Parkinson’s symptoms show up differently in each person. For one person, hand tremor is the first thing anyone notices; another has no tremor at all and only finds that movement is slowing down. Broadly, they can be divided into motor symptoms and non-motor symptoms.

The four main motor symptoms

  • Tremor: a rest tremor — the hand or the jaw shaking while you are still. It is the best-known symptom of Parkinson’s, but in practice only about half of people with Parkinson’s are reported to experience it. When the thumb and the other fingers meet in a circle so that it looks as though a pill were being rolled, this is sometimes called “pill-rolling.” It gets worse with tension or stress, and usually disappears when you move or while you sleep.
  • Bradykinesia: movement slowing down across the board.
  • Rigidity: the muscles in the arms and legs becoming stiff.
  • Postural instability: balance becoming difficult and the risk of falling rising. It usually appears after the disease has progressed.

Beyond these, the arm swing while walking may decrease, facial expression may change less, walking may stop as if freezing in place from time to time, and the voice may get quieter or handwriting may become noticeably smaller (micrographia).

A woman in a white jacket walking down a street during the day

Most start on one side of the body

Parkinson’s symptoms usually appear first on one side of the body — one arm or one leg — and often spread slowly to the other side over time. That is why, early after diagnosis, it is so common to hear symptoms described as weighted to one side: “only my left hand shakes,” or “only my right leg is stiff.”

The non-motor symptoms that are harder to see

Reduced sense of smell, constipation, sleep problems (thrashing about badly in your sleep, or behavior that looks like acting out a dream), depression and anxiety, changes in thinking, chronic fatigue, and orthostatic hypotension — dizziness on standing up — are also frequently reported in Parkinson’s. Because these non-motor symptoms don’t show on the outside, they are often hard to connect to Parkinson’s right away, but they can affect daily life just as much as the motor symptoms do.

Motor fluctuations during medication treatment

After a few years on a medication such as levodopa, you may experience motor fluctuationsThe alternation between 'on' periods, when the medication is working, and 'off' periods, when it wears away and symptoms return. As the disease progresses it can become irregular, with little relation to dose timing.Learn more, in which “on” periods where the medication is holding and “off” periods where it wears away and the symptoms return keep alternating. Early on this is fairly predictable — an off period arriving as the time for the next dose approaches — but as the disease progresses it can come irregularly, with little relation to dose timing. In the other direction, as the brain becomes increasingly sensitive to dopamine, dyskinesiaInvoluntary movements that develop as the brain becomes increasingly sensitive to dopamine after taking a medication such as levodopa over a long period.Learn more — unintended movement — can develop as well. These changes are not caused by taking your medication wrongly; they happen because the way the brain responds to the drug changes as the disease progresses. Most of it can be managed by adjusting medication, so describing your symptom pattern to your care team in detail matters.

It shows up differently in each person

Even with the same Parkinson’s, which symptom appears first, how severe it is and how quickly it progresses all differ from person to person. You don’t have to experience every symptom listed above to have Parkinson’s, and having only a few of them is common.

If you notice changes like these

The following changes are worth having checked at a clinic.

  • Your hand, fingers or jaw shake slightly while you are still
  • Your handwriting has become noticeably smaller than it used to be
  • You can’t smell things well any more (food smells don’t come through)
  • You thrash about badly in your sleep, or behave as though acting out a dream
  • Your body feels stiff when you walk and your arms don’t swing much
  • Bowel movements have become harder and constipation more frequent
  • Your voice has got quieter, or sounds hoarse
  • People tell you your face looks blank, regardless of your mood
  • You often feel dizzy when getting up from a chair
  • Your back is more stooped and hunched than it used to be

Having one or two of these does not mean you have Parkinson’s, but if several overlap or they keep getting worse, it’s worth seeing a neurologist.

This article is not a substitute for medical diagnosis or treatment. If your symptoms are worrying you, please talk with your care team.