Parkinson's disease: early signs, diagnosis and treatment

Your hand has started to tremble while it rests in your lap. Or someone close to you has noticed you've slowed down, your handwriting has shrunk, and one arm no longer swings when you walk.

These can be early signs of Parkinson's disease, a progressive condition caused by the loss of nerve cells in the brain that produce dopamine. Parkinson's UK estimates that around 166,000 people in the UK have it, and that someone is diagnosed every 20 minutes. Other conditions cause similar symptoms too, which is why a proper examination matters.

If you'd like these symptoms looked at, a private GP appointment at our Harley Street clinic is £150. The GP examines you, looks for other causes and, if Parkinson's is suspected, can fast-track you to Prof Arshad Rather, Consultant Geriatrician, through a specialist referral.

What are the early signs of Parkinson's?

Symptoms develop gradually and are easy to put down to age or tiredness. The three classic motor features are a tremor that usually starts in one hand at rest, rigidity or stiffness in the limbs and trunk, and bradykinesia, which means slowness of movement.

Here's the one thing worth remembering: bradykinesia is the defining feature. Without slowness of movement, Parkinson's can't be diagnosed, however noticeable the tremor.

As the condition progresses, balance becomes less steady. Walking may turn into a shuffle with less arm swing, turning can feel unsteady, and the face may become less expressive.

Non-motor symptoms can appear years before the movement problems. They include loss of smell, constipation, low mood, anxiety, fatigue and acting out dreams during sleep (REM sleep behaviour disorder). Later on, thinking and memory, pain, bladder problems and dizziness on standing can be affected, and these often have more effect on daily life than the tremor.

Is it Parkinson's or another kind of tremor?

Many people who worry about Parkinson's have a different tremor altogether. The pattern helps a doctor tell them apart.

How a Parkinson's tremor differs from essential tremor

Some medicines, an overactive thyroid, anxiety and too much caffeine can all cause shaking too, which is part of what the GP checks.

Is there a blood test for Parkinson's?

No blood test confirms Parkinson's. Blood tests are still useful, because they can rule out other causes of tremor, tiredness or slowness, such as a thyroid problem.

Diagnosis is clinical. A neurologist with expertise in movement disorders looks for bradykinesia plus a rest tremor, rigidity or both, and follows how the symptoms change over time.

A DaTSCAN, a scan of the brain's dopamine system, can help when the picture is unclear, for example to separate essential tremor from Parkinson's. A brain MRI won't show Parkinson's itself, but it can rule out other structural causes.

NICE advises that anyone with suspected Parkinson's is referred quickly, and untreated, to a specialist. Starting medication before that assessment can mask symptoms and make the diagnosis harder.

How is Parkinson's treated?

Levodopa is the most effective medicine for the motor symptoms. It replaces the dopamine the brain no longer makes enough of, and it's usually combined with a decarboxylase inhibitor, as co-beneldopa or co-careldopa, to reduce side effects.

Dopamine agonists such as ropinirole, pramipexole or a rotigotine patch stimulate dopamine receptors directly and may be used instead of, or alongside, levodopa. MAO-B inhibitors such as rasagiline, selegiline and safinamide slow the breakdown of dopamine in the brain.

Treatment goes well beyond medicine. Physiotherapy helps keep mobility and balance, occupational therapy helps with daily tasks, and speech and language therapy supports voice and swallowing. Regular exercise, especially activities that challenge balance and coordination, has strong evidence for slowing the loss of function.

What if memory or thinking is changing?

Changes in memory, attention or planning can develop in Parkinson's, and they can also have other causes. If memory is the main concern, our memory clinic, led by Prof Arshad Rather, offers a structured assessment from £2,499, arranged after an enquiry.

Our guide on when to see a memory clinic explains which changes are worth assessing.

How we can help

A private GP appointment at 117a Harley Street costs £150. If your symptoms could suggest Parkinson's, your GP examines you, checks for other causes and can fast-track you to Prof Arshad Rather, Consultant Geriatrician, for a specialist assessment before any treatment is started, as NICE recommends.

If you already have a diagnosis, we offer ongoing GP support, medication reviews and coordination with your neurology team. We can also arrange blood tests, bone density scans, and referrals to physiotherapy, occupational therapy or speech therapy as needed.