8 Early Warning Signs of Parkinson’s Disease

Some symptoms can be easy to overlook

Jen A. MIller

Updated October 29, 2025

Reviewed by

Rachel Dolhun, M.D.

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En español

Published May 04, 2022

/ Updated October 29, 2025

A male doctor talking with a male patient in an exam room

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At least 1.1 million people in the United States are living with Parkinson’s disease. It’s the second-most-common neurodegenerative disease after Alzheimer’s disease, with estimates that 90,000 people are diagnosed with Parkinson’s disease each year.

Age is the most common risk factor, with the average age of onset around age 60. Understandably, older adults, who are most affected by the disease, are on the lookout for possible signs of the condition.

Most of us can recognize some signs of Parkinson’s disease, such as tremor and trouble walking. Yet, 25 percent of people with Parkinson's may never develop a tremor, research shows. Other, early-stage symptoms can appear a decade or more before the disease presents in more obvious physical forms. And they are often mistaken for something else — including normal aging.

Common problems among older adults, such as trouble sleeping, constipation, muscle stiffness and increased anxiety and depression, are related to early-stage Parkinson’s. Experiencing them doesn’t mean you have Parkinson’s disease, but they are worth discussing with your doctor, especially if you have several of them at the same time.

“The early signs are normally not problems that bring anybody to the doctor,” says Dr. Michele Tagliati, director of the division of movement disorders and vice chair of the department of neurology at Cedars-Sinai Medical Center. But there is increasing awareness of early signs, he says.

That’s a good thing because it means that people are coming into offices like his to be evaluated earlier. Though there is no cure for Parkinson’s, medications can treat some of the symptoms, lifestyle changes can help manage the disease and an early diagnosis can ease planning. Plus, an early diagnosis allows people to participate in research that is exploring ways to prevent or delay disease progression.

Here are eight things to look for.

1. Acting out your dreams

Physically acting out dreams, punching kicking or yelling while sleeping, is known as REM sleep behavior disorder. It can be an early warning sign of Parkinson’s. “We are supposed to be completely still and paralyzed” during sleep, Tagliati says, but for someone with Parkinson’s, the “mechanism in the brain that oversees this phase of sleep is somewhat defective.”

One sign of this problem is falling out of bed. If you live with someone, they might see or hear you acting out your dreams or jumping out of bed suddenly. If you live alone, you may wake up with twisted sheets or jar yourself awake yelling, says Dr. Camilla Kilbane, a neurologist and movement disorder specialist at University Hospitals Cleveland Medical Center.

2. Loss of smell

Losing your sense of smell, or hyposmia, is a well-known symptom of COVID-19 and other viral infections. But in those cases, after the infection, the sense of smell usually returns. In Parkinson's the loss is usually permanent.

Researchers aren’t quite sure why loss of smell occurs with Parkinson’s, Tagliati says, but this symptom appears in 90 percent of early-stage Parkinson’s cases. One popular theory says that Parkinson's may start in the olfactory bulb, the part of the brain that controls sense of smell. Some researchers believe clumps of the protein alpha-synuclein (a hallmark of Parkinson's disease) may form in the olfactory bulb before moving to other parts of the brain.

Like sleep problems, issues with smell are easy to brush off and attribute to something else. But loss of smell shouldn’t be ignored, especially in the presence of other symptoms.

3. Constipation

Parkinson’s affects the autonomic nervous system, which controls bodily functions we don’t normally think about, such as going to the bathroom. Parkinson’s might also affect the gut microbiome, according to a study published in the journal Neurology, which in turn affects how your digestive system functions — or doesn’t. A third of U.S. adults over age 60 report having constipation, so if you have this condition, mention it to your doctor, but there’s no reason to panic.

4. Anxiety/depression

Parkinson’s harms the brain’s ability to create serotonin and dopamine, two chemicals that affect mood. Changes in the levels of these chemicals, also called neurotransmitters, can lead to increased anxiety and depression. According to the Parkinson’s Foundation, patients can experience depression or anxiety for two to five years before diagnosis.

Parkinson’s-induced mood disorder isn’t typically drastic, like major depression, Kilbane says. But a spouse or family member might notice a change — for example, when a normally happy person becomes a worrier.

“It’s so subtle that people may not go to the doctor,” she says.

5. Soft voice

According to the Parkinson’s Foundation, 89 percent of people with Parkinson’s will have speech and voice disorders. That often shows up first in their voice’s volume. A person may speak more softly without realizing it, Kilbane says, and a spouse, friend or family member has to ask the person to speak up or repeat himself.

6. Masked face

Parkinson’s affects muscles in the face, which experience the same gradual stiffening as the rest of the body. People with Parkinson’s will have “less facial mimicry and less spontaneous smiling,” says Kilbane, who calls this condition “poker face.”

People might think you’re angry or upset because your positive emotions are less likely to translate into a smile or other facial cues that show joy or appreciation.

7. Stiffness and gait problems

It’s common for undiagnosed Parkinson’s patients to view stiffness and gait problems as part of aging, Kilbane says. “You anticipate as you get older that you may slow down a bit in your movements, you might be a little stiffer and might shuffle a bit,” she says.

Stiffness from Parkinson’s can be mistaken for arthritis, but it will appear in the muscles, not the joints. It can be hard for a person to make that distinction without medical guidance, Kilbane says. Gait problems can show up in someone who has trouble keeping up with their peers on a walk or getting in and out of a car — again, something that might be attributed to old age. But both are signs of potential Parkinson’s.

8. Resting tremors

Shaking in the hand, foot or leg is often the first obvious visual sign of Parkinson’s, Tagliati says. By the time Parkinson’s affects muscles in this way, most patients have already experienced early signals such as sleep, smell and digestion problems — sometimes for years. Involuntary movements are typically on one side of the body — not necessarily the dominant side — and occur when the limb is at rest. “Normally, when you use the hand, the tremor goes away,” Tagliati says. “Many people put their hand in a pocket, and nothing really happens.” A tremor in the chin can also happen in Parkinson’s and should be investigated.

Researchers are learning how our daily activities can support our brain health, including exercise, diet, music and social connections — for people with and without brain disorders.

Editor's note: This story, first published May 4, 2022, has been updated to include new information.

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Jen A. Miller is a contributing writer and author of Running: A Love Story. Her work has appeared in The New York Times, The Washington Post, Slate and O, The Oprah Magazine, among other publications.

Rachel Dolhun, M.D., is a fellowship-trained movement disorder specialist, double-board certified neurologist and lifestyle medicine physician. She is the principal medical advisor at The Michael J. Fox Foundation for Parkinson's Research.