A 58-year-old school teacher, Kishan Arora (name changed) from Mayur Vihar, New Delhi came to my office with what he called a "minor inconvenience." He said it with a smile, as if he were sorry. He was only worried that his handwriting had gotten very small and cramped in the last few months. This change bothered him as a teacher who had spent years writing on blackboards and correcting notebooks, but not enough to ask for help right away. He thought it was just getting older.
He didn't feel any pain, tremors, or other scary symptoms that would have made him change his routine. He was still going to school, still taking classes, and still living what he thought was a normal life. The picture didn't start to change until his wife gently added her thoughts. She had heard that his voice had gotten softer and even faded at times. His steps, which had been quick and sure, were now slower. When he walked, his arms no longer moved naturally. These weren't complaints; they were just small changes that were easy to miss in the flow of daily life.
He stopped when I asked him how long he had seen these changes. "Maybe six months, maybe longer," he said. He had, like many other patients, gotten used to the changes instead of questioning them.
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The signs were clear, but not very strong. He thought he was just getting older, but what he was really experiencing was the early stages of Parkinson's disease. This disease often starts with changes that are so subtle that they blend into everyday life instead of tremors.
This is the reality of Parkinson’s. It doesn't usually come in a big way. It comes in slowly, almost politely, changing little things like handwriting, voice, and speed before slowly changing the body and mind. And by the time people realise what it really is, valuable time for early intervention has often already been lost.
Not just a movement disorder
Parkinson's disease happens when cells in the brain that make dopamine slowly die off. The most obvious signs are tremors, stiffness, and slow movements, but the condition is much more than just motor symptoms. Sleep problems, depression, anxiety, and cognitive decline are all common symptoms of the disease.
The slow and silent progression of Parkinson's makes it especially hard to deal with. Symptoms grow over time and are often thought to be a normal part of getting older.
A growing problem India can't ignore
Parkinson's is now the neurological disorder that is growing the fastest around the world. The World Health Organisation says that the number of people with Parkinson's has more than doubled in the last 25 years, reaching more than 8.5 million around the world.
India is also seeing this trend. According to estimates, almost 1% of people over 60 may be affected. As people live longer, the number of patients is expected to rise sharply. According to data from the Indian Council of Medical Research, the overall disease burden of neurological disorders in India has more than doubled in the last 30 years.
But the bigger problem is that people aren't getting the right diagnosis. A lot of people only see a neurologist when their symptoms start to get in the way of their daily lives.
The early signs we miss: Parkinson's rarely starts with a bang. It starts out slowly.
Some early warning signs are:
• Small shakes in one hand
• Routine tasks take longer
• Less swinging of the arms while walking
• Voice that is soft or fading
• Changes in how you write
• Problems with sleep
People often think these symptoms are just tiredness or getting older. By the time they are recognised as a pattern, important time for early intervention may have already been lost.
The hidden effect beyond motion
Parkinson's is more than just a physical problem; it's a very personal one.
Depression and anxiety are common and can happen even before motor symptoms. Some patients develop cognitive impairment over time. Fatigue and sleep problems make life even worse.
The stress on caregivers is just as important. In India, where family members are the main caregivers, the emotional and financial stress can be very high, but not many people talk about it.
Why it's important to find out early
There is no cure for Parkinson's disease, but an early diagnosis can change the course of the disease in a big way.
Timely intervention is helpful:
• Make it easier to control symptoms
• Stay independent for longer• Slow decline in function
The problem is not that there is no treatment, but that people wait too long to get it.
Care Improvements: More Than Just Medicine
There have been a lot of changes in how Parkinson's is treated.
Drugs like levodopa are still the main part of treatment. Deep Brain Stimulation (DBS) and other advanced treatments can help some patients a lot.
But good care today is more than just taking medicine. A multidisciplinary approach is essential:
• Physiotherapy to help you move better
• Speech therapy for voice and swallowing
• Occupational therapy to help with daily tasks
• Help with structured exercise and lifestyle
Care for people with Parkinson's is no longer episodic; it is now ongoing and all-encompassing.
India's one-of-a-kind problem
India has a unique set of problems when it comes to managing Parkinson's.
People still don't know much about it, especially in smaller towns and rural areas. Neurologists are not evenly available, and most of the specialised care is in cities. Patients often avoid social interactions because of social stigma, which makes both their physical and mental health worse.
People think that even estimates of how common it is, which range from 15 to 67 cases per 100,000 people, don't show the full extent of the problem.
A day to think about and do
World Parkinson's Day is not just about raising awareness; it's also about taking action.
We need to:
• Be aware of early signs
• Encourage people to see a doctor on time
• Help people understand how patients and caregivers feel
• Make long-term neurological care systems stronger
We doctors often tell our patients:
"Parkinson's doesn't mean you have to give up your independence. With the right care, you can manage the disease.
A future of hope
Parkinson's is a long-term illness, but there is still hope.
Patients can keep living meaningful and productive lives if they get an early diagnosis, structured treatment, and ongoing support. India really needs to change how it sees the disease early on and how it reacts with urgency and understanding.
What we do early on in Parkinson's disease determines what happens later.
Dr Sanjay Pandey is the Professor and Head of Department – Neurology and Stroke Medicine at Amrita Hospital, Faridabad.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.