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One of the first complaints presented to doctors by many people later diagnosed with Parkinson’s Disease is an involuntary tremor or shaking of the hands, fingers, arms, legs, jaw, and face. You’re most likely to notice this tremor when your hands are at rest rather than when you’re using them, although you may see more tremors while your hands and arms are in use as the disease progresses.  There are many causes of tremors. Parkinson's Disease is one of the most common causes, and tremors are often the first sign of the disease. The tremor and other symptoms may initially appear only on one side of the body, or they may appear worse on one side than the other. A repetitive “pill-rolling" movement between the thumb and finger—named because it looks as though the person is rolling a pill between their fingers—is characteristic of a Parkinsonian tremor. Some symptoms of Parkinson's are caused by the larger symptom of slowed movements (also known as bradykinesia). This primarily affects motor functions from walking and balance to writing and even motor functions that are often considered reflexive or spontaneous.  These slowed movements are a very common early sign of Parkinson’s, and may show up at the onset of the disease in 80% of patients. Some people might have a hard time describing what they are feeling and use words like “weakness,” “tiredness,” or “incoordination” when talking about these symptoms. Look for distortions in voluntary movements. In addition to involuntary movements, those with Parkinson’s may experience disturbances in their voluntary movements beyond just slowness. Some of the treatments used for Parkinson's disease may cause abnormal involuntary movements, or an increase in movement, referred to as dyskinesia. These distortions (dyskinesias) can be similar to a “tic” in appearance and worsen with psychological stress. Advanced dyskinesia is most often seen in patients who have been on the medication Levodopa for some time. A common symptom of Parkinson’s is a shuffling gait with short steps and a tendency to lean forward. People with Parkinson's often have difficulty with their balance, and there is sometimes a tendency to fall forward, causing the person to walk faster and faster to keep from falling over. This pattern is called a "festinating gait," and it is very common in Parkinson's disease. This symptom typically shows up in the later stages of the disease. Those with Parkinson’s Disease often lean forward at the waist when standing or walking. This is because Parkinson's can cause posture and balance problems, including rigidity. There is a tendency to flex the arms and the head so that the person appears bent over with the elbows flexed and the head down.  Rigidity can affect the whole body, and might you feel stiff or sore. Check for postural rigidity. Also referred to as “cog-wheeling,” this symptom presents as a hallmark, rigid motion when an examiner moves the arm of a patient through basic flexion and extension motions. The rigidity and resistance to movement is most obvious with passive movement of the wrists and elbow. Cog-wheeling may happen when the increased muscle tone related to rigidity is combined with a tremor. Some cognitive impairment is common, but usually not until late in the course of the disease. Around 90% of those with PD will show signs of speech disturbances at some point. These can present as quieter speech, breathy or hoarse qualities to the voice, and reduced precision with language. The voice often becomes soft or whispery because the vocal muscles lack mobility. Up to 60% of those with PD may show signs or anxiety or depression. PD affects some of the mood-stabilizing portions of the brain, which leads to this increased chance for depression, especially paired with the quality of life for patients in late stages of the disease. The muscles used to push food through the digestive system are also affected by PD. This can lead to a variety of gastrointestinal issues from incontinence to constipation. These same symptoms often present along with difficulty swallowing food as well. Many of the involuntary movements associated with Parkinson’s make it increasingly difficult for those with the disease to get a full night of sleep. Other symptoms—such as muscle rigidity making it difficult to roll over at night or bladder issues leading to getting up at night to urinate frequently—compound the sleep disruptions experienced by those with PD.

Summary:
Watch for tremors in your hands and/or fingers. Check for slowed or distorted movements. Look out for a shuffling gait. Examine your posture. Examine for cognitive impairment. Check for speech disturbances. Watch for signs of depression or anxiety. Check for gastrointestinal issues. Watch for difficulty sleeping.