Parkinson’s disease mainly affects the central nervous system, which is made up of the brain and spinal cord. In Parkinson’s disease, the brain cells that produce a neurotransmitter (a chemical that transmits nerve signals between cells) called dopamine begin to die off. As these cells die, levels of dopamine drop, and communication between the brain and the rest of the body is impaired. Researchers believe parkinsonian symptoms become apparent when about half the dopaminergic cells have been destroyed. Levels of other neurotransmitters rise to compensate for the loss of dopamine, causing more symptoms.

Medications and other treatments can help manage many Parkinson’s symptoms.

Symptoms of Parkinson’s vary by the type of parkinsonism and between individuals. Someone with Parkinson’s will not necessarily experience all or even most symptoms. Parkinson’s is a progressive disease, which means that symptoms worsen gradually over time, new symptoms appear, and disability accumulates.

Motor Symptoms

Everyone with Parkinson’s experiences symptoms related to movement, known as motor symptoms. In early stages of Parkinson’s, motor symptoms are typically limited to or worse on one side of the body. Motor symptoms are the hallmarks of parkinsonism, and the condition cannot be diagnosed without them. The most common motor symptoms of Parkinson’s include:

• Bradykinesia (slowed movement)
• Tremor
• Rigidity
• Loss of balance

Other motor symptoms of parkinsonism include:

• Stooped posture
• Shuffling gait
• Dystonia (repetitive twisting, swaying, or head-bobbing motions)
• Painful muscle contractions
• Muscle jerks or twitches
• Freezing episodes
• A masklike facial expression
• Decreased blinking
• Softer, slurred, or mumbled speech
• A monotone voice
• Drooling
• Dysphagia (difficulty swallowing)
• Micrographia (small handwriting)
• Slowed or abnormal eye movements
• Eyelid spasms
• Difficulty opening the eyes

Nonmotor Symptoms

Many people with Parkinson’s can experience many other types of symptoms in addition to motor symptoms. These can affect their thinking, mood, or other aspects of their health.

Cognitive Symptoms

Between 20 percent and 50 percent of those with Parkinson’s eventually experience cognitive difficulties, which can be mild or result in a dementia diagnosis. Cognitive changes, often referred to collectively as “cog fog” or “brain fog,” can include problems with memory, attention, processing information, finding the right words, slurred speech, learning and remembering new things, organization, and getting lost in familiar places.

Psychotic Symptoms

Between 25 percent and 70 percent of people with Parkinson’s experience some form of psychosis, a loss of connection with reality. Psychosis can either be caused directly by the disease or as a side effect of treatment.

Psychotic symptoms can include:

• Visual hallucinations — Seeing things that aren’t really there, like people, animals, or objects
• Delusions — Strongly believing something that isn’t true, like thinking you’re being followed or targeted
• Paranoia — Feeling suspicious or afraid without reason, such as thinking others are plotting against you
• Irrational fears — Experiencing overwhelming fears or anxieties that don’t seem logical or are blown out of proportion
• Flashbacks — Reliving a past event, often vivid and intense, as if it’s happening again in the present
• Nightmares — Having disturbing or frightening dreams that can feel very real and cause distress upon waking

Sensory Symptoms

Anosmia (decreased sense of smell) is very common and often among the earliest symptoms of Parkinson’s. Approximately 95 percent of people with Parkinson’s show at least some loss of sense of smell, according to Parkinson’s UK.

Some people with Parkinson’s experience vision changes, including:

• Blurred vision
• Double vision
• Loss of sensitivity in the perception of color and contrast

Parkinsonism may also affect a person’s sense of taste, causing foods to taste different or less flavorful than before. This can lead to changes in food preferences, decreased appetite, and challenges in maintaining a balanced diet.

Mood and Personality Changes

Parkinson’s and medications for the condition often cause changes in mood and can affect personality traits. Psychological symptoms of Parkinson’s can include:

• Depression — Feeling persistently sad, hopeless, or losing interest in things that once brought joy
• Anxiety — Experiencing excessive worry or fear about everyday situations, often with physical symptoms like restlessness or a racing heart
• Anger — Having sudden outbursts of frustration or rage, sometimes without clear reason
• Irritability — Feeling easily annoyed or short-tempered, even with minor frustrations
• Jealousy — Developing unwarranted feelings of envy or suspicion, especially in relationships
• Changes in libido — Experiencing heightened or reduced sexual desire, which can impact relationships and emotional well-being
• Impulsiveness — Acting on urges without thinking them through, such as making hasty decisions or taking unnecessary risks
• Compulsive behavior — Engaging in repetitive actions, like gambling, shopping, or eating, even when they have negative consequences

Fatigue

Fatigue — which refers to persistent exhaustion that doesn’t improve with rest — is common in Parkinson’s. Fatigue may not be caused directly by Parkinson’s. Rather, it may stem from other symptoms, including motor difficulties, sleep problems, and depression, or be among the side effects of medication for parkinsonism.

Sleep Difficulties

Problems with sleep are widespread in people with Parkinson’s. One specific issue is rapid eye movement (REM) sleep behavior disorder, which causes individuals to physically act out their dreams while asleep.

Other sleep symptoms include:

• Insomnia — Difficulty falling asleep or staying asleep throughout the night, leading to poor-quality rest and fatigue
• Restless legs syndrome — An uncontrollable urge to move the legs, often accompanied by uncomfortable sensations, which can disrupt sleep
• Nightmares — Disturbing or frightening dreams that can lead to waking up abruptly and difficulty returning to sleep
• Difficulty turning over in bed — Stiffness and slowed movements during the night, making it hard to change positions while sleeping, which can interrupt restful sleep

Orthostatic Hypotension

Orthostatic hypotension refers to a sudden drop in blood pressure when standing up, causing dizziness or lightheadedness. It affects around 33 percent of people with Parkinson’s and can lead to fainting and dangerous falls. This symptom may result from Parkinson’s disease itself — due to damage to the nervous system — or as a side effect of Parkinson’s medications. Orthostatic hypotension typically happens within three minutes of standing and is more common in older individuals and those who have had Parkinson’s for a longer period.

Gastrointestinal Problems

People with Parkinson’s often experience stomach and digestion issues like constipation and slow stomach emptying (called gastroparesis). Constipation can cause uncomfortable bloating, cramping, and trouble having regular bowel movements.

Gastroparesis can make a person feel full quickly, even after eating just a small amount, and may also lead to bloating and nausea. These problems happen because Parkinson’s affects the body’s ability to control digestion properly.

Bladder and Urinary Difficulties

Many people with Parkinson’s experience bladder and urinary problems. The most common bladder symptoms include needing to urinate frequently and feeling a sudden, urgent need to go, even when the bladder isn’t full. This is due to an overactive bladder, which signals the brain to empty prematurely.

Some may also experience trouble fully emptying the bladder, leading to hesitation or difficulty starting to urinate, and incomplete bladder emptying. These issues can be frustrating and disrupt daily life, including frequent trips to the bathroom at night.

Pain

Pain in Parkinson’s disease comes in many varieties. Although Parkinson’s is not widely considered a painful disease, it can cause muscle pain from cramps and repetitive movements, neuropathy (nerve pain, or pins-and-needles numbness sensation), shooting pain such as sciatica, or a sharp, burning pain. Pain usually occurs on the side of the body most affected by Parkinson’s symptoms.

Sexual Difficulties

Around 79 percent of men and 87 percent of women with Parkinson’s experience sexual dysfunction, according to research in Brain Sciences. Symptoms include lowered libido (sex drive) and difficulty orgasming. Motor symptoms can also make physical aspects of sex problematic.

Parkinson’s can also lead to:

• Erectile dysfunction
• Ejaculation problems
• Decreased arousal
• Vaginal dryness
• Pain from vaginal penetration during intercourse

A small number of people with Parkinson’s — less than 1 percent — develop hypersexuality (compulsive sexual behavior) due to certain medications.

Melanoma

Melanoma — a dangerous form of skin cancer — is not a symptom of Parkinson’s disease. However, researchers have found a statistical association: People with Parkinson’s are about four times more likely to develop melanoma, and individuals who have had melanoma are also more likely to develop Parkinson’s. While these findings suggest a link, scientists have not yet established a direct causative relationship between the two conditions.

What Are the Early Signs of Parkinson’s?

Parkinson’s begins differently for each person. Research shows that nonmotor symptoms, such as constipation and loss of smell, may appear years before the motor symptoms of Parkinson’s develop, though these are often not recognized as signs of the disease at the time.

Other common early signs include sleep disturbances like REM sleep behavior disorder, micrographia (progressively smaller handwriting), expressionless face, pain, or a softer, quieter voice. Some people may first notice motor symptoms, such as stiffness, tremors, or difficulty walking or moving.

It’s important to note that Parkinson’s symptoms often begin on one side of the body and can progress gradually. Some individuals may experience a combination of these symptoms at once.

Do Men and Women Experience Different Parkinson’s Symptoms?

Research has shown that females typically develop Parkinson’s about two years later than males, according to Orphanet. Men are nearly twice as likely as women to develop Parkinson’s, and the genders may experience the disease differently.

A comprehensive review of recent research in the Journal of Parkinson’s Disease explored how Parkinson’s disease affects men and women differently. Per the review, women are more likely to experience tremor as their first motor symptom, while men more often experience stiffness and slowed movement.

Nonmotor symptoms also vary between men and women. Women are more likely to report fatigue, depression, restless legs, constipation, pain, loss of taste or smell, weight change, and excessive sweating, according to the review. Men experience higher rates of sexual dysfunction, drooling, and REM sleep behavior disorder. Additionally, men are more likely to experience cognitive decline.

Dopaminergic medications — drugs that influence dopamine levels — may be less effective in women, according to the review. Women are more likely to develop dyskinesia (involuntary movements) as a side effect of these drugs. This is partly due to greater levodopa bioavailability, meaning their bodies tend to retain higher levels of the medication.

Talk to Your Doctor

Living with Parkinson’s brings a wide range of motor and nonmotor symptoms that can deeply affect daily life, both for individuals and their loved ones. Challenges like tremors, stiffness, fatigue, and cognitive changes may worsen over time, but treatments — medications, therapies, and lifestyle adjustments — can help manage these symptoms. Regular consultation with a neurologist or health care professional is key to staying informed about the best options for managing the condition and maintaining quality of life.

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