Sir HN Reliance Foundation Hospital neurologist shares Parkinson’s warning signs to watch out for if you are 40 or above
While many associate Parkinson’s disease exclusively with the elderly and visible tremors, Dr Arun Shah, director of Neurology at Sir HN Reliance Foundation Hospital, Mumbai, is warning that the foundation of the condition is often laid decades earlier. Also read | Faridabad and Panchkula neurologists share Parkinson’s red flags, bust common myths: ‘Can affect even people in 30s…’
In an interview with HT Lifestyle, he revealed that the brain may begin changing as early as a person’s 40s. “To most people, the term Parkinson’s disease is related to elderly patients who suffer from hand trembling. In reality, the symptoms emerge much earlier and discreetly,” Dr Shah said.
According to him, the traditional image of the disease is a late-stage representation, but ‘Parkinson’s disease does not usually start with trembling hands’. “The signs come through the nervous system years before the disease is diagnosed, even in one’s 40s and 50s. Researchers have found out that the initial symptoms of the disease can start showing 10–15 years before any movement disorders develop,” Dr Shah said.
The ‘silent’ red flags
The danger of waiting for a tremor is that significant neurological damage may already have occurred. Dr Shah warned, “The majority of the brain cells that produce dopamine may already be damaged when patients notice their hands trembling.”
To catch the disease in its ‘whispering’ stage, Dr Shah identified several non-motor and subtle motor signs:
1. Unexplained slowness: “Slowness is among the least recognised early signs,” Dr Shah said. “Routine activities like fastening your shirt buttons, typing, or walking could become slower. The tendency is usually disregarded as age or tiredness, but any chronic slowing should be noted,” he added.
2. Uneven arm swing: “Usually, both arms swing the same during walking; however, in the early stages of Parkinson’s disease, one arm swings less naturally than the other,” he observed, adding that ‘family members could notice this slight discrepancy’.
3. Loss of smell (anosmia): This sensory change often precedes motor issues by years. Dr Shah described it as ‘when the detection of normal smells like citrus or spices starts several years before movement signs develop’.
4. The ‘masked face’: If others comment on your lack of expression, it may be physiological. “Do people tell you that you always look serious? This is due to facial muscle stiffness, and hence limited expressions resulting in a masked appearance,” said Dr Shah.
5. Micrographia: Even handwriting offers a clue. Dr Shah noted that ‘when handwriting is getting progressively smaller or crowded… then it might be a motor symptom of Parkinson’s’.
6. Digestive and sleep issues: Dr Shah highlighted the ‘gut-brain axis’, noting, “Slow transit times and chronic constipation tend to be early signs.” He added, “Sleepwalking and shouting during sleep is a sign that one may have REM sleep behaviour disorder, and therefore a likelihood of having Parkinson’s.”
Proactive brain health
While there is no guaranteed way to prevent the condition, Dr Shah said that lifestyle choices can build ‘cognitive reserve’ and protect neural pathways:
⦿ Movement as maintenance
“Physical exercise is one of the most potent ways we can take care of our brains via our lifestyles,” Dr Shah said. He recommended activities that challenge the brain and body simultaneously: “Exercises that challenge coordination and rhythmic skills – brisk walking, dancing, playing racquet sports, yoga, or cycling – create new neural connections… try to do at least 25 minutes every day.”
⦿ Dietary defense
To support the ‘brain-gut relationship’, Dr Shah suggested ‘adhering to a Mediterranean-type diet full of fresh produce, nuts, whole grains, olive oil, and fibre’. He also noted a potential benefit in your morning brew: “A few studies show that moderate consumption of caffeine may reduce the chances of developing Parkinson’s disease. The consumption of coffee and/or tea can also give antioxidant properties.”
⦿ Cognitive challenge
“Scanning through your social media feed doesn’t always count as exercise for your mind,” Dr Shah cautioned. Instead, he urged people to engage in active learning: “For example, learning a new language, mastering an instrument, reading a book, or taking up an activity keeps the mind plastic.”
A call for vigilance, not fear
Dr Shah clarified that a single symptom is not a diagnosis, but a pattern warrants a medical consultation: “While on their own they don’t indicate one has Parkinson’s disease, several together, especially after 40 years, should be discussed with one’s physician.“
He concluded with a reminder of the window of opportunity available in middle age: “If you’ve observed these signs, do not freak out, as there might be a benign reason behind them. Nevertheless, it’s important to remember that this is a critical time for your brain health, since your 40s and 50s are significant years for Parkinson’s. It never screams; it whispers.”
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
