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Paying attention to early, subtle changes and acting on them can make a meaningful difference in managing Parkinson’s disease and improving quality of life.
Although Parkinson’s cannot be treated fully, an early diagnosis allows doctors to initiate treatment sooner, helping to control symptoms more effectively
Parkinson’s is a chronic and progressive neurological disorder that affects muscle control, movement, and balance, which is why people often think that tremors are its first symptom. It is important to understand that it doesn’t always start with shaking hands; in various cases, the early signs are subtle and easy to overlook. These early changes often appear long before tremors develop, leading to a delay in early medical intervention.
We speak to Dr Anurag Saxena, Cluster Head – Delhi NCR, Neurosurgery, Manipal Hospitals, Dwarka, New Delhi, to understand the lesser-known symptoms of Parkinson’s.
When neurons in an area of the brain known as the substantia nigra become impaired or die, Parkinson’s develops. These neurons are responsible for producing a chemical called dopamine, which helps in coordinating the body’s movements. When the level of dopamine decreases, it becomes difficult to control movements, leading to Parkinson’s. The symptoms are often overlooked as a sign of ageing, making people more confused in diagnosing.
Early Changes People Often Miss
Several subtle changes that people overlook most of the time, lay the foundation of Parkinson’s:
• Slow Movement: The first and most prominent symptom is the slowing of movement. Even simple actions such as buttoning a shirt, lacing shoes, or brushing teeth take twice the normal time.
• Muscle stiffness and rigidity: Constant stiffness is often confused with joint problems or a sore muscle. It is not like the stiffness due to old age because it does not get better with rest.
• Reduced facial expression: People may appear less expressive, with a “masked” facial appearance, even though emotions remain unchanged.
• Changes in handwriting: The handwriting may shrink and get more squeezed, which is usually seen even before tremors start.
• Soft or low voice: The voice may become softer, one tone, or unclear, making it difficult for others to catch what is said.
• Loss of smell: A reduced ability to smell, especially for everyday scents, can be an early non-motor sign of Parkinson’s.
• Sleep disturbances and fatigue: Poor sleep, excessive daytime tiredness, or acting out dreams may appear early and are often overlooked.
Early detection matters
Parkinson’s disease can play a crucial role in improving long-term outcomes. Although it cannot be treated fully, an early diagnosis allows doctors to initiate treatment sooner, helping to control symptoms more effectively and slow functional decline. Medications can be introduced at the right stage to manage movement-related issues, while early physiotherapy and regular exercise can help preserve mobility, strength, and balance for a longer period. Speech and occupational therapy can also be started early to address subtle changes in communication and daily activities, reducing future complications.
Treatment options available
Controlling symptoms and maintaining mobility is currently the hallmark of managing patients with Parkinson’s disease. So far, medications that stimulate dopamine function are very effective in reducing muscle stiffness and making movement easier. Physiotherapy and exercises on a regular basis are necessary for keeping balance and flexibility. For some patients whose symptoms are no longer adequately controlled with medication alone, Deep Brain Stimulation (DBS) may be considered. DBS is a surgical treatment in which thin electrodes are placed in specific areas of the brain that control movement. These electrodes deliver controlled electrical impulses that help regulate abnormal brain signals responsible for Parkinson’s symptoms.
Parkinson’s disease is more than a movement disorder, and tremors are not always the first warning sign. Paying attention to early, subtle changes and acting on them can make a meaningful difference in managing the condition and improving quality of life.
March 14, 2026, 20:33 IST