The subtle signs of Parkinson's disease

Written by: Dr Prashanth Reddy
Edited by: Emma McLeod

Typically, the signs of Parkinson’s disease are quite easy to identify, but what are these signs? And what tests can be done to determine if you, or someone you know, is suspected of having Parkinson’s disease? Dr Prashanth Reddy explains in this article.

A close up of an elderly man's hands on the top of his walking stick. Many patients with Parkinson's disease require a walking aid for stability.

Easy to spot symptoms of Parkinson’s disease

There are some straightforward symptoms when it comes to identifying Parkinson’s disease. According to the UK Parkinson’s Disease Society Brain Bank (UKPDSBB), one of the key signs is slowness of movements which progressively becomes slower (bradykinesia). This slowness can affect the initiation of voluntary movement as well as the speed of the movement. The UKPDSBB also says that this slowness is almost always associated with at least one of the following:

  • Muscular rigidity
  • Tremors
  • Balance issues

In tremor-dominant Parkinson’s, as the name suggests, tremors are the dominant symptom. In akinetic-rigid Parkinson’s, tremors are often absent from the range of symptoms and patients have profound bradykinesia.


Before making a diagnosis of Parkinson’s disease, it’s imperative to exclude other conditions or possibilities first. For example, in older patients, it’s possible to incorrectly attribute their slow movement and rigidity purely to their age, arthritis and the only seemingly present symptom is stiffness.


Harder to spot symptoms of Parkinson’s disease

  • Sometimes, a patient with Parkinson’s who doesn’t experience tremors can find that their handwriting becomes progressively smaller.
  • Someone with a tremor may find that the tremor stops or becomes much more subtle once they start moving.
  • Carers or patients might notice a lack of facial expressions (hypomimia)
  • A change in posture
  • The inability to flex their leg muscles as such, resulting in shuffling as they walk.


Testing for Parkinson’s disease

Tests are used to eliminate the possibility of other conditions with similar symptoms. A DaTScan is useful if the clinical diagnosis is uncertain to determine if the patient has Parkinson’s disease. Routine blood tests can check if there is a reason for a patient’s increasing physical slowness or if anaemia, vitamin deficiencies or chronic liver or renal disease is at fault.


A tremor can be caused by Parkinson’s or a condition such as hyperthyroidism, side effects of medications or vascular disease of the brain. Tests can be carried out to exclude these conditions and this can be in the form of a brain CT scan or a brain MRI, the latter being more sensitive when distinguishing the cause.


Visit Mr Reddy’s profile to learn how he can help you with the diagnosis and treatment of Parkinson’s disease

By Dr Prashanth Reddy

Dr Prashanth Reddy is a highly acclaimed consultant in geriatric medicine and general medicine, with a particular interest in neurogeriatrics, working privately at both London Bridge Hospital and the Guthrie Clinic at King's College Hospital, a major teaching hospital in London. He specialises in treating elderly patients with complex medical conditions such as Parkinson's disease, restless leg syndrome, dystonia, dementia, stroke and comprehensive geriatric assessments. He has vast experience (10 years) with advanced therapies for Parkinson’s disease.

Dr Reddy graduated from Bangalore Medical School in 2000 and moved to the UK for specialist training. He obtained his MRCP in 2005 and pursued a research MD from King's College London and the Institute of Psychiatry. He published his first-ever comparative study on advanced therapies in Parkinson's.

He is currently the lead consultant for the acute health and ageing unit at King’s College Hospital and works at the International Parkinson's Centre of Excellence which focuses on high quality clinical and translational work addressing non-motor aspects of Parkinson's disease. He is also the neuro-gerontology liaison between the neurology and gerontology services at King's. He has integrated the care provided for patients with Parkinson's, dementia and stroke under one roof in a novel neuro-geriatric clinic, the first of its kind in the UK.

Dr Reddy teaches at King's College London and has published several research papers, review articles and book chapters in the field of movement disorders. He has a research interest in the field of Parkinson’s disease and is able to continue his research interest with the help of the Clinical Research Network (CRN) in London.  

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