The first signs of Parkinson's disease are usually subtle and one-sided: a tremor in one hand at rest, slower movement, smaller handwriting, reduced arm swing when walking, and a quieter voice. Reduced sense of smell and acting out dreams often precede movement symptoms by years.
The first signs of Parkinson's disease are usually subtle and one-sided: a tremor in one hand at rest, slower movement, smaller handwriting, reduced arm swing when walking, and a quieter voice. Reduced sense of smell and acting out dreams often precede movement symptoms by years.
Parkinson's disease typically begins asymmetrically, which is one of the more useful diagnostic clues. A resting tremor in one hand, present when the limb is relaxed and reduced by purposeful movement, is the most recognised sign, though a substantial minority never develop tremor at all. Bradykinesia, meaning slowness and reduction in the size of movements, is the requirement for diagnosis: handwriting becoming smaller, buttons taking longer, one arm swinging less when walking.
Several non-motor features commonly precede movement symptoms, sometimes by years. Reduced sense of smell is among the most frequent. REM sleep behaviour disorder, where someone physically acts out dreams rather than lying still, is strongly associated. Constipation, low mood and a quieter, more monotone voice also appear early. Individually these are non-specific and common; together, and alongside an emerging motor sign, they become meaningful.
Parkinson's disease is diagnosed clinically, by examination, and there is no blood test that confirms it. The examination looks for bradykinesia alongside tremor or rigidity, and considers alternatives including essential tremor, drug-induced parkinsonism from certain medications, and other parkinsonian syndromes with different trajectories. Response to treatment sometimes contributes to confirming the diagnosis over time rather than at a single visit.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: National Institute of Neurological Disorders and Stroke; MedlinePlus, National Library of Medicine; National Institute on Aging.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.