Managing Depression In Parkinsons Disease
People with Parkinsons, family members and caregivers may not always recognize the signs of depression and anxiety. If you are experiencing depression as a symptom of Parkinsons, it is important to know it can be treated.
Here are some suggestions:
- For information and support on living well with Parkinsons disease, contact our Information and Referral line.
- As much as possible, remain socially engaged and physically active. Resist the urge to isolate yourself.
- You may want to consult a psychologist and there are medications that help relieve depression in people with Parkinsons, including nortriptyline and citalopram .
Is Early Diagnosis Possible
Experts are becoming more aware of symptoms of Parkinsons that precede physical manifestations. Clues to the disease that sometimes show up before motor symptoms and before a formal diagnosis are called prodromal symptoms. These include the loss of sense of smell, a sleep disturbance called REM behavior disorder, ongoing constipation thats not otherwise explained and mood disorders, such as anxiety and depression.
Research into these and other early symptoms holds promise for even more sensitive testing and diagnosis.
For example, biomarker research is trying to answer the question of who gets Parkinsons disease. Researchers hope that once doctors can predict that a person with very early symptoms will eventually get Parkinsons disease, those patients can be appropriately treated. At the very least, these advances could greatly delay progression.
Parkinson’s Disease and Movement Disorders Center
Our center provides compassionate and timely treatment to patients with movement disorders, such as dystonia, ataxia, essential tremor and similar conditions. But our mission goes beyond patient care excellence. By offering educational events and support groups, we empower patients and caregivers to become better partners in their health.
Looking For Signs Of Parkinsons
Your specialist will examine you to look for common signs of Parkinsons. You may be asked to:
- write or draw to see if your writing is small or gradually fades
- walk to see whether theres a reduction in the natural swing of your arm or in your stride length and speed
- speak to see if your voice is soft or lacks volume
The specialist will also look at and ask you about your:
- face to see if there is a masked look or if you have difficulty with facial expressions
- limbs to see if you have a tremor, any stiffness or slowness of movement
As well as examining you for any of the typical signs of Parkinsons, the specialist will also look for signs that may suggest a different diagnosis.
It may be helpful to take someone with you for support when seeing a specialist. Taking a list of questions you want to ask can also be useful so you dont forget to mention something you want to know about. If a healthcare professional says something you dont understand, dont be afraid to ask them to explain what they mean.
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Early Signs Of Parkinson’s
Early physical signs include the common motor symptoms: tremor, muscle rigidity and slowness. They may also include the following:
- Symptoms starting on one side of the body
- Change in facial expression
- Failure to swing one arm when walking
- Stooped posture
- Loss of sense of smell
- Depression or anxiety
Some of these symptoms are quite common and by no means exclusive to Parkinsons, so if you have some of them, it does not mean you have Parkinsons.
Is Parkinsons Disease Inherited
Scientists have discovered gene mutations that are associated with Parkinsons disease.
There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.
Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.
Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.
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Single Photon Emission Computed Tomography
In single photon emission computed tomography , a gamma ray-emitting radioactive isotope is tagged to a molecule of interest , which is given to the person with by intravenous injection. The labelled cocaine derivatives 123I–CIT and 123I-FP-CIT tropane) have most commonly been used, although only the latter is licensed in the UK. These label the presynaptic dopamine re- site and thus the presynaptic neurone, which can be visualised in two-dimensional images. These demonstrate normal uptake in the caudate and putamen in controls and in people with essential tremor, neuroleptic-induced parkinsonism or psychogenic parkinsonism, but reduced uptake in those with PD, PD with dementia, or .
How useful is SPECT in discriminating from alternative conditions?
Brain Imaging And Other Tools To Aid Diagnosis Of Parkinsons
In addition to taking a history and performing a detailed neurologic examination, physicians sometimes use brain imaging to help support a particular diagnosis. However, these studies have their limitations in the diagnosis of Parkinsons disease and are typically used only in select patients. Brain imaging is not routinely performed by neurologists or movement disorder specialists when they are considering a diagnosis, especially if the persons symptoms strongly suggest to the physician that idiopathic Parkinsons disease is the correct diagnosis.
Helping diagnose Parkinsons with DaTscan and other tests
Rather, use of imaging is most helpful when the diagnosis is uncertain, or when physicians are looking for changes in the brain that are more typical of one of several Parkinsonian syndromes and other conditions that can mimic Parkinsons. Imaging studies to evaluate Parkinsons disease and Parkinsonian syndromes include magnetic resonance imaging , which examines the structure of the brain, and DaTscan, an imaging test approved by the Food and Drug Administration to detect the dopamine function in the brain. A DaTscan may help differentiate idiopathic Parkinsons disease from certain other neurologic disorders. Most physicians offices will have access to MRI however, DaTscan imaging may only be available at larger hospitals or medical centers.
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Molecular Imaging In Parkinson’s Disease
The diagnosis of PD relies on the clinical manifestation of cardinal motor symptoms, bradykinesia, and tremor at rest or rigidity . A positive response to dopaminergic drugs is supportive of the diagnosis. Single photon emission computed tomography or PET ligands that are specific for dopamine transporters indirectly enable the quantification of the deficit of dopaminergic nigrostriatal projections and can provide further support of diagnosis . Deficiencies of monoamine synthesis can be measured with dihydroxyphenylalanine which is a substrate for the enzyme aromatic amino acid decarboxylase in all monoaminergic neurons including noradrenergic neurons .
The role of deficits of noradrenaline in motor and non-motor symptoms is not clear and research on the noradrenergic system in PD patients has been hindered by lack of specific methods to visualize the noradrenergic neurons and projections in vivo. We have recently carried out PET studies to investigate the role of noradrenaline in non-motor symptoms in PD patients and these studies will form the basis of discussions in the paragraphs below.
Paul Johns BSc BM MSc FRCPath, in, 2014
Elimination Of Other Conditions
Although no test can diagnose Parkinson’s disease itself, your doctor may order blood tests or imaging studies to rule out other causes of your symptoms.
Your doctor will want to know about any medication or recreational drugs you take, since some drugs can cause symptoms similar to those of Parkinson’s.
Parkinson’s disease doesn’t show up on radiological studies like X-ray, MRI , or CT scans.
Doctors sometimes order dopamine transporter SPECT imaging to determine whether a person with suspected Parkinson’s has a different disorder called essential tremor.
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What Tests Diagnose Parkinson’s Disease
There currently are no tests that can definitively diagnose Parkinsons Disease. A diagnosis is based on the clinical findings of your physician in combination with your report on the symptoms you are experiencing.
In situations where an older person presents with the typical features of Parkinsons and they are responsive to dopamine replacement therapy, there is unlikely to be any benefit to further investigation or imaging.
What Are The Complications Of Parkinson Disease
Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.
Parkinson disease dementia can cause problems with:
- Speaking and communicating with others
- Problem solving
- Forgetfulness
- Paying attention
If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.
Experts don’t understand how or why dementia often occurs with Parkinson disease. Its clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimer’s disease, another type of dementia.
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Diagnosis Of Parkinsons Disease
A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.
Imaging And Lab Tests
Your doctor may order some imaging tests and laboratory tests. Imaging tests can include computed tomography scans and magnetic resonance imaging scans. Laboratory tests can include blood tests and urine tests.
While these tests and scans will not help diagnose Parkinsons disease, they can help rule out other conditions that have similar symptoms.
Your doctor may also suggest that you get a dopamine transporter scan . This scan requires a single-photon emission computed tomography scanner. It involves an injection of a small amount of a radioactive drug so that your doctor can study the dopamine systems in your brain .
While a DaTscan cannot conclusively prove that you have Parkinsons, it can help confirm your doctors diagnosis and eliminate other conditions.
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What Are The Symptoms
Each person is affected differently by Parkinsons disease and no two people will experience exactly the same symptoms. The impact of Parkinsons disease can be unpredictable and it is common for people to have good days and bad days.
The main symptoms of Parkinsons disease are:
- tremor
- rigidity
- balance problems
- problems with posture
Other possible symptoms include difficulty initiating movement , a shuffling gait when walking, and freezing when trying to move . People might experience a loss of facial expression, speech problems , swallowing problems, bowel and bladder problems, difficulties at night and tiredness during the day. Skin can become greasy and people might experience excessive sweating. Sexual problems are common. People often experience depression and anxiety. Another common symptom is small handwriting .
Other less common symptoms can include pain and memory problems.
What Are The Stages Of Parkinsons
Neurologists often use a system of stages, called the Hoehn and Yahr scale, to describe the progression of symptoms. These stages are:
- Stage 1 Symptoms are seen on one side of the body only.
- Stage 2 Symptoms are seen on both sides of the body. There’s no impairment of balance.
- Stage 3 Balance impairment has begun. In this mild to moderate stage of the disease, the person is still physically independent.
- Stage 4 This stage is marked by severe disability, but the person is still able to walk or stand unassisted.
- Stage 5 The person is wheelchair-bound or bedridden unless assisted.
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Living With Parkinson’s Disease
Coming to terms with a diagnosis of Parkinson’s and living with the disease is challenging and will take a lot of adjustment. There are still things you can do that can help you to feel more in control of your situation and to stay positive. Some things that might help could include:
- choosing to lead a healthy lifestyle
- making informed decisions related to your treatment
- keeping a diary of your symptoms in preparation for meetings with health and social care professionals
- attending a self-management course
What Causes Parkinson Disease
Parkinson disease arises from decreased dopamine production in the brain. The absence of dopamine makes it hard for the brain to coordinate muscle movements. Low dopamine also contributes to mood and cognitive problems later in the course of the disease. Experts don’t know what triggers the development of Parkinson disease most of the time. Early onset Parkinson disease is often inherited and is the result of certain gene defects.
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What Is Parkinsons Disease
Parkinsons disease is a progressive brain disorder that affects mobility and mental ability. If you or a loved one has been diagnosed with Parkinsons, you may be wondering about life expectancy.
According to some research, on average, people with Parkinsons can expect to live almost as long as those who dont have the condition.
What Are The Surgical Treatments For Parkinsons Disease
Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.
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How Is Parkinson Disease Diagnosed
Parkinson disease can be hard to diagnose. No single test can identify it. Parkinson can be easily mistaken for another health condition. A healthcare provider will usually take a medical history, including a family history to find out if anyone else in your family has Parkinson’s disease. He or she will also do a neurological exam. Sometimes, an MRI or CT scan, or some other imaging scan of the brain can identify other problems or rule out other diseases.
From Evidence To Recommendation
The pathological studies emphasise the need for particular care in making a clinical diagnosis of . There is limited evidence to suggest that the UK Brain Bank Criteria have adequate sensitivity and specificity in comparison with post-mortem findings. The accuracy of diagnosis using the Brain Bank criteria increases as the condition progresses.
The availability of brain tissue has fostered much valuable research in recent years and should be encouraged in the future. Diagnostic information derived from post-mortem examination can also be of value to the families of individual patients.
RECOMMENDATIONS
- R9.
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should be diagnosed clinically and based on the UK Parkinsons Disease Society Brain Bank Criteria.
- R10.
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Clinicians should be encouraged to discuss with patients the possibility of tissue donation to a brain bank for purposes of diagnostic confirmation and research.
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Diagnosing Early Onset Parkinsons Disease
There is no single test to detect Parkinsons. A diagnosis may be difficult and take a while. The condition is usually diagnosed by a neurologist based on a review of your symptoms and a physical exam.
A DaTscan to visualize your brains dopamine system may help confirm diagnosis. Blood tests and other imaging tests, such as an MRI scan, dont diagnose Parkinsons. However, they may be used to rule out other conditions.
Obtaining A Parkinson’s Disease Diagnosis
During the exam, the neurologist will look for cardinal symptoms of the disease. Facial expressions and features will be assessed. The doctor will look for signs of tremor while the patient is at rest. The doctor may watch how easily the patient stands up from sitting in a chair. The doctor may also stand behind the patient and gently pull back on the patients shoulders and look for how easily the patient can regain balance. Good responsiveness to levodopa also helps support the diagnosis of PD. However, taking levodopa may exclude patients from clinical studies that need to recruit recently diagnosed patients who have not yet had treatment . Participation in a clinical trial should be discussed with the doctor.
PD can be challenging to accurately diagnose, particularly in early stages of the disease, which is why a neurologist trained in movement disorders is critical. Approximately 5-10% of patients with PD are misdiagnosed, as many of the symptoms of PD are similar to other diseases. If the patient thinks that he or she has been misdiagnosed, a second opinion may help.1,2
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