11 Early Signs of Parkinson’s That Appear Years Before the Tremors Start

Most people wait for a shaking hand to see a neurologist. But by the time a tremor shows up, significant dopamine loss has already occurred in the brain. You want to catch it earlier than that.

The medical world calls this the “prodromal phase.” This is the early stage where subtle clues appear, often unrelated to movement. New research in 2024 and 2025 has helped doctors identify these specific warning signs with more accuracy.

If you know what to look for, you can tell the difference between normal aging and a potential neurodegenerative disease.

Here are the 11 early signs of Parkinson’s you should know about.

1. REM Sleep Behavior Disorder

REM Sleep Behavior Disorder involves acting out dreams physically because the brain fails to paralyze the body during sleep.

This condition acts as the strongest single predictor of Parkinson’s disease according to recent medical data. A 2025 study suggests this relates to how fluid circulates in the brain and fails to clear out proteins during rest.

• Kicking or punching while asleep
• Waking up with bruises or scratches
• Vivid unpleasant dreams where you are fighting

2. Loss of Smell

Loss of smell is often dismissed as aging or allergies but it is persistent and progressive in early Parkinson’s cases.

Doctors call this hyposmia and it happens because the olfactory bulb is often one of the first areas affected by dopamine changes. Research shows that 90% of patients experience this change decades before motor symptoms begin.

• Difficulty smelling bananas or dill pickles
• Trouble detecting the scent of peanut butter
• Smell loss not caused by a sinus infection

3. Chronic Constipation

Leading researchers suggest that for many patients Parkinson’s starts in the gut and travels to the brain via the vagus nerve.

Dopamine regulates muscle movement in your gut so low levels significantly slow down your digestion. Studies show this symptom can appear 20 years prior to a formal diagnosis.

• Bowel movements less than 3 times a week
• Needing laxatives regularly to stay regular
• Straining constantly during bathroom visits

4. Persistent Frozen Shoulder

Many people spend months treating a frozen shoulder as arthritis or a sports injury without success.

Stiffness in Parkinson’s usually affects one side of the body more than the other and typically the side where a tremor might eventually appear. You might also notice that the arm on that side does not swing naturally when you walk.

• Stiffness and pain on just one side
• Pain not caused by a workout or fall
• Lack of natural arm swing while walking

5. Micrographia or Small Handwriting

You might notice your handwriting getting smaller and more crowded as you write across the page. Doctors call this micrographia and it happens because of bradykinesia which is a slowness of movement.

Your brain sends weaker signals to your hands and makes fine motor skills difficult to maintain.

• Letters shrinking by the end of a sentence
• Difficulty writing checks or notes
• Reviewing grocery lists from 5 years ago shows a size difference

6. Orthostatic Hypotension

Feeling lightheaded or woozy immediately after standing up is called Orthostatic Hypotension. It happens when your autonomic nervous system fails to squeeze blood vessels fast enough to push blood to your head.

Recent studies link this specifically to the body-first subtype where blood pressure drops significantly upon standing.

• Visual graying out when standing quickly
• Feeling faint in the morning
• Significant drop in blood pressure

7. Apathy and Loss of Motivation

Apathy is distinct from depression because you lack the executive drive to start tasks rather than feeling sad. You might sit in a chair for hours perfectly content to do nothing because the chemical signal to move is not firing.

Family members usually notice this loss of motivation before the patient realizes it.

• Stopping hobbies you used to love
• Needing prompts from others to start simple chores
• Feeling flat rather than sad or hopeless

8. The Masked Face

Parkinson’s causes rigidity in the small muscles of the face which can give you a serious or staring look.

A typical person blinks 15 to 20 times a minute but this rate slows down significantly in early stages. Friends might ask if you are upset even when you feel perfectly fine.

• Reduced blinking rate causing dry eyes
• Poker face appearance that hides emotions
• Staring without blinking for long periods

9. Soft or Monotone Voice

You might think people are going deaf but it is likely your voice getting softer due to hypophonia. Just as leg muscles get stiff so do the muscles that control your vocal cords and breath.

Your voice might sound breathy or monotone and lose the normal ups and downs of conversation.

• Voice trailing off at the end of sentences
• Feeling like you are shouting when you are whispering
• Hoarse or raspy tone to your speech

10. Foot Dystonia

Painful cramping or curling of the toes often happens to the big toe or causes the foot to turn inward. This condition is called dystonia and relates to faulty brain signals rather than just dehydration or muscle fatigue.

It is very common in Young Onset Parkinson’s and frequently happens during exercise.

• Toes curling under tightly against your will
• Foot turning inward while walking
• Cramps occurring during morning exercise

11. Excessive Sweating

Unexplained sweating often affects the upper body while the lower body remains surprisingly dry. This condition is called hyperhidrosis and signals that the internal thermostat of the body is not regulating temperature correctly.

It affects about 24% of patients and is often misdiagnosed as hormonal changes.

• Drenching night sweats
• Sweating while eating meals
• Extreme sensitivity to hot or cold temperatures