Nine Signs You May Have Parkinson’s — Even if You Don’t Have Tremors

A diminished sense of smell. Trouble sleeping. A stiff shoulder that won’t go away. Parkinson’s disease rarely begins with a dramatic tremor. Instead, it often starts quietly — with subtle changes that are easy to overlook or dismiss.

Diego Torres-Russotto, M.D., chair of neurology at Baptist Health Miami Neuroscience Institute, is a movement disorders specialist whose practice includes Parkinson’s disease, tremors, gait disturbance, tics and other neurological disturbances. He says Parkinson’s symptoms can start long before someone realizes a neurological disorder may be developing.

Diagnosing Parkinson’s requires a comprehensive clinical evaluation that includes the patient’s medical history, symptom review and neurological exam. There is no single blood test or scan that independently confirms Parkinson’s, he says.

“As clinicians, we generally look for bradykinesia, or slowness of movement, plus at least one other core feature such as resting tremor, limb rigidity or change in gait or balance,” Dr. Torres-Russotto says. “An MRI and bloodwork can help rule out other conditions or support the assessment. But they don’t replace expert clinical judgment.”

Sometimes, other tests are useful, including a DaTscan (Dopamine Transporter Scan) or a skin biopsy looking for the abnormal protein that causes Idiopathic Parkinson’s disease. Dr. Torres-Russotto says there is evidence that movement disorders subspecialists are highly accurate in confirming Parkinson’s disease diagnoses, but the process can take time.

New Tools Are Improving Parkinson’s Diagnoses

While patients with advanced disease have symptoms that are fairly obvious, that’s not always the case for those with early-stage Parkinson’s, says Sameea Husain, D.O., director of movement disorder neurology at Marcus Neuroscience Institute, part of Baptist Health, at Boca Raton Regional Hospital.

Newer tools such as Syn-One testing are enhancing confirmation accuracy and speeding results.

“By identifying abnormal alpha-synuclein in nerve fibers of the skin, which has been linked to Parkinson’s and other movement disorders, this skin-biopsy-based test can help us confirm a clinical diagnosis with up to 96.7 percent accuracy,” Dr. Husain notes.

Another major benefit of Syn-One? The results are available in weeks, not months, says Dr. Husain. “Every week spent waiting for confirmation just delays for another week our ability to help our patients manage their disease. The sooner we can confirm our diagnosis, the better.”

Dr. Husain notes that not everyone with Parkinson’s has tremors. “The symptoms that many patients often ignore are frequently the ones that arrive before a classic tremor — or even instead of tremor.”

The Early Signs That Many People Miss

According to Dr. Husain, some of the most important warning signs come earlier and can appear unrelated, says. Early symptoms that could be precursors of Parkinson’s may include:

Body Changes

• Loss or reduced sense of smell
• Constipation

Movement Changes

• Smaller handwriting
• Reduced arm swing while walking
• One-sided stiffness or shoulder pain
• Stooped posture or balance changes

Sleep and Voice Changes

• Acting out dreams (REM sleep disorder)
• A softer, more monotone voice

Dr. Husain emphasizes that while no single symptom itself should be considered a definitive confirmation of Parkinson’s, “a cluster of any of these would be concerning and should prompt an evaluation by a movement disorders specialist.”

The problem, she adds, is that many of these early symptoms are often mistaken for stress, aging or orthopedic issues. “As a result, patients often just treat their symptoms and they delay seeking care — until they start experiencing disabling tremors. By that time, the disease has already progressed.”

What is Parkinson’s Disease?

Parkinson’s disease is a progressive neurological disorder that affects dopamine-producing neurons in a part of the brain called the substantia nigra. As dopamine levels decline, movement becomes slower and more difficult to control.

Symptoms generally develop slowly over years. Disease progression is often different from one person to another but people with Parkinson’s may experience:

• Tremor, mainly at rest
• Bradykinesia (slowness of movement)
• Limb rigidity
• Gait and balance problems

The Parkinson’s Foundation estimates that more than 1.1 million people in the United States are living with Parkinson’s disease, a number expected to reach 1.2 million by 2030. Nearly 90,000 people are newly diagnosed each year. The prevalence of the disease increases with age and tends to be higher in men, the Foundation also reports.

While the disease itself is not fatal, complications from Parkinson’s can be serious. According to the U.S. Centers for Disease Control and Prevention (CDC), complications from Parkinson’s is the 14^th leading cause of death in the U.S.

Why a Parkinson’s Diagnosis Isn’t Always Straightforward

When a diagnosis of Parkinson’s is suspected, ruling out other types of movement disorders is the first step, Dr. Husain says.

“Before you can treat the disease, you have to know which disease you’re treating,” she says. “Not every tremor is Parkinson’s and not every Parkinson’s patient starts with tremor, which is why evaluation by a specialist matters.”

Many movement disorders have common symptoms that affect one’s gait, balance and other functions, adds Dr. Husain. “A misdiagnosis at this point could lead to ineffective treatment plans and poor outcomes.”

This is why you want to see a fellowship-trained neurologist at a specialized center such as Marcus Neuroscience Institute or Miami Neuroscience Institute, she says. “You want someone who is specially trained to spot the sometimes-subtle differences between Parkinson’s disease and other movement disorders.”

Is it Parkinson’s or Essential Tremor?

Parkinson’s is often confused with essential tremor (ET), but understanding when the tremor happens helps the neurologist distinguish between conditions, says Dr. Torres-Russotto.

• Parkinson’s tremor: occurs at rest
• Essential tremor: occurs during activity

“Parkinson’s disease is typically associated with a resting tremor because the tremor occurs while the affected body part is at rest, while essential tremor is considered an action tremor,” he explains. “A person with ET experiences tremors while performing a task, such as holding or drinking a beverage, typing on their computer or texting on their phone.”

Treatment Options Expanding for Parkinson’s Disease

Although there is no cure for Parkinson’s, Dr. Torres-Russotto says treatment options vary and include medications, surgery and, for some patients, an innovative, non-invasive approach being used by Baptist Health Brain & Spine Care experts.

• Medications: These can significantly improve symptoms like tremor, stiffness and slowness, especially early in the disease. They don’t stop the condition from progressing, however, and their effects may wear off over time. Also, patients can experience significant side effects.
• Duopa™ Pump Therapy: A treatment that delivers a steady flow of Parkinson’s medication directly into the intestine, in gel form rather than a pill. This improves drug absorption and helps control symptoms more consistently throughout the day.
• Deep Brain Stimulation (DBS): Typically used for people whose symptoms are no longer well controlled with medication. Thin electrodes implanted into specific areas of the brain are connected to a small pacemaker-like placed under the skin in the chest. This sends controlled electrical signals to the brain that help regulate the abnormal activity causing tremors and stiffness.
• High-Intensity Focused Ultrasound (HIFU): HIFU is a painless, non-invasive treatment in which the patient remains alert while thousands of targeted sound waves are precisely focused on a small area of brain tissue causing their tremors and stiffness. It can be used for some Parkinson’s patient whose symptoms aren’t adequately controlled by medication.

The Most Powerful Therapy Might Surprise You

At both Miami Neuroscience Institute and Marcus Neuroscience Institute, Dr. Torres-Russotto says patients have access to the most advanced treatments for movement disorders. These can go a long way in restoring daily function and improving the patient’s quality of life.

Yet modern medicine can take you only so far, he emphasizes. “Advanced treatments can and certainly do help but the number one therapeutic driver of success in Parkinson’s disease is exercise and physical activity,” Dr. Torres-Russotto states. “The more active patients are — and the more varied their movement — the better their outcomes and quality of life.”

Don’t Ignore the Subtle Signs of Parkinson’s

Parkinson’s disease doesn’t always announce itself clearly. It often begins with small, easily overlooked changes. Recognizing those signs early — and seeking care from a movement disorders specialist — can make a meaningful difference. Click here to learn more about the Parkinson’s disease treatments and specialists at Baptist Health Brain & Spine Care.