There are sometimes first signs of Parkinson's long before the disease is diagnosed. They are often not noticed at all or are considered to be a normal part of aging. For instance, fine motor skills typically deteriorate and handwriting changes. People sometimes lose their sense of rhythm, or their arms no longer swing when walking. Their facial expression often becomes more fixed and mask-like. Constipation, difficulty sleeping and mood swings are also common. Many people experience a deterioration or complete loss of their sense of smell.
It is not unusual for several years to pass between the first signs of Parkinson's and the diagnosis. The course of the disease varies greatly.
The symptoms usually come on gradually. Over time, movements become slower, muscles stiffer and tremors more intense. In early stages, medication can usually considerably improve the symptoms or even make them go away.
After about five to ten years, the symptoms often get worse again. That's because the brain cells are damaged further as the disease progresses. The effects of the medication are no longer strong enough and fluctuate a lot. People may sometimes move extremely slowly for a while and then move normally again. These are referred to as "off" and "on" phases. The disease can also cause involuntary movements, and people with Parkinson’s may occasionally flap their arms, smack their lips or make sudden, jerky movements. Other symptoms like speech difficulties, poor memory, bladder problems, hallucinations and depression can follow. Some people also develop dementia.
In later stages, people with Parkinson's need support with lots of everyday activities like eating and drinking, standing up and moving about, getting dressed and washing. They find it increasingly difficult to move, and some people can only speak very quietly or have trouble swallowing.