Learn to identify early signs of Parkinson’s disease. Discover motor and nonmotor symptoms, screening tips and when to refer patients.

Published: July 23, 2025

Early recognition of Parkinson’s disease requires health care providers to look beyond the classic tremor. Parkinson’s disease affects approximately 1 million people in the United States, with 90,000 new diagnoses each year. Despite its prevalence, early recognition remains challenging for health care providers.

Parkinson’s disease is the most common neurodegenerative movement disorder, characterized by abnormal movement patterns, including difficulty moving, slowness, stiffness and tremor.

“Everybody thinks about tremor, and certainly many with Parkinson’s have tremor, but about 20% of patients with Parkinson’s don’t have tremor,” said Jason L. Crowell, M.D., neurologist and movement disorder specialist at Norton Neuroscience Institute. “It is not uncommon for there to be a delay in diagnosis in patients who present without a tremor.”

Noticing early signs of Parkinson’s

Health care providers should maintain a high index of suspicion for certain motor and nonmotor symptoms:

Motor symptoms

The classic triad includes:

• Bradykinesia: Slowness of movement is the most essential finding and must be present for diagnosis. Look for slowness where movements become interrupted and progressively smaller with successive repetitions.
• Resting tremor: Tremor occurs when hands are at rest, either by the patient’s side or in their lap.
• Rigidity: Stiffness can be noted during passive range of motion examination.

These symptoms typically present asymmetrically, affecting one side of the body more than the other, initially.

Nonmotor symptoms

Several nonmotor symptoms may precede motor manifestations:

• Anosmia: Loss of sense of smell
• REM sleep behavior disorder: Acting out dreams during sleep
• Constipation: Nonspecific but has a close association with Parkinson’s disease.
• Depression and anxiety: May appear before motor symptoms

Questions to ask family members

When evaluating patients, health care providers should inquire about the specific functional changes that families might observe:

Changes in movement and gait

• “Are they not picking their feet up when they walk?”
• “Are they moving more slowly when you take walks together?”
• “Do they now walk behind you when they used to walk beside you?”

Fine motor skills

• “Have you noticed changes in handwriting?”
• “Is there more difficulty chopping things in the kitchen?”
• “Are there problems with buttons, zippers or other fine motor tasks?”

Sleep and sensory changes

• “Does your loved one act out dreams or move excessively during sleep?”
• “Have you noticed a decreased sense of smell?”

Screening guidelines to improve early recognition

Providers should use the following clinical evaluation approach when Parkinson’s disease is suspected:

1. Comprehensive history: Focus on both motor and nonmotor symptoms, paying particular attention for symptoms presenting on only one side of the body.
2. Neurological examination: Look specifically for:
   • Bradykinesia with decrementing amplitude
   • Tremor when an arm or leg is at rest
   • Rigidity in an arm or leg
   • Postural instability (typically in later stages)
3. Functional assessment: Evaluate handwriting, walking pattern and ability to perform rapid alternating movements.

Consider increased surveillance in patients with the following risk factors:

• Exposure to herbicides and pesticides
• Rural upbringing or farm background
• Family history of Parkinson’s (though only 10% to 15% of cases are inherited)

When to refer to neurology

Primary care providers should consider referral to a movement disorders specialist when:

• Two or more cardinal motor symptoms are present
• Symptoms are interfering with daily activities
• There is diagnostic uncertainty

The Norton Neuroscience Institute Cressman Parkinson’s & Movement Disorders Center is dedicated to offering the most advanced treatments and support for people with Parkinson’s disease.  To detect early signs of Parkinson’s, health care providers must look for symptoms beyond the classic tremor and focus on the constellation of motor and nonmotor symptoms, particularly bradykinesia and rigidity.

In maintaining clinical suspicion, providers should ask targeted questions about functional changes, recognizing that early symptoms, though seemingly unrelated, may form a cohesive clinical picture. The goal of early recognition extends beyond diagnosis; it enables timely interventions that can preserve quality of life and potentially slow disease progression. Norton Neuroscience Institute offers some of the most advanced treatments available to help control symptoms.