Parkinson’s disease may begin years before the tremor appears: Neurologist Dr Sudhir Kumar explains

Parkinson's disease is easily noticeable by the tremors it causes; however, Dr Sudhir Kumar shares that it is not the earliest of symptoms.

If you have ever seen an elderly person whose hands are trembling, you have likely spotted someone who suffers from Parkinson's disease. It is one of the most common neurodegenerative diseases in the world that affects movement, and as per the Mayo Clinic website, it worsens over time.

The symptoms of Parkinson’s disease starts slow. The first symptom can be as subtle as a barely noticeable tremor in just one hand or sometimes a foot or the jaw. While tremors are the most common symptom of the disease, it is not the only one. And according to Hyderabad-based neurologist Dr Sudhir Kumar, it might not even be the first.

Taking to X (formerly Twitter) on September 4, Dr Kumar shared subtle signs that can indicate the onset of Parkinson’s disease in individuals years before the first tremor appears. They are presented as follows.

Parkinson’s disease symptoms that precede the tremors

As per Dr Kumar, the following clues of Parkinson’s disease can appear five to 10 years before people go in for a diagnosis. They include:

1. REM sleep behaviour disorder, such as acting out dreams
2. Loss of smell
3. Persistent constipation
4. Depression/anxiety or unexplained fatigue
5. Subtle motor changes, such as smaller handwriting, reduced arm swing, softer voice, and slowing of finger movements.

In the words of the neurologist, “A single symptom usually means little; these features are common in the general population. But a combination, especially REM sleep behaviour disorder, loss of smell and subtle motor changes, can be an important warning signal.”

Dr Kumar cautioned that Parkinson’s disease does not suddenly “start” when tremor appears; the biology may begin many years earlier.

“Recognising the prodromal phase could eventually allow us to identify people at high risk before classical Parkinsonism becomes established,” he added.

About the expert

Dr Sudhir Kumar is a veteran neurologist at Apollo Hospitals, Jubilee Hills, Hyderabad. With over 26 years of experience and qualifications including MBBS, MD (internal medicine), and DM (neurology), he treats a wide range of conditions such as dementia, ALS, cerebral palsy, back pain, Canavan disease, and more.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

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