Dear Savvy Senior,

What are the early signs of Parkinson’s disease? My husband was recently diagnosed after noticing a slight thumb tremor but we’re wondering if we missed any other early warning signs. — Curious Wife

Dear Curious,

Recognizing the early signs of Parkinson’s disease is challenging because the symptoms are often subtle and/or similar to those in other health conditions, which means they can be overlooked, dismissed or misdiagnosed.

Parkinson’s disease, which afflicts around 1 million Americans, is a degenerative disorder that occurs when the brain’s dopamine-producing neurons die or become impaired. This happens in the part of the brain that controls movement, which can cause tremors, stiffness and difficulty with walking, balance and coordination.

The symptoms usually begin gradually and get worse over time, and the progression of symptoms is often different from one person to another. Some people with Parkinson’s become severely disabled, while others may experience only minor motor disruptions.

While the cause of Parkinson’s disease is unknown, scientists believe genetics and environmental factors (exposure to certain toxins) play a key role. Most people with Parkinson’s first develop the disease around age 60, and men are more likely to develop it than are women.

Parkinson’s disease is difficult to diagnose because there’s no definitive test to confirm it. That said, here are some of the key signs and symptoms of which to be aware.

Restless sleeping: This is a REM sleep behavior disorder (talking in your sleep, sleepwalking) and one of the strongest and earliest pre-diagnostic symptoms of Parkinson’s disease.

Loss of smell: Not being able to smell certain foods well such as bananas, dill pickles or licorice. This symptom occurs in 70% to 90% of patients.

Constipation: Problems with digestion and bowel movements are issues for people with Parkinson’s, and an early sign that can occur up to 20 years before being diagnosed.

Changes in handwriting: Writing may become harder, and your handwriting may appear much smaller than it has in the past.

Soft voice: According to the Parkinson’s Foundation, 89% of people with the disease will have speech and voice disorders, which often shows up first in volume of the voice.

Tremors: Slight shaking or tremor in your finger, thumb, hand or chin. The tremor usually happens at rest, and when you move the extremity, it may disappear. This is the most recognizable outward sign of Parkinson’s disease.

Slowed movement: Over time, Parkinson’s disease can slow movements, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair.

Masked face: The muscles in the face experience the same gradual stiffening as the rest of the body, which results in lack of smiling and facial expressions.

Impaired posture and balance: Stooping, leaning or slouching when you stand, and/or balance problems can all be an early sign of Parkinson’s.

Having these symptoms doesn’t mean a person has Parkinson’s disease. But if you are experiencing any of them, and you’re older than 60, consider talking with your doctor, who may order a DaT scan or Syn-One (Skin Biopsy) Test to help diagnose it.

For more information, visit the Parkinson’s Foundation at Parkinson.org.

Send your questions or comments to questions@savvysenior.org, or to Savvy Senior, P.O. Box 5443, Norman, OK 73070.