Private parkinson's disease clinic in London, same-day specialist medicine.

Early signs

• Reduced sense of smell — often present for years beforehand, and rarely reported
• Acting out dreams — shouting, punching or kicking in sleep. A strong early predictor
• Constipation, sometimes for a decade before movement symptoms
• Smaller handwriting that shrinks across a line
• Reduced arm swing on one side when walking — often noticed by others first
• A quieter, more monotonous voice
• Reduced facial expression, mistaken for low mood or disinterest
• Low mood and anxiety, which can precede the diagnosis by years

The movement symptoms

• Slowness (bradykinesia) — required for the diagnosis. Movements become smaller and slower with repetition.
• Tremor at rest — typically one hand, often described as pill-rolling, and it reduces when you use the hand. A tremor that appears when holding a cup or writing is more likely essential tremor, which is different and commoner.
• Rigidity — stiffness that is often mistaken for arthritis or a frozen shoulder.
• Balance problems, usually later.
• Symptoms characteristically start on one side and stay worse on that side.

Diagnosis

Clinical, made by a specialist. There is no blood test. A DaTscan is used where the diagnosis is unclear, particularly to distinguish Parkinson's from essential tremor or drug-induced parkinsonism. Medication is a common and reversible cause — antipsychotics, metoclopramide and prochlorperazine all produce parkinsonism, and stopping them resolves it. That is always checked.

Treatment

• Levodopa is the most effective treatment for movement symptoms. Dopamine agonists and MAO-B inhibitors are alternatives in some circumstances.
• Timing matters enormously. Doses are often needed at precise intervals, and being an hour late causes a noticeable 'off' period. In hospital this is frequently got wrong — carry your own supply and your timings, and say so.
• Take levodopa 30 to 60 minutes before food, particularly protein, which competes with its absorption.
• Dopamine agonists can cause impulse control problems — gambling, shopping, eating or hypersexuality. This is a drug effect, it is common, it is often concealed, and it resolves on changing treatment. Tell us, and tell family to watch for it.
• Deep brain stimulation and infusion therapies for selected people later on.

Beyond movement

Constipation, bladder urgency, low blood pressure on standing, sleep disturbance, pain, low mood, anxiety and cognitive change are all part of the condition and are all treatable. They frequently affect quality of life more than the tremor does, and they are worth raising specifically because appointments tend to focus on movement.

What helps