14/09/2026
Issued on behalf of the Arrie Rautenbach Parkinson's Foundation
What Parkinson’s disease can look like – and the early signs you shouldn’t ignore
For former Absa CEO Arrie Rautenbach, one of the earliest signs that something was wrong was not a tremor. It was pain. A persistent pain in his left shoulder that eventually spread into his arm, wrist and hand. At the time, it seemed like a musculoskeletal problem. He was told he had arthritis and underwent cortisone injections in his wrist and finger joints. The relief was temporary. Looking back now, Arrie realises that this was one of the first clues that his body was trying to tell him something.
“I never suspected that I would be diagnosed with anything serious, let alone a brain disease,” he says.
Just months before his formal diagnosis in 2024, Arrie had undergone a full executive medical, with no serious health concerns identified. Yet, in hindsight, he had already been experiencing a collection of symptoms that he had never connected. His left arm was painful. His speech was changing. His voice pitch was becoming harder to control. His facial expressions had become less animated. He was experiencing bladder problems and difficulties with sleep, as well as unexplained anxiety attacks. When he walked, his left arm no longer swung naturally and his left foot dragged slightly.
Then came the diagnosis – Parkinson’s disease. Arrie’s experience highlights a crucial fact that is often lost in the public understanding of Parkinson’s – it is not simply a disease that causes people to shake.
Parkinson’s disease is a progressive neurological disorder affecting the brain and areas involved in movement and dopamine production. While tremors are one of the best-known symptoms, Parkinson’s can affect movement, speech, sleep, mood, pain, the autonomic nervous system and cognitive function. Symptoms also differ considerably from one person to another and can develop gradually over time. The World Health Organization describes Parkinson’s as the fastest-growing neurological disorder globally. Its estimates showed that in 2019, more than 8.5 million people were living with Parkinson’s disease worldwide, having doubled over the previous 25 years.
To understand why Parkinson’s can look so different from one person to the next, it helps to understand what is happening inside the brain. At its core, Parkinson’s disease is a neurodegenerative disorder in which nerve cells become damaged and progressively die. One of the areas most affected is a small region deep within the brain called the substantia nigra. The neurons in this area produce dopamine, a chemical messenger that plays an important role in the brain circuits responsible for controlling and coordinating movement.
As these dopamine-producing neurons are lost, communication within these circuits becomes disrupted. The result is not simply that the brain “forgets” how to move. Rather, the finely balanced system that helps initiate, regulate and coordinate movement begins to function differently.
This is why a person may become slower, stiffer, develop a tremor or experience changes in walking and balance. The loss of dopamine alters the activity of the brain’s movement circuits, producing the characteristic motor symptoms associated with Parkinson’s.
But Parkinson’s is much more than a disorder of movement. The disease affects several interconnected systems in the brain and nervous system. Researchers have also identified abnormalities involving a protein called alpha-synuclein, which can misfold and accumulate inside nerve cells. These abnormal protein deposits are a major feature of Parkinson’s and are thought to contribute to damage to neurons.
Scientists are also investigating several other processes that may play a role in the disease, including problems with mitochondria – the structures that provide energy to cells – inflammation, oxidative stress and the brain’s ability to clear damaged proteins. These mechanisms are known to be involved in Parkinson’s, but researchers are still working to understand exactly how they interact and which processes happen first.
This is one reason Parkinson’s can produce such a wide range of symptoms. The parts of the nervous system affected by the disease are involved in far more than simply moving an arm or leg. Changes in these networks can contribute to problems with sleep, speech, facial expression, mood, pain and the autonomic nervous system, which regulates functions such as blood pressure and other processes that happen largely without conscious thought.
So, while the loss of dopamine-producing neurons is central to Parkinson’s, it would be an oversimplification to say that the disease is simply about “running out of dopamine”. The deeper scientific question is why those neurons become damaged in the first place. And that is something medicine still does not fully understand.
For most people with Parkinson’s, there is no single known cause. Researchers believe the disease probably develops through a complex interaction of genetic, biological and environmental factors. Understanding how these different processes interact – and why the disease progresses differently from one person to another – remains an important area of research.
In other words, doctors understand a great deal about what Parkinson’s does to the brain. They understand which cells are affected, how dopamine is involved and why many of the symptoms occur. What they do not yet fully understand is why the process begins, why it progresses at different rates in different people, and how it might ultimately be stopped. That gap in understanding is one of the reasons Parkinson’s research remains so important. Yet recognising the disease, particularly in its early stages, can be difficult.
When most people think about Parkinson’s, they picture someone with visibly shaking hands. But not everyone with Parkinson’s has a tremor, and some of the earliest clues may have nothing to do with shaking at all. These less obvious symptoms can include:
Persistent pain or stiffness. Pain, particularly in one shoulder or limb, can sometimes appear before more obvious movement symptoms. In Arrie’s case, severe pain in his left shoulder was, in retrospect, his earliest sign.
Changes in walking or movement. One-sided changes can be significant. An arm that stops swinging naturally, a foot that begins to drag, difficulty getting out of a chair, smaller or slower movements, or a general sense that one side of the body is not moving as it once did can all warrant investigation.
Changes in facial expression. Parkinson’s can reduce spontaneous facial movement, causing what is sometimes described as a masked or less expressive face. Changes in speech and voice can also occur, including softer speech or changes in the way the voice sounds.
Sleep disturbances. Problems with sleep can be associated with Parkinson’s, and certain sleep disorders can occur before more recognisable movement symptoms emerge.
Constipation and bladder problems. Parkinson’s can affect the autonomic nervous system, which regulates functions that happen largely without conscious thought. Constipation, urinary symptoms and blood-pressure changes can therefore form part of the picture.
Changes in mood and mental wellbeing. Anxiety, depression and apathy can occur as part of Parkinson’s and should not necessarily be dismissed as unrelated emotional issues.
Changes in the sense of smell. A reduced sense of smell is another recognised non-motor symptom associated with Parkinson’s.
None of these symptoms, on their own, means that someone has Parkinson’s disease. Many have numerous possible causes. The concern arises when symptoms are persistent, unusual, unexplained or begin appearing together – particularly when there are noticeable changes on one side of the body. That is when connecting the dots becomes important.
For Arrie, the diagnosis eventually made sense of symptoms that had previously seemed disconnected.
“None of these in isolation refers to anything serious, especially if you are used to operating in a high stress environment,” he says. “But when you connect the dots you realise that there’s a systemic problem in your body.”
That observation gets to the heart of why Parkinson’s can be so difficult to identify. There is currently no single blood test, brain scan or other test that definitively diagnoses Parkinson’s disease. Diagnosis is primarily clinical, based on a person's medical history, symptoms and neurological examination. Other tests may be used to support the assessment or rule out other conditions. This means recognising patterns really matters.
A person might initially see a physiotherapist for a painful shoulder, a doctor for sleep problems, or another healthcare professional for anxiety or urinary symptoms without anyone immediately seeing how those seemingly unrelated issues might fit together. Arrie believes this is an area that needs far greater attention.
“Brain diseases aren’t high on the doctors’ lists of possible outcomes,” he says. “I believe something must be done about this.”
Research into Parkinson’s within the South African population remains limited, and there is not currently a robust national prevalence figure that can accurately tell us how many South Africans are living with the disease. South African researchers have specifically highlighted the limited epidemiological data available, while studies have also pointed to increasing Parkinson’s incidence in sub-Saharan Africa.
“We have world-class medical treatments in South Africa,” he says. “The challenge with Parkinson’s and other neurological diseases is that it requires a multidimensional and multidisciplinary approach. This implies an integrated solution, and that is not the way the medical model currently works.”
He believes there may also be people living with Parkinson’s who have not yet been correctly diagnosed or who are unable to access appropriate specialist care. The Arrie Rautenbach Parkinson’s Foundation was established to help change that landscape, with a focus on awareness, education, research, patient and caregiver support, and sustainable funding.
Arrie does not suggest that people should diagnose themselves. Rather, the message is to become more aware of changes that might otherwise be explained away as ageing, stress, arthritis, tiredness or simply “one of those things”. A tremor is not the only reason to ask questions.
“I hope to live a long and fulfilled life with Parkinson’s using my diagnosis as a ‘gift’ to firstly give me purpose and secondly, to make a sustainable difference to help others that are in a similar position.”
For Arrie, that starts with something deceptively simple: helping people understand that Parkinson’s does not always announce itself with a shaking hand, but instead through a variety of other, smaller symptoms. And sometimes, the first step is learning to connect the dots.
Those who would like to contribute to the Foundation’s work in Parkinson’s awareness, education, support and future research can make a donation:
The Arrie Rautenbach Parkinson’s Foundation
Absa Bank
Current Account: 4073783756
Branch Code: 632005
For more information, please visit https://arrieforparkinsons.com/
ENDS
This article is intended for public education and awareness and is not a substitute for medical advice. Parkinson’s disease can present differently from person to person, and symptoms described above can have many possible causes. Anyone experiencing persistent or unexplained symptoms should consult an appropriate healthcare professional.