When Is a Tremor a Sign of Parkinson’s Disease?

Are you often asked by others if you are nervous or cold? Do you frequently hide your hands in your pockets when you walk to avoid stares from passersby, or sit on top of your hands to stop them from shaking? Tremor when at rest can be one of the initial symptoms of Parkinson's disease (PD), a chronic progressive neurologic disorder caused by the deficiency of dopamine. PD tremors present typically in the hands. Usually, it manifests itself while at rest in the thumbs, but any of the fingers can shake, resembling a rapid tap as if sending a Morse code message. This tremor is often more noticeable to others when sitting or walking. Unlike the more common tremor known as essential tremor (ET) which occur primarily with action; by definition, a rest tremor disappears as soon as a deliberate movement or motion is made, such as reaching for a cup. 

Although penmanship is also affected by both types of tremors, the characteristic features of those with PD are small, tight and progressively diminutive handwriting (micrographia) rather than shaky. Both types of tremors can worsen with stress and caffeine intake. 

Along with tremors, patients with PD are stiff, and therefore have trouble performing normal activities (i.e. bathing and dressing) due to lack of mobility. They often complain of shoulder pain caused by stiffness in the joint. Another important finding is an inherent slowness when performing any type of movement (e.g. walking, eating, and opening doors and jars). Further, Parkinson’s patients have difficulty with gait and balance, leading to frequent falls. Other symptoms accompanying tremors include loss of smell, visual deficits, fatigue, pain, sleep complications, and mood disorders along with bowel and bladder difficulties. Sometimes the latter findings may precede the tremor itself.  

If you exhibit any of these characteristic features, especially if there is a family history of tremors or Parkinson's disease, then you may be one of the nearly 1.5 million people living with PD in the USA. Although at present there is no known cure, there are many efficacious therapies including medications such as levodopa, the Gold standard of treatment, and surgeries like deep brain stimulation (DBS). Thus, I recommend seeking immediate care from a movement disorder specialist. Early treatment of Parkinson’s is associated with an increased quality of life and decreased disability.