Which Parkinson Symptoms Cause the Most Trouble as Disease Progresses?

According to a poll conducted by Parkinson’s UK, issues such as walking, speaking, and balance and falls proved most significantly burdensome as the condition progresses, whereas tremor and psychological health becomes less important.

As a clinically heterogeneous neurodegenerative condition characterized by motor and nonmotor issues, there are a myriad of symptoms known to be associated with Parkinson disease (PD).

However, are there symptoms that prove most burdensome for patients with PD?

According to a recent poll conducted by Parkinson’s UK, this may depend on how far along a patient is within their disease course.

"While PD has some common features such as tremor, rigidity, and bradykinesia, the disease is highly varied, with each individual experiencing their own unique blend of symptoms and side effects," said lead investigator Claire J. Bale, MS, of Parkinson's UK, in a statement.

The poll, whose findings were published in the Journal of Parkinson’s Disease, surveyed 790 people with PD on what aspects of the condition, up to 3, they would most like to see improvement in. Responses identified 2295 PD-related issues that were then grouped into 24 broad symptom domains:

  • 1358 (59.1%) categorized as motor symptoms
  • 859 (37.4%) categorized as non-motor issues
  • 78 (3.4%) categorized as medication problems

"We worked with people affected by PD to create, deliver, and analyze the responses to this survey, ensuring that the findings truly represent the voice of people with the condition," explained Bale.

Of the participant responses, the most frequently mentioned motor symptoms were tremor (n = 238), balance and falls (n = 154), movement problems (n = 148), walking (n = 142), and stiffness (n = 129). Most frequently reported nonmotor symptoms included fatigue and energy (n = 180), psychological health (n = 154), sleep problems (n = 133), pain and unpleasant sensations (n = 110), and cognitive function (n = 110).

Notably, as the disease progresses, mentions of tremor, which was the most frequently reported symptom overall, decreased from being reported among 14.4% of patients who had been living with PD for 2 years or less to 4.1% of patients who had lived with PD for 11 years or more (P < .0001).

“Other symptoms that also become less frequently reported by disease duration include stiffness (P = .0026) and psychological health (P = .0344),” added the study authors.

Conversely, symptoms that grew in prominence from the early stages to advanced stages of PD included problems with walking (P = .048), balance and falls (P = 0.0035), speech problems (P = .0009), freezing (P = .0002), dyskinesia (P < 0.0001), and OFF periods (P < .0001).

For patients with PD lasting for 11 years or more, balance and falls served as the most important issue.

"The results of this study emphasize that symptom and treatment priorities are personal and may change substantially as PD progresses,” said Bale. “Patients' own personal priorities for improving life must be at the center of their care, and understanding these priorities is vital to ensuring future research focuses on what's most important to patients."


Port RJ, Rumsby M, Brown G, Harrison IF, Amjad A, Bale CJ. People with Parkinson’s disease: what symptoms do they most want to improve and how does this change with disease duration? J Parkinsons Dis. Published online April 13, 2021. doi:10.3233/JPD-202346

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