Know the symptoms of Parkinson’s disease beyond tremors

Senator José Serra (PSDB) will be removed from the Senate after receiving the diagnosis of Parkinson’s disease at an early stage. The disease is commonly associated with tremors, but it can manifest itself in other symptoms. It is necessary to pay attention to the signs, especially in people over 60 years, so that it is possible to carry out the treatment and improve the quality of life, experts explain.

“Not every tremor is Parkinson’s,” says Natally Santiago, a functional neurosurgeon at Hospital San Gennaro. She clarifies that the characteristic tremor of the disease is called “rest tremor”, that is, it occurs when movements are not being performed and, when performing actions, it can decrease or even disappear.

Parkinson’s is a neurodegenerative disease that affects the production of dopamine, a neurotransmitter responsible for movements, explains the doctor. Therefore, in addition to tremors, two other characteristic signs of the disease are related to movement: muscle rigidity and bradykinesia.

Photo: Tomaz Silva/Agência Brasil

“One of the most important signs is the slowness of movement, which we call bradykinesia. The person’s speed to move and perform the movements is very slow”, says Frederico Haidar Jorge, neurologist at Hospital Santa Catarina.

In addition to the three signs, Parkinson’s patients may have other symptoms, he said. Among them, postural instability, decrease in facial expressions, difficulty chewing and swallowing, lower voice, decreased perception of smell and changes in sleep, emotional or cognitive.

“There is no specific test for Parkinson’s. Diagnosis depends on the patient’s clinical history, which we call anamnesis, and on neurological exams. We also do complementary exams to rule out other situations”, informs the neurologist from Santa Catarina.

When identifying symptoms, medical evaluation is essential. That’s because different causes can trigger what doctors call parkinsionism or parkinsonian syndrome, a set of neurological symptoms found in Parkinson’s disease but not necessarily indicating its presence.

“70% of cases of Parkinsonian syndrome are due to Parkinson’s disease, but the other 30%, approximately, are other neurodegenerative diseases and even drugs that can lead the person to have signs and symptoms”, clarifies Alex Baeta, neurologist at BP – A Beneficência Portuguesa in São Paulo.

Baeta reports that the most common form of the disease is the idiopathic one, that is, whose origin cannot be identified. In some cases, it is possible to identify individuals at high risk of having Parkinson’s due to genetic inheritance. “There is no way to prevent Parkinson’s disease with the resources currently available,” he says.

Treatment is multidisciplinary Parkinson’s disease has no cure, but doctors stress the importance of treatment in the early stages. According to the neurosurgeon at Hospital San Gennaro, Natally Santiago, treatment with a specialist improves the patient’s quality of life and manages to control the evolution of symptoms.

“The evolution of the disease can vary, but generally, in the first five years, it has a good response to drug treatment. Antiparkinsonian medications have a good effect”, explains.

In addition to medications, other methods are used to treat Parkinson’s patients. Physiotherapy and occupational therapy are ways to work the movement of the body and fight symptoms. Speech therapy is also an option for those who have difficulty speaking, chewing and swallowing.

“In some situations, we can evaluate the surgical treatment for the patient. It consists of implanting a brain pacemaker […] that sends electrical stimuli and helps improve symptoms”, clarifies Santiago.

Body movement is a key point in the treatment of the disease. “For Parkinsonian patients, physical activity is fundamental, like drinking water, because this reduces the signs and symptoms a little, if associated with proper treatment”, says neurologist Alex Baeta.


Parkinson’s disease

Which is?

Neurodegenerative disease that affects the production of dopamine, a neurotransmitter responsible for movement
It mainly affects people over 60 years old
Genetic inheritance is a risk factor, but in most cases it is a disease that develops without a specific cause.
There is no cure, but there is treatment



Tremor while the affected part is still
muscle stiffness
slowness of movement
One side of the body may be affected first (eg, person does not move one arm properly when walking)
Less broad movements
Body slightly projected forward
Decrease in the size of the letters you write

No engines

sleep disorders
trapped intestine
Loss or reduced ability to smell
excessive sleep during the day
Dementia (at a very advanced stage)

How the diagnosis is made:

Patient’s clinical history
Neurological and complementary exams

Disease evolution:

The progression is variable and uneven among patients
It usually has a regular course and no rapid or dramatic changes.


Speech Therapy
Occupational therapy


Seek a neurologist in case of suspicion or symptoms;
Exercise regularly to preserve body movement

Sources: Alex Baeta, neurologist Beneficência Portuguesa of São Paulo; Frederico Haidar Jorge, neurologist at Hospital Santa Catarina; Natally Santiago, functional neurosurgeon at Hospital San Gennaro; Brazil Parkinson Association; Ministry of Health