The Early Signs of Parkinson’s, Including Two Newly Recognised Ones

A retired teacher once described the moment she knew something was off. Not a tremor. Not a fall. Her signature on a birthday card had shrunk to half its usual size, and she had to squeeze the last letters against the edge of the envelope. Her husband, meanwhile, had been sleeping in the guest room for a year because she kicked and shouted in her sleep. Neither of them connected the two.

That is how Parkinson’s tends to arrive: quietly, in a scatter of small changes that each have an innocent explanation. A stiff shoulder blamed on the garden. Coffee that no longer smells like anything. Constipation that has gone on so long it feels normal.

Researchers have spent two decades mapping this early period, and the list keeps growing. Two additions, hearing loss and epilepsy, surprised even specialists. Here is what the evidence supports, what it does not, and what is worth mentioning to a doctor.

What does Parkinson's feel like in the beginning?

Most people describe the early months as vague rather than dramatic. An arm that does not swing when they walk. A foot that seems to catch on the carpet. A sense of moving through the day at three-quarter speed while everyone else is at full pace. Fatigue is common, and so is a low, flat mood that does not quite match circumstances.

One feature stands out: asymmetry. Parkinson’s almost always begins on one side of the body. The Mayo Clinic notes that symptoms usually start on one side and stay worse on that side even after both are affected. A right-handed person may notice their handwriting change; a left-handed person may find buttons suddenly fiddly.

Stiffness often shows up first as pain. A frozen shoulder that physical therapy does not fix, or an ache in the hip on one side, sends many people to an orthopedic clinic long before anyone thinks of the brain. The NHS lists this muscle stiffness, along with slowness of movement and tremor, as the three main symptoms, but adds that the condition can also cause problems with balance, sense of smell, sleep, and memory.

Timing matters too. The NHS points out that most people develop symptoms after age 50, though around 1 in 20 first notice them before 40. Younger onset often looks different, with stiffness and cramping in a foot more prominent than tremor. Whatever the age, the pattern is the same: a slow, one-sided drift that friends and family sometimes spot before the person does.

Why early signs appear years before the tremor

The tremor most people associate with Parkinson’s is a late arrival. To understand why, it helps to know what is happening inside the brain. Deep in the midbrain sits a small cluster of cells called the substantia nigra, which produce dopamine, a chemical messenger that keeps movement smooth and automatic. In Parkinson’s, these cells gradually die.

The brain compensates remarkably well for a long time. According to the NHS, the classic movement symptoms usually become apparent only after around 80% of these dopamine-producing cells have been lost. Everything before that point is a kind of silent phase, and it is here that the so-called premotor or prodromal signs live.

Why smell, sleep, and digestion? The answer lies in a protein called alpha-synuclein. The National Institute of Neurological Disorders and Stroke explains that in Parkinson’s this protein clumps into deposits called Lewy bodies, and these are found not just in the substantia nigra but in the olfactory bulb (which processes smell), the brainstem regions that regulate sleep, and even the nerves of the gut.

One influential theory proposes that the disease process begins in the nose and intestines and travels upward along nerve pathways over many years, reaching the movement centers last. The evidence for this is strong in some people and weaker in others, and researchers now think there may be more than one route. Either way, the practical message is clear: the body often signals trouble long before the hand shakes.

Loss of smell: often the first clue nobody notices

Ask someone with Parkinson’s when their sense of smell faded and many will pause, think, and say they cannot remember. That is the trouble with smell. It slips away gradually, and unlike sight or hearing, we rarely test it. Coffee becomes background. Gas leaks go unnoticed. A partner remarks that the milk has turned, and the person genuinely cannot tell.

The Mayo Clinic lists a reduced sense of smell among the symptoms of Parkinson’s, and it consistently appears in research as one of the earliest, with many people reporting the change years before any movement problem. The mechanism links back to Lewy bodies forming in the olfactory bulb, one of the first brain regions affected.

Here is where honesty matters. Smell loss is extremely common for reasons that have nothing to do with Parkinson’s: viral infections, nasal polyps, allergies, head injury, smoking, and plain aging. Most people who lose their sense of smell will never develop Parkinson’s. What raises interest is smell loss that arrives with no obvious nasal cause, does not recover, and keeps company with other items on this list.

A simple habit is worth adopting. Notice whether you can smell everyday things: soap, coffee grounds, a cut orange, a struck match. If several of these have gone quiet and you cannot pin it on a cold, mention it at your next appointment. On its own it proves nothing. Alongside vivid, physically active dreams or new constipation, it becomes a thread worth pulling.

Acting out dreams: the sleep disorder that predicts Parkinson's

Normal dreaming comes with a built-in safety switch. During REM sleep, the stage when dreams are most vivid, the brainstem paralyzes the body’s large muscles so the sleeper stays still. In REM sleep behavior disorder, that switch fails. People punch, kick, leap out of bed, or shout full sentences while dreaming, often about being chased or attacked.

Of all the premotor signs, this one carries the most weight. The Mayo Clinic describes acting out dreams as a sleep problem associated with Parkinson’s, and long-term studies following people with REM sleep behavior disorder have found that a large share go on to develop Parkinson’s or a related condition over the following years. This is why sleep specialists take it seriously and why neurologists ask about it directly.

Bed partners are the usual witnesses. The person often has no idea, or remembers only a vivid dream, and learns about the kicking from the bruises on their spouse’s shin. Injuries to either partner are common, and many couples end up sleeping apart without anyone asking why.

Distinguishing this from ordinary restlessness or sleepwalking matters. Sleepwalking happens in deep non-REM sleep, usually in the first part of the night, and the person is not dreaming. Dream enactment happens later, in REM sleep, and the movements match the dream’s story. A sleep study can tell the difference by recording muscle activity during REM.

If you or a partner physically act out dreams, especially past age 50, raise it with a doctor. Effective ways to make the bedroom safer exist, and it opens a conversation about monitoring over time.

Constipation and the gut connection

Digestion is not the first thing anyone associates with a brain condition, yet the gut may be where Parkinson’s makes some of its earliest moves. The NHS lists constipation among the physical symptoms, and studies of people later diagnosed show that sluggish bowels often predate movement problems by years.

The intestines have their own nerve network, sometimes called the second brain, with hundreds of millions of neurons coordinating the muscular waves that push food along. Autopsy studies have found alpha-synuclein deposits in these gut nerves in people with Parkinson’s, which fits the idea that the disease process can begin outside the brain and slow intestinal movement long before dopamine cells are affected.

The pattern to watch is new, persistent constipation without an obvious cause. Not the occasional bad week after travel or a change in diet, but a steady shift toward fewer bowel movements, harder stools, and straining, lasting months. The Cleveland Clinic also notes that reduced activity and the slowing of automatic muscle movements contribute as the condition progresses.

Constipation is one of the most common complaints in any primary care office, and the overwhelming majority of cases are down to low fiber, low fluid intake, inactivity, medications, or thyroid problems. It becomes more interesting as a Parkinson’s clue only in combination, when it sits alongside smell loss, dream enactment, or a change in handwriting. Doctors think in patterns, not isolated symptoms, and this is exactly the kind of detail worth adding to the picture.

Small handwriting, a soft voice, and a face that stops moving

Some of the most telling early changes are the ones other people notice first. A friend asks you to repeat yourself. A colleague wonders why you look so serious in meetings. Your bank flags a signature that no longer matches the one on file.

Handwriting is a classic. The Mayo Clinic describes writing that becomes small and cramped, a phenomenon doctors call micrographia. Letters often start at normal size and shrink across the line as the hand runs out of automatic momentum. Compare a current shopping list with one from a few years ago and the difference can be startling.

Speech follows a similar logic. Voices become softer, flatter, sometimes hoarse or rushed, with less of the natural rise and fall that carries meaning. People frequently insist they are speaking normally and feel that everyone else has started mumbling. The muscles of the larynx and chest wall are simply not generating their usual force.

The face changes for the same reason. Fewer spontaneous expressions and reduced blinking create what clinicians call hypomimia, or a masked face. Family members may read it as sadness, boredom, or anger when the person feels none of those things. This misreading strains relationships and is one reason depression and Parkinson’s are so often tangled together in the early years.

Each of these traces back to bradykinesia, the slowness and reduced amplitude of movement that the NHS identifies as a core feature. The brain is not sending the small, continuous adjustments that keep writing large, speech loud, and faces animated. Noticing this in yourself is hard; noticing it in someone you love is often the first step toward a diagnosis.

Tremor, stiffness, and slowness: the classic motor signs explained

When movement symptoms finally surface, they come in three recognizable forms. Knowing what each actually looks like helps separate genuine warning signs from everyday aches and jitters.

Tremor in Parkinson’s is a resting tremor. The Mayo Clinic describes it typically beginning in a hand or fingers, sometimes as a back-and-forth rubbing of thumb and forefinger known as pill-rolling. The key word is resting. It appears when the hand lies in the lap or hangs at the side, and it often eases when the hand reaches for a cup. Stress makes it worse; sleep makes it disappear. A tremor that only appears when you hold a fork or pour tea points somewhere else, usually essential tremor.

Rigidity is stiffness that does not loosen with stretching. The NHS notes it can make facial expressions difficult and cause painful muscle cramps. Doctors feel for it by moving a relaxed limb and noticing a steady resistance, sometimes with a ratchety quality.

Bradykinesia, the slowness, is the one that must be present for a diagnosis. It shows up as shorter steps, difficulty rising from a chair, a reduced arm swing on one side, and trouble with rapid repetitive movements like tapping or buttoning.

Not everyone gets all three, and roughly a quarter of people never develop a noticeable tremor at all, which is one reason the condition can be missed. A stooped posture, a shuffling gait, and a tendency to freeze mid-step tend to come later. The early picture is usually one side, one or two of these features, and a nagging sense that something has changed.

What are the two newly recognised early signs of Parkinson's?

In 2022, a research team published an analysis in JAMA Neurology drawing on primary care records from more than a million people in East London, a population far more ethnically and economically diverse than most Parkinson’s studies. They compared people who went on to receive a Parkinson’s diagnosis with those who did not, looking back through the records for symptoms and conditions recorded in the preceding years.

Familiar signs surfaced as expected: tremor, constipation, depression, anxiety, memory complaints, and low blood pressure on standing. Two findings were new. Hearing loss and epilepsy were both recorded meaningfully more often in people who were later diagnosed with Parkinson’s, and the associations held even after accounting for age and other factors.

What does this mean in practice, and what does it not mean? It does not mean that hearing loss causes Parkinson’s, or that a person with epilepsy should expect to develop it. Most people with either condition never will. The findings describe an association in health records, which can arise for several reasons: shared underlying biology, medications, or simply that people under medical care for one condition are more likely to have another noticed.

The biological case is not far-fetched. Alpha-synuclein pathology has been found in the inner ear and auditory pathways in some studies, and the same brain network disruption that causes Parkinson’s could plausibly lower the seizure threshold. Larger studies are needed, and other groups are now looking at whether these findings hold in different populations.

For now, the reasonable position is this: new, unexplained hearing loss or a first seizure in midlife are worth investigating in their own right. If they arrive alongside smell loss, dream enactment, or one-sided stiffness, that combination deserves a neurologist’s attention.

What are the morning symptoms of Parkinson's disease?

Mornings tell a particular story. Many people with early Parkinson’s describe the first hour after waking as their stiffest and slowest. Getting out of bed becomes a project: rolling over is harder, sitting up takes a deliberate push, and the first steps to the bathroom feel wooden. Tremor, if present, may be more noticeable before the day’s activity warms things up.

The reasons are partly mechanical and partly chemical. Muscles that have been still for eight hours are stiff in anyone, but rigidity in Parkinson’s amplifies this. Dopamine signaling also tends to be lowest after a long overnight gap, and for people already on treatment, the NHS notes that symptoms can return as the effect of medication wears off between doses. Overnight is the longest such gap. Prescribing clinicians manage this in various ways, and any change belongs in that conversation, not in a magazine article.

Other morning features people report include cramping in the toes or foot, sometimes called dystonia, particularly in younger-onset Parkinson’s; a heavy, foggy feeling that lifts slowly; low blood pressure on standing that brings dizziness at the bedside; and a dry mouth or drooling from reduced automatic swallowing during sleep.

Poor sleep compounds everything. The Mayo Clinic lists sleep problems, including waking often during the night and daytime sleepiness, among the condition’s non-motor effects. A person who has spent the night fragmented by dream enactment, bathroom trips, and difficulty turning over is not going to feel sharp at seven a.m.

Keeping a brief morning log for two or three weeks, noting stiffness, tremor, mood, and how long it takes to feel mobile, gives a clinician far more to work with than a general sense of feeling rough.

What is the 2 finger test for Parkinson's?

Short videos circulating online show people tapping their thumb and index finger together as fast as they can and declaring the result a Parkinson’s test. The idea has a real origin, but the internet version strips out everything that makes it useful.

Finger tapping is a genuine part of the standardized neurological examination for Parkinson’s. A clinician asks the person to tap index finger against thumb as quickly and widely as possible, ten or more times, and watches each hand separately. They are looking for specific things: whether the taps get smaller as they go on (decrement), whether the rhythm breaks down or hesitates, whether speed drops off, and crucially whether one hand performs noticeably worse than the other. These are the fingerprints of bradykinesia described by the NHS as slowness of movement, and they are hard to fake or to hide.

What the test cannot do is diagnose anyone in a bathroom mirror. Tapping speed varies with age, arthritis, fatigue, caffeine, anxiety, and how much attention a person pays to the task. Plenty of healthy people tap slowly; some people with early Parkinson’s tap quite well. A trained examiner interprets the tapping alongside a walk down the corridor, a check of muscle tone, a look at handwriting, a review of the history, and often a second visit months later.

The Johns Hopkins Medicine overview is clear that there is no single laboratory test for Parkinson’s; the diagnosis rests on clinical examination and history. Finger tapping is one instrument in that orchestra. Enjoy the video if you like, then let a neurologist do the interpreting.

What illness is confused with Parkinson's?

Parkinson’s is a clinical diagnosis, which means it is also a diagnosis that can be wrong. Several conditions produce overlapping features, and early on even experienced neurologists sometimes revise their opinion as the picture evolves. Knowing the main look-alikes helps explain why a doctor might hesitate or ask for a follow-up visit.

Condition	How it overlaps	What usually sets it apart
Essential tremor	Shaking hands	Tremor appears during action (pouring, writing), affects both sides, often runs in families, no stiffness or slowness
Drug-induced parkinsonism	Slowness, stiffness, tremor	Begins after starting certain medicines that block dopamine; usually symmetric; may improve when the drug is changed by the prescriber
Vascular parkinsonism	Shuffling gait, balance problems	Caused by small strokes; affects legs more than arms; brain imaging shows vascular damage
Normal pressure hydrocephalus	Slow, wide-based walking	Comes with urinary urgency and memory decline; imaging shows enlarged fluid spaces in the brain
Atypical parkinsonian syndromes	Early symptoms nearly identical	Faster progression, early falls, eye movement problems, or early blood pressure and bladder failure
Depression or anxiety	Flat expression, slowness, fatigue	Movement improves as mood lifts; no rigidity on examination

The Mayo Clinic notes that no specific test exists to diagnose Parkinson’s, so clinicians rely on history, examination, and sometimes imaging to rule out alternatives. A drug review is one of the highest-yield steps, since certain medicines for nausea, psychiatric conditions, and dizziness can produce a convincing imitation. The MedlinePlus overview describes Parkinson’s as one of a group of movement disorders, and sorting out which one is often a matter of watching how things unfold over one to two years rather than a single snapshot.

Can a blood test or skin test find Parkinson's early?

Headlines about detecting Parkinson’s in blood, spinal fluid, or skin arrive every few months, and the excitement is understandable. If the disease process begins many years before symptoms, a reliable biological marker could transform how early people are identified and how new treatments are tested. Where does the evidence actually stand?

The most advanced approach targets alpha-synuclein, the protein the NINDS identifies as the main component of Lewy bodies. Laboratory techniques called seed amplification assays take a sample of cerebrospinal fluid, add normal protein, and watch whether misfolded seeds in the sample cause it to clump. Large research cohorts have shown these assays can identify most people with clinically diagnosed Parkinson’s and can be positive in people with REM sleep behavior disorder or smell loss who have not yet developed movement symptoms.

Skin biopsy is a second route, since alpha-synuclein deposits can be found in the small nerve fibers of the skin. Blood-based versions are in development, and some early results are promising, though blood is a far noisier sample than spinal fluid.

The caveats are substantial. These tests are used in research settings and in some specialist centers to support a diagnosis, not to screen healthy people. A positive result in a person with no symptoms does not tell them when, or whether, symptoms will begin, and there is currently no treatment proven to delay the disease in that window. Imaging scans of the dopamine system exist and can help distinguish Parkinson’s from essential tremor, but they cannot separate Parkinson’s from the atypical syndromes.

The honest summary: the science is moving fast, the tools are real, and their place in routine care is still being worked out. Ask a neurologist what, if anything, would change your care before pursuing one.

When to see a doctor about possible early Parkinson's

The signs in this article are common, and most people who have one or two of them do not have Parkinson’s. The purpose of knowing them is not to worry but to notice patterns and get them assessed sooner rather than later. Earlier evaluation means earlier support for symptoms that affect daily life, whatever the cause turns out to be.

Book an appointment with your primary care clinician if you notice a resting tremor in one hand, stiffness or slowness that is clearly worse on one side, handwriting that has shrunk, a voice others describe as quiet, or a combination of smell loss, constipation, and physically acting out dreams. The NHS advises seeing a doctor if you are concerned you may have symptoms of Parkinson’s, and a referral to a neurologist is the usual next step when the examination raises questions.

Before the visit, write down when each change began, which side it affects, what makes it better or worse, and a full list of medications and supplements, since some drugs mimic Parkinson’s. Bring a partner or friend who has observed your sleep and walking; their account is often more useful than your own.

Seek urgent care, rather than waiting for a routine appointment, if any of the following occur: a first-ever seizure; sudden weakness, numbness, facial drooping, or slurred speech, which can signal a stroke; a fall with head injury or loss of consciousness; sudden severe confusion; or a tremor or movement problem that appears abruptly over hours rather than months. These red flags point to conditions that need immediate attention and are not the slow pattern typical of Parkinson’s.

Diagnosis can take time, sometimes more than one visit, and that uncertainty is normal. The decisions about testing, monitoring, and any treatment sit with you and your treating team, informed by how things evolve.

Frequently asked questions

What are the 2 new early signs of Parkinson's?

Hearing loss and epilepsy are the two newly recognized early signs. A 2022 study in JAMA Neurology, based on primary care records from more than a million people in East London, found both conditions were recorded more often in people who later received a Parkinson’s diagnosis. The finding is an association, not proof of cause, and most people with hearing loss or epilepsy never develop Parkinson’s. Researchers are now testing whether the link holds in other populations.

What does Parkinson's feel like in the beginning?

Early Parkinson’s usually feels subtle and one-sided: a stiff or aching shoulder, a hand that does not swing when walking, a foot that catches, and a general sense of moving more slowly than usual. Fatigue, low mood, and smaller handwriting are common. Many people first see an orthopedic specialist for shoulder pain before anyone considers a neurological cause. Tremor, when it occurs, tends to appear in one resting hand.

What are the morning symptoms of Parkinson's disease?

Mornings are often the stiffest and slowest part of the day. People describe difficulty rolling over and getting out of bed, wooden first steps, more noticeable tremor before activity warms the body, foot or toe cramping, dizziness on standing, and a foggy feeling that lifts slowly. Overnight is the longest gap in dopamine signaling, and disrupted sleep from dream enactment or frequent waking makes early mornings harder still.

What is the 2 finger test for Parkinson's?

The 2 finger test refers to finger tapping, a real component of the neurological examination in which a person taps thumb and index finger together rapidly while a clinician watches for shrinking amplitude, slowing, hesitation, and differences between hands. These are signs of bradykinesia. Social media versions cannot diagnose anything, because tapping speed varies with age, arthritis, fatigue, and attention. A trained examiner interprets it alongside gait, muscle tone, and history.

What illness is confused with Parkinson's?

Essential tremor is the most common mix-up, but it causes shaking during action rather than at rest and lacks stiffness or slowness. Drug-induced parkinsonism from certain nausea, psychiatric, or dizziness medicines can look almost identical. Vascular parkinsonism from small strokes, normal pressure hydrocephalus, atypical parkinsonian syndromes, and depression can also mimic early Parkinson’s. Because no single test confirms the diagnosis, neurologists often observe how symptoms evolve over one to two years.

How early can signs of Parkinson's appear before diagnosis?

Some non-motor signs can appear years, and in some people more than a decade, before movement symptoms bring a diagnosis. Loss of smell, REM sleep behavior disorder, constipation, depression, and anxiety are the best-documented early features. This long lead time reflects the brain’s ability to compensate for dopamine cell loss until roughly 80% of those cells are gone. Individual timelines vary widely, and having early signs does not mean Parkinson’s is inevitable.

Is loss of smell always a sign of Parkinson's?

No. Smell loss is extremely common and usually caused by viral infections, allergies, nasal polyps, head injury, smoking, or aging. It becomes relevant to Parkinson’s only when it is unexplained, does not recover, and appears alongside other early features such as acting out dreams, new constipation, or one-sided stiffness. Most people who lose their sense of smell never develop Parkinson’s, so on its own it is a reason for a routine check, not alarm.

Does everyone with Parkinson's have a tremor?

No. Roughly a quarter of people with Parkinson’s never develop a noticeable tremor, and their condition is sometimes recognized later because stiffness and slowness are easier to attribute to aging or arthritis. Bradykinesia, the slowness of movement, is the feature required for diagnosis. When tremor is present, it typically occurs at rest in one hand, sometimes as a rubbing motion between thumb and forefinger, and eases during purposeful movement.

Can a blood test detect Parkinson's early?

Not yet in routine care. Research assays that detect misfolded alpha-synuclein in spinal fluid can identify most people with clinically diagnosed Parkinson’s and are positive in some people with early signs such as smell loss or REM sleep behavior disorder. Skin biopsy and blood-based versions are in development. These tools are used mainly in research and specialist settings, and a positive result cannot predict when or whether symptoms will begin.

When should I see a doctor about possible Parkinson's symptoms?

See your primary care clinician if you notice a resting tremor in one hand, stiffness or slowness that is worse on one side, shrinking handwriting, a quieter voice, or a cluster of smell loss, constipation, and dream enactment. Seek urgent care for a first seizure, sudden weakness or slurred speech, a fall with head injury, or movement problems that appear over hours rather than months, since these point to conditions needing immediate attention.

References

• NHS: Parkinson's disease: Symptoms
• NIH National Institute of Neurological Disorders and Stroke: Parkinson's Disease
• MedlinePlus: Parkinson's Disease
• Cleveland Clinic: Parkinson's Disease: An Overview

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.