule a consultation online.

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