The Mystery Of Parkinsons Disease
NCH Medical Group Neurologist Saju Abraham answers questions about Parkinsons disease.
Parkinsons disease is not uncommon in the United States about one million people have Parkinsons and more than 50,000 new cases are diagnosed each year. And yet the cause of Parkinsons remains unclear, and its debilitating impact on patients can vary widely. Many of us may know someone with Parkinsons and yet still feel it is a mystery.
Parkinsons disease is treatable, NCH Medical Group Neurologist Saju Abraham, M.D. emphasizes, but it is a serious neurological disorder that affects the bodys movement and can include tremors and trouble walking.
Dr. Abraham answers some basic questions about Parkinsons to try to help us unlock the mysteries behind this disease.
Q: Do we know what causes Parkinsons disease?
Dr. Abraham: While we havent established a clear cause to Parkinsons, we do know that many things contribute to its onset, including genetics, environmental triggers and trauma. What usually happens is that dopamine producing cells breakdown causing abnormal brain activity leading to the disease.
Q: We hear a lot about screening and early intervention for other serious conditions, but are there screening options available for Parkinsons?
Q: Is there any way to prevent Parkinsons disease?
Q: What are some signs and symptoms of Parkinsons disease?
Q: Can you live a full life with Parkinsons disease?
Dr. Saju Abraham can be reached at 847-725-8401.
Other Medicines Used For Pd
- Catechol-O-methyltransferase inhibitors are relatively new medicines. They include tolcapone, entacapone and opicapone. These help to stop the breakdown of levodopa by the body, so more of each dose of levodopa can get into the brain to work. A COMT inhibitor is sometimes advised in addition to levodopa when symptoms are not well controlled by levodopa alone.
- Other medicines are sometimes used to help relieve symptoms. They have various effects which try to correct the chemical imbalance in the brain. They include beta-blockers, amantadine and anticholinergic medicines. One of these may be tried when symptoms are mild. However, you are likely to need levodopa or a dopamine agonist at some point.
Various things may influence which medicine is advised. For example, your age, severity of symptoms, how well your symptoms respond to treatment, if side-effects develop, other medicines that you may take, etc. Your specialist will advise on the best medicine for you to take. Whatever medicine or medicines you are prescribed, read the leaflet in the medicine packet for a full list of possible side-effects. Mention to your doctor if you develop a troublesome side-effect. A modification of the dose, dose schedule, or the type of medication, may be possible to help keep side-effects to a minimum.
Who Develops Parkinson’s Disease
PD mainly develops in people over the age of 50. It becomes more common with increasing age. About 5 in 1,000 people in their 60s and about 40 in 1,000 people in their 80s have PD. It affects men and women but is a little more common in men. Rarely, it develops in people under the age of 50.
PD is not usually inherited and it can affect anyone. However, one type of PD, which appears in the small number of people who develop it before the age of 50, may be linked to inherited factors. Several family members may be affected.
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Rehabilitation For Parkinsons Patients
Parkinsons disease patients may find that rehabilitation services, including physical therapy, ease symptoms. Therapy focuses on helping patients build strength and move more easily. Goals may include improving walking, balance and overall movement.
Ask your doctor or specialist about getting a referral for rehabilitation with a therapist. Often rehabilitation services are close to home, in your community.
MaineHealth has home care services that support patients in their homes. Services may include:
- Help with laundry and household chores
- Counseling and emotional support
- Personal care help with daily activities
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.
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Can Parkinsons Disease Be Diagnosed By How You Smell
Theres evidence that people with Parkinsons disease may emit a specific type of scent, which is related to increased sebum production. However, doctors have not developed a way to use this odor to diagnose the disease. More research is being done to see how the finding can help with diagnosis and treatment.
Passive Manipulation Of Limbs
To test for the presence of rigidity, we need to passively manipulate the limbs of the patient. However, If the disease is in its early stage or the symptoms are well controlled with medications, we may not be able to see rigidity. We will need to use some activation maneuvers, that basically consist in performing repetitive movements with the limb contralateral to the one that is being tested.
Also, there are two types of rigidity:
– Lead-pipe rigidity: where the tone is uniformly and smoothly increased throughout the entire range of movement
– Cogwheel rigidity: where a tremor is superimposed on the hypertonia, making the movement irregular due to intermittent increase and reduction of tone
Upper Extremity Testing
For the upper extremity the most sensitive joint where to check for rigidity is the wrist. To uncover rigidity, passively rotate the wrist and feel for a resistance to the movement. It is very important that the arm of the patient is fully relaxed when rotating the wrist. To do this, place your proximal hand under the patients forearm, while your distal hand grabs and rotates the wrist of the patient. When rigidity is present, the range of motion will be preserved but you will feel a resistance in performing the movement.
Wrist rotation with activation maneuver.
It is also possible to test for rigidity in the elbow by passively flexing and extending the forearm.
Elbow flexion-extension with activation maneuver.
Lower Extremity Testing
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Other Challenges Of Diagnosing Parkinsons Disease
Parkinsons disease progresses slowly, often with non-motor symptoms appearing months or years before motor symptoms. This can make it challenging for doctors to diagnose you in the early stages, especially since the diagnostic criteria is based mostly on motor symptoms. You may have to wait until your symptoms progress for you and your doctor to confirm your diagnosis.14
Age and gender can be another issue. Since Parkinsons is associated more with older men, doctors may not think their younger or female patients have Parkinsons.5 On the other hand, since the disease is associated with aging, your symptoms may be blamed on getting older.
Remember that movement disorder specialists are extremely knowledgeable about Parkinsons disease and can help put the pieces together where other more generalized doctors may not. Never hesitate to fight for the care you deserve.
Related: Heres whats important to remember if you were just diagnosed with Parkinsons disease.
How Parkinsons Disease Is Diagnosed
Diagnosing Parkinsons disease can be complicated because there isnt a specific blood test or screening test that can determine whether or not you have it.
Instead, Parkinsons is diagnosed clinically, which means a doctor will examine you, review your symptoms and medical history, and diagnose accordingly.
Parkinsons disease is a neurological condition that can make movement difficult. If your general practitioner thinks you might have Parkinsons, they may refer you to a neurologist who specializes in movement disorders for a diagnosis.
It can be challenging to catch Parkinsons in the early stages because the symptoms may be too mild to notice or meet the diagnostic criteria. Also, early Parkinsons symptoms are often mistaken for typical signs of aging.
The symptoms of Parkinsons disease are also similar to those of other health conditions, which may be misdiagnosed as Parkinsons at first. Your doctor may suggest specific tests and scans to help eliminate other conditions that can mimic the symptoms of Parkinsons disease.
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What Are The Diagnostic Criteria For Parkinsons
Doctors diagnose Parkinsons clinically based on your symptoms and medical history.
No individual test can be used to diagnose Parkinsons. Many other neurogenerative conditions can lead to similar symptoms, so your doctor may use a blood test, brain scans, or other tests to rule out other conditions.
If Its Not Parkinsons Disease What Could It Be
Here are some possibilities:
Side effects of medication: Certain drugs used for mental illnesses like psychosis or major depression can bring on symptoms like the ones caused by Parkinsonâs disease. Anti-nausea drugs can, too, but they typically happen on both sides of your body at the same time. They usually go away a few weeks after you stop taking the medication.
Essential tremor: This is a common movement disorder that causes shaking, most often in your hands or arms. Itâs more noticeable when youâre using them, like when you eat or write. Tremors caused by Parkinsonâs disease usually happen when youâre not moving.
Progressive supranuclear palsy: People with this rare disease can have problems with balance, which may cause them to fall a lot. They donât tend to have tremors, but they do have blurry vision and issues with eye movement. These symptoms usually get worse faster than with Parkinson’s disease.
Normal pressure hydrocephalus : This happens when a certain kind of fluid builds up in your brain and causes pressure. People with NPH usually have trouble walking, a loss of bladder control, and dementia.
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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
In A Sense The Certainty Of Diagnosis Was Good I Belonged Somewhere
I still have no confirmed diagnosis. The swathe of neurological symptoms still persist today some aspects of movement are identified as functional movement disorder, but otherwise it has been a question of ruling in/out alternative causes for some symptoms.
One theory is that an initial brain insult during the 2006 anaesthetic, together with a gastro drug I was taking at the time that has Parkinsonism as a side effect, combined to give me Parkinsons disease. But now this original brain insult plus nine years of my brains neuroplasticity being driven into new behaviours by Parkinsons drugs, plus issues that arose during Parkinsons drug withdrawal are the current neurological problems that I have to contend with.
Fortunately, while there is widespread dysfunction, I have been told that there does not appear to be any brain disease processes associated with these symptoms. Again, there are no tests to prove/disprove this and one remains reliant on the expertise of brilliant neuroscientists.
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How Parkinson’s Disease Is Diagnosed
Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology.
There’s no “gold standard” test that will diagnose Parkinson’s disease . Instead, a physician relies on their own clinical observations and judgment, along with a patient’s description of possible signs and symptoms, to make the diagnosis. That, of course, makes a physical examination very important in this process. Much of your doctor’s exam will be aimed at assessing whether you have the so-called cardinal signs of Parkinson’s: resting tremor, rigidity , bradykinesia and postural instability .
How To Test For Parkinson’s Disease
This article was medically reviewed by Erik Kramer, DO, MPH. Dr. Erik Kramer is a Primary Care Physician at the University of Colorado, specializing in internal medicine, diabetes, and weight management. He received his Doctorate in Osteopathic Medicine from the Touro University Nevada College of Osteopathic Medicine in 2012. Dr. Kramer is a Diplomate of the American Board of Obesity Medicine and is board certified.There are 10 references cited in this article, which can be found at the bottom of the page. This article has been viewed 35,437 times.
Parkinsons Disease is a progressive neurodegenerative disorder affecting both motor and non-motor abilities. It afflicts 1% of those over 60 years of age.XResearch sourceJOHN D. GAZEWOOD, MD, MSPH,D. ROXANNE RICHARDS, MD,KARL CLEBAK, MD, Parkinsons An Update, The American Family Physician, 2013 Feb 15 87:267-273 It is a progressive disorder of the central nervous system. PD is caused by a lack of dopamine, a chemical that helps the parts of your brain responsible for motor function communicate with each other. This condition often causes tremors, muscle stiffness, slowness, and poor balance. If you suspect that you, or someone you love, has Parkinsons, it is important to know how you can diagnose this condition. Begin by trying to identify symptoms of the disease at home, and then see your doctor for an appropriate medical diagnosis.
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What Are The Treatments
Currently there is no cure for Parkinsons disease.
Symptoms can be mild in the early stages of the condition and people might not need immediate treatment. Your doctor and specialist will monitor your situation.
There are several different types of drugs used to treat Parkinsons disease. Drug treatments are tailored to each individuals needs and are likely to involve a combination of different drugs. Your medication should be reviewed regularly. It is likely that, over time, changes will be made to the types of drugs you take and the doses you take each day.
The main types of drug treatment for Parkinsons disease are:
- drugs which replace dopamine
- drugs which mimic the role of dopamine
- drugs which inhibit the activity of acetylcholine
- drugs which prevent the body breaking down dopamine
- other drugs such as anti-sickness medication
Everybody is affected differently by medication. The possible side effects of Parkinsons disease drugs include nausea , vomiting , tiredness and dizziness. Some people might experience confusion, nightmares and hallucinations. For some people, dopamine agonists have been linked to compulsive behaviour such as addictive gambling or hypersexuality .
The effectiveness of the main drug treatment levodopa can wear off over time and its long-term use can cause some people to develop involuntary twisting or writhing movements of the arms, legs or face . To reduce the risk, doctors might delay the use of levodopa for younger people.
What Are My Next Steps
If your doctor doesnt diagnose Parkinsons, they can help you find out what the best next step is depending on what condition they suspect. In some cases, treatment may be as simple as changing the dosage of a medication that may be leading to Parkinsons-like symptoms.
Receiving a Parkinsons diagnosis can be overwhelming. If your diagnosis is confirmed, contact a movement disorder specialist as soon as possible. A specialist can help you develop a strategy to delay the onset of more severe disease and manage symptoms youre already experiencing.
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How Can I Try To Get An Early Diagnosis
By the time Parkinsons causes noticeable motor symptoms, usually about 50 percent of the cells that produce dopamine in your substantia nigra have already died off. Non-motor symptoms, such as constipation, loss of smell, or restless sleep, often appear before motor symptoms.
Theres still debate among medical professionals on how long non-motor symptoms may appear before an individual has noticeable changes in their movement. Its thought that they could appear years to decades beforehand.
But a formal Parkinsons diagnosis requires the symptom slowness of movement. In the time before this symptom appears, your doctor cant make a Parkinsons diagnosis, but they may alert you that youre at a high risk of developing Parkinsons in the future if these or other symptoms appear at any point.
Brain Imaging Can Help With Diagnosis
Doctors use two tests that take detailed pictures of your brain. Each one may help your doctor make a diagnosis. These tests are:
- PET scan: This shows how your brain functions. It shows how the brain uses sugar. This scan can help tell the difference between Parkinson’s and .
- DaTscan: This shows problems with brain cells that make dopamine. Healthy brain cells light up during the test. Cells without enough dopamine appear dark. This scan can help your doctor tell the difference between Parkinson’s and a brain disease called .
Imaging studies are a newer way to diagnose Parkinson’s. However, not every healthcare facility can do them. It takes an experienced doctor to interpret the scans accurately. These scans also can be very expensive. Be sure to check with your insurance company ahead of time to see whether you are covered and what your out-of-pocket costs will be.
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