What Doctors Look For When Diagnosing Parkinsons
Certain physical signs and symptoms noticed by the patient or his or her loved ones are usually what prompt a person to see the doctor. These are the symptoms most often noticed by patients or their families:
Shaking or;tremor: Called resting tremor, a trembling of a hand or foot that happens when the patient is at rest and typically stops when he or she is active or moving
Bradykinesia: Slowness of movement in the limbs, face, walking or overall body
Rigidity: Stiffness in the arms, legs or;trunk
Posture instability: Trouble with balance and possible falls
Once the patient is at the doctors office, the physician:
Takes a medical history and does a physical examination.
Asks about current and past medications. Some medications may cause symptoms that mimic Parkinsons disease.
Performs a neurological examination, testing agility, muscle tone, gait and balance.
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Physical Examination And Tests
A trip to the neurologists office often includes what seems like dozens of questions, along with multiple tests.
There currently are no diagnostic blood tests for Parkinson’s disease, but your doctor may do some routine blood and urine tests to assess your overall health. Your blood pressure will be taken sitting and standing to look for orthostatic hypotension.
A movement disorder specialist will do a variety of physical tests to assess you as well.
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Response To Parkinsons Drugs
After examining you, and depending on the severity of your symptoms, your specialist may suggest you take medication for Parkinsons. If your symptoms improve after taking Parkinsons medication for a few weeks or months, your specialist may confirm a Parkinsons diagnosis. However, some people with other forms of parkinsonism will also respond well to these drugs.;
Your specialist may suggest you have a scan to help make a diagnosis. However, scans alone cant make a definite diagnosis of Parkinsons, so they are not commonly used.
Tips For Caring For Someone With Parkinsons Disease
Caring for a loved one with early onset Parkinsons can be difficult. If youre a caregiver for someone with this condition, its important that you remember your own emotional and physical health.
Not only are you dealing with a difficult diagnosis, youre also managing an increased number of responsibilities. Burnout is common in caregivers, so make sure youre checking in with your own needs.
The Michael J. Fox Foundation Center for Parkinsons Research recommends these tips for caregivers:
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Testing For Parkinson’s Disease
There are no blood tests or brain scans that can make the diagnosis of Parkinsons disease. Right now, the diagnosis of Parkinsons disease is still made based on the history and the examination.;;
In some cases, a doctor may order medical imaging such as a; or an ;to make sure nothing else is happening, but these scans will not show any changes relating to Parkinsons disease.
In 2012, the FDA approved a special kind of brain scan called a DaT scan. In this scan, people receive an injection of a dye and then pictures show if there is a brain problem relating to the chemical dopamine. However, this scan was approved only to help figure out if someone with tremor has a disease in the Parkinson family or if their tremor might be related to a different disease called familial essential tremor.;
Most of the time, a neurologist especially a movement disorders specialist can know if someone has a disease in the Parkinson family or familial essential tremor without doing this scan. It is also important to know that this scan cannot help a doctor know if a person has Parkinsons disease or one of the other parkinsonisms. Thus, this scan is only used in a few situations. It is not for everyone who might have Parkinsons disease.
In This Section:
What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
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What Tests Might I Have
People who have Parkinsonâs disease donât make enough of a brain chemical called dopamine, which helps you move. If those first tests donât show a reason for your symptoms, your doctor may ask you to try a medication called carbidopa-levodopa, which your brain can turn into dopamine. If your symptoms get much better after you start the drug, your doctor probably will tell you that you have Parkinsonâs disease.
If the medication doesnât work for you and thereâs no other explanation for your issues, your doctor might suggest an imaging test called a DaTscan. This uses a small amount of a radioactive drug and a special scanner, called a single photon emission computed tomography scanner, to see how much dopamine is in your brain. This test can’t tell you for sure that you have Parkinson’s disease, but it can give your doctor more information to work with.
It can take a long time for some people to get a diagnosis. You may need to see your neurologist regularly so they can keep an eye on your symptoms and eventually figure out whatâs behind them.
The Importance Of Early Diagnosis
Early detection and diagnosis is important because the treatments for PD are more effective in the early stages of the disease. In addition, physical therapy and exercise, which greatly improve symptoms and delay progression of the disease, are much easier to perform in the early stages.
Current diagnosis is made through the presence of motor symptoms; however, researchers have found that by the time motor symptoms occur, over 60% of all dopamine neurons in the basal ganglia of the brain have been damaged. Non-motor symptoms become apparent in people with PD long before motor symptoms, including sleep disturbances and loss of the sense of smell.3
Active areas of research include looking for markers in the blood, urine, or cerebral spinal fluid that reliably detect PD, called biomarkers. In addition, brain imaging tests that have high sensitivity for detecting PD are also being actively researched.4
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Parkinson’s Disease Is A Movement Disorder
Parkinson’s disease is a movement disorder that is degenerative and chronic, and symptoms continue and generally worsen over time. The National Institute of Neurological Disorders and Stroke estimates about 50,000 people are diagnosed with PD each year in the U.S. The cause of PD is unknown. There is currently no cure, but there are several treatment options available to manage symptoms including medications and surgery.
Who Gets Parkinson’s Disease
About 1 million people in the United States have Parkinson’s disease, and both men and women can get it. Symptoms usually appear when someone is older than 50 and it becomes more common as people get older.
Many people wonder if you’re more likely to get Parkinson’s disease if you have a relative who has it. Although the role that heredity plays isn’t completely understood, we do know that if a close relative like a parent, brother, or sister has Parkinson’s, there is a greater chance of developing the disease. But Parkinson’s disease is not contagious. You can’t get it by simply being around someone who has it.
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Likelihood Of Referral According To Final Diagnosis
Overall, 74% of all cases with a diagnosis of Parkinson’s disease had been seen by a specialist. However, when these cases were classified by final diagnosis , it was observed that, paradoxically, fewer cases with atypical disease had been seen by a specialist compared with those with classical Parkinson’s disease ; p = 0.02).
Problems With Balance Or Walking
Bradykinesia can also contribute to increasing instability, walking difficulties and changes in gait. An early symptom of this is a decrease in the natural swing of one or both arms when walking. As things progress, the steps you take may become slower and smaller, and you may start shuffling your feet.
Some people with Parkinsons disease may also experience freezing episodes where it can feel like their feet are stuck in place, which can increase the risk of falling.
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There Are No Laboratory Tests To Diagnose Parkinson’s Disease
Currently there are no laboratory tests that can diagnose Parkinson’s disease. This can make it difficult to accurately diagnose because PD resembles other movement disorders. In order to diagnose PD, a physician will take a complete medical history and perform a neurological exam. Additional testing may be done simply to rule out other neurological conditions that may resemble Parkinson’s.
Datscan: A Test To Help In The Diagnosis Of Parkinsons
In 2011, the Food and Drug Administration approved an imaging test to help diagnose PD. In this test, a radioactive tracer, Ioflupane 123I, also known as DaTscan, is injected into the blood, where it circulates around the body and makes its way into the brain. It attaches itself to the dopamine transporter, a molecule found on dopamine neurons. Several hours after the tracer has been injected, special imaging equipment scans the head to detect the presence of DaTscan.
People with PD will typically have a smaller signal in a part of the brain called the striatum, where the ends of the dopamine neurons are meant to be. Here is a normal scan on the left, which would indicate a healthy dopamine system, next to an abnormal scan on the right, which would indicate an unhealthy dopamine system.
It is important to note that conventional MRI imaging will appear normal in PD and is therefore not helpful in confirming the diagnosis. Other atypical parkinsonian conditions, such as vascular parkinsonism however, can have abnormalities on MRI, so the test may be done to rule out other diagnoses.
What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
What Are The Pitfalls Of Datscan
DaTscan will appear abnormal in any disease in which there is a loss of dopamine nerve endings in the striatum. Therefore, Parkinson-plus syndromes, discussed in a prior blog, such as Progressive supranuclear palsy , Corticobasal ganglionic degeneration and Multiple system atrophy all typically demonstrate abnormal DaTscans. DaTscan therefore cannot be used to distinguish between these syndromes.
Every medical test has a false positive and a false negative rate. This means, that it is inevitable that in a certain percentage of people who have PD, the DaTscan will be read as normal and in a certain percentage of people without PD, the DaTscan will be read as abnormal. Results of any medical test that is performed, must therefore be considered within the entire clinical context.
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Comparison Of Patients In Whom A Diagnosis Of Parkinson’s Disease Was Maintained Or Rejected
Patients in whom a diagnosis of Parkinson’s disease was confirmed had more severe disease as measured by the Hoehn and Yahr stage , more often had a tremor at rest or a classical pill rolling tremor , and more often reported a good initial and sustained response to levodopa than those in whom it was rejected.
Patients in whom the diagnosis was changed to non-parkinsonian tremor had no other parkinsonian features such as rigidity, bradykinesia, hypomimia, or monotonous speech. They also reported falls significantly less frequently and had higher mini-mental state scores . Those in whom the diagnosis was changed to atypical parkinsonism had more severe akinesia , rigidity , and postural instability , less commonly reported an initially or currently good response to levodopa , but more often had incontinence and additional features incompatible with Parkinson’s disease. Those in whom the diagnosis was changed to vascular parkinsonism were older than those in whom a diagnosis of Parkinson’s disease was confirmed , had a larger number of smoking years , more often had gait difficulties as their first complaint , and had more severe postural instability ; they never had a rest tremor.
How The Levodopa Test Is Conducted
The levodopa test is given at least eight hours after the patients last dose of any medication to boost dopamine levels in the brain and usually takes place in the morning.;Motor functions are analyzed before the test and again 60 to 90 minutes after taking levodopa using part 3 of the unified Parkinsons disease rating;scale .
- Degree of difficulty while rising from a chair
- General posture
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Treatment Options For Early Onset Parkinsons Disease
Parkinsons treatment aims to slow the diseases progression. Medication treatment options may include the following:
- Levodopa is a chemical thats converted to dopamine in the brain. People with early onset Parkinsons may experience more negative side effects, such as involuntary movements.
- MAO-B inhibitors can help reduce the breakdown of dopamine in the brain.
- Catechol-O-methyltransferase inhibitors can help extend Levodopas effects on the brain.
- Anticholinergics can help reduce tremors.
- Amantadine may be used to improve muscle control and relieve stiffness.
Determining Diagnosis Through Response To Parkinsons Medication
If a persons symptoms and neurologic examination are only suggestive of Parkinsons disease or if the diagnosis is otherwise in doubt, the physician may, nevertheless, prescribe a medication intended for Parkinsons disease to provide additional information. In the case of idiopathic Parkinsons, there is typically a positive, predictable response to Parkinsons disease medication; in the case of some related Parkinsonian syndromes, the response to medication may not be particularly robust, or it may be absent entirely.
Unfortunately, there are no standard biological tests for the disease, such as a blood test. However, researchers are actively trying to find biomarkers in blood and other bodily fluids that could help confirm the diagnosis.
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Symptoms Of Parkinson’s Disease
The symptoms and rate of progression of Parkinsons are different among individuals. Effects of normal aging are sometimes confused for Parkinsons. It is difficult to accurately diagnose this disease because there is not a test that can accurately do it.
There are physical and non-physical symptoms that could indicate someone has Parkinsons disease:
Early stage symptoms
Parkinson’s disease occurs gradually. At first, the symptoms might not even be noticeable. Early symptoms can include feeling mild tremors or having difficulty getting out of bed or a chair. The person might start to notice that they are speaking softer than usual, or that their handwriting looks different.
Usually, it is friends or family members who are the first to notice changes in someone with early Parkinson’s. For example, they may notice that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
Referral To A Specialist
If your GP suspects Parkinson’s disease, you’ll be referred to a specialist.
This will usually be:
- a neurologist, a specialist in conditions affecting the brain and nervous system
- a geriatrician, a specialist in problems affecting elderly people
The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement.
A diagnosis of Parkinson’s disease is likely if you have at least 2 of the 3 following symptoms:
- shaking or tremor in a part of your body that usually only occurs at rest
- slowness of movement
- muscle stiffness
If your symptoms improve after taking a medication called levodopa, it’s more likely you have Parkinson’s disease.
Special brain scans, such as a;single photon emission computed tomography scan, may also be carried out in some cases;to try to;rule out;other causes of;your symptoms.