What Is Parkinsons Disease
Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.
Gait & Balance Abnormalities
Parkinsons Disease Exam
Patients with Parkinsons disease can develop an alteration of the postural reflexes that causes instability in gait and balance control. Such alterations usually develop later in the course of the illness and are a major cause of disability, especially because of the high risk for falls that derives.
Using the exam to pick up postural instability is of the utmost importance for the management of patients with PD, since it will trigger either a medication adjustment or a physical therapy intervention both aimed at falls prevention.
We have three tests for this part of the PD exam:
1) Standing up from a chair
2) Free walking
3) Provoked pull test maneuver for balance
What Are The Treatments For Parkinson’s Disease
There is no cure for PD, and no treatment prevents the disease from progressing. However, treatments can usually ease symptoms.
- At first, you may not need any treatment when the symptoms are mild. A specialist may simply see you every now and then to monitor how the disease is progressing.
- A medicine that eases symptoms is usually started when symptoms become troublesome.
- Therapies such as physiotherapy, occupational therapy and speech therapy may also be useful as the disease progresses.
- Surgery may be an option for severe cases.
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How Is Parkinson’s Diagnosed
This information looks at what parkinsonism is, how Parkinsons and other similar conditions may be diagnosed, and explains some of the tests that may be involved in the process.
Most people with a form of parkinsonism have idiopathic Parkinsons disease, also known as Parkinsons. Idiopathic means the cause is unknown.
Other less common forms of parkinsonism include multiple system atrophy , progressive supranuclear palsy , drug-induced parkinsonism and vascular Parkinsons.
If youre concerned about symptoms youve been experiencing, you should visit your GP. If your GP suspects you have Parkinsons, clinical guidelines recommend they should refer you quickly to a specialist with experience in diagnosing the condition .
Its not always easy to diagnose the condition. So its important that you see a Parkinsons specialist to get an accurate diagnosis and to consider the best treatment options.
Diagnosing Parkinsons can take some time as there are other conditions, such as essential tremor , with similar symptoms. There is also currently no definitive test for diagnosing Parkinsons.
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.
Causes Of Parkinson’s Disease
Parkinsons occurs when neurons in the part of the brain that control body movement become impaired or die. These neurons are responsible for creating dopamine, an important brain chemical that is vital for normal body function.
With fewer of these neurons in the brain, insufficient dopamine is created. Scientists are still not sure what exactly causes these neurons to become impaired or die.
People with Parkinsons also lose nerve endings that produce norepinephrine, the chemical messenger of the sympathetic nervous system that controls heart rate and blood pressure. This could be why fatigue and a decrease in blood pressure regularly occur with people who have Parkinsons.
While there have been cases of the disease that appear to be hereditary and can be traced to specific genetic mutations, there isnt enough evidence yet to conclusively prove it is passed down from parents to their children.
Most cases of Parkinsons occur randomly, and researchers believe a combination of genetic and environmental factors are responsible.
What Is The Prognosis For Parkinsons Disease
The rate at which Parkinsons progresses varies from patient to patient. Some patients experience its changes over 20 years or more. While others find the disease advances quicker.
Parkinsons is not a fatal disease. However, secondary complications from symptoms may increase falls, blood clots or pneumonia, which can be life-threatening. These are more common in later stages of Parkinsons.
In general, the average life expectancy of Parkinson’s patients is similar to people without the disease.
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Ruling Out Other Conditions
The symptoms of PD are similar to symptoms caused by other conditions, and an important part of the diagnosis process is excluding other diseases that may be the source of the patients symptoms. Other diseases that could cause similar symptoms include stroke, hydrocephalus, or other neurodegenerative disorders. Some medications can also cause Parkinsons like symptoms, and the doctor will assess these. Good responsiveness to levodopa for the motor symptoms is indicative of PD. However, many clinical trials need patients newly diagnosed with PD that have never taken levodopa. So, it may be worthwhile discussing participation in clinical trials with the doctor first.1
Your Home And Lifestyle
- Modify your activities and your home. For example, simplify your daily activities, and change the location of furniture so that you can hold on to something as you move around the house.
- Eat healthy foods, including plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, and low-fat dairy products.
- Exercise and do physiotherapy. They have benefits in both early and advanced stages of the disease.
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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
How Do Symptoms Progress And What Is The Outlook
The symptoms of PD tend to become gradually worse over time. However, the speed of progression varies greatly from person to person. When symptoms first begin, you may not need treatment when symptoms are relatively mild.
Most people with PD can expect to have some time of relatively mild symptoms. Then, when the symptoms become worse, they can expect several years of good or reasonable control of the symptoms with medication. But everyone is different and it is difficult to predict for an individual how quickly the disease will progress. Some people may only be slightly disabled 20 years after PD first begins, whereas others may be very disabled after 10 years.
Research into PD is active. For example, one main aim of research is to find medicines that prevent the damage to the affected cells, rather than just treating the symptoms, which is the main value of treatment at present. Further research on these chemicals continues. Research is underway using stem cell therapy to help treat PD. Other researchers are looking at alpha synuclein, a protein that gathers around the junction between nerve cells and is thought to affect the way messages are conducted between the brain and the nerves controlling movement.
Further reading and references
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Environmental And Genetic Factors
Scientists are also working to learn more about environmental factors and genetic factors that might contribute to the risk of developing Parkinsons. One recent genetic research breakthrough is the development of a DNA chip called NeuroX, which could potentially determine a persons risk, but more research is needed.
Parkinsons disease is the result of complicated combination of interconnected events, as described it. Since aging is the most common risk factor, future treatments may need to take degeneration of certain neurons into account.
Definition And Differential Diagnosis
There are many manifestations of but the classical diagnostic symptoms are:
- slowness and poverty of movement
The physical signs of include:
- slowness of movement
- rest tremor.
At diagnosis, these signs are usually unilateral, but they become bilateral as the disease progresses. Later in the disease additional signs may be present including postural instability , cognitive impairment and orthostatic hypotension .
There is no single way to define Parkinsons disease or what is often called idiopathic Parkinsons disease in order to differentiate it from other causes of parkinsonism, such as multiple system atrophy and progressive supranuclear palsy .
is traditionally defined, pathologically, by the finding of Lewy bodies and degeneration of catecholaminergic neurones at post-mortem. Using a pathological definition of PD is problematic for a number of reasons:
- A pathological diagnosis is not practical in life.
- Lewy body inclusions in catecholaminergic neurones are seen in individuals without clinical evidence of it is presumed that these are pre-clinical cases.
- Lewy bodies have not been found in otherwise typical individuals with with Parkin mutations, although such rare young-onset genetic cases of PD might be said not to have idiopathic PD.
In recent years, attempts to define genetically have become possible with the discovery of monogenic forms of the disease. However, such families account for a very small proportion of cases.
Common causes of tremor.
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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.
Consider The Age And Time Factor
Doctors also keep in mind other factors when diagnosing Parkinson’s. For instance:
- The disease is not common in people younger than 50.
- Diagnosing Parkinson’s can be tricky and may take time.
- Other diseases can cause similar symptoms. Your doctor will try to rule out other diseases that mimic Parkinson’s such as .
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Some Other General Points
Stay as active as possible. Exercise regularly as much as you are able. This may not be possible when the condition is more advanced. However, it is something to consider when symptoms are not too bad. You may walk more slowly than before but a daily walk is good exercise and may help to loosen up stiff muscles. Well-meaning relatives or friends may tell you to rest and take things easy. However, as much as possible and for as long as possible, resist the temptation for others to do things for you just because it may be quicker.
Constipation is common in people with PD. Help to reduce the chance of this by having lots to drink and eat plenty of vegetables, fruit, and foods high in fibre. Exercise can also improve constipation. Sometimes laxatives may be needed to treat constipation.
Some medicines taken for other conditions can interfere with dopamine and make PD worse. These may be prescribed for such things as mental illness, sickness, vertigo and dizziness. Check with your doctor if you are unsure about any medicines that you take.
Driving. If you are a driver you should tell the DVLA and your insurance company if you develop PD. Your insurance may be invalid if you do not. Depending on the severity of symptoms and the medicines that you are taking, you may still be allowed to drive following a medical assessment.
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.
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Taking Medicine With Food
Early in the disease, it might be helpful to take pills with food to help with nausea, which may be caused by some of the medicines for Parkinson’s disease.
Later in the disease, taking the medicines at least 1 hour before meals may help them work best.
Some medicines for Parkinson’s disease don’t work as well if you take them at the same time you eat food with protein in it, such as meat or cheese. The protein can block the medicine and keep it from working as well as it should.
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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What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
Assessing Level Of Rigidity
Doctors also look for rigidity by moving the joints in your elbows, wrists, knees, and ankles to see if there’s resistance. The resistance may be smooth or may appear as slight hesitations in movements, known as cogwheeling. This is sometimes made more obvious by the patient actively moving the opposite limb.
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How Is Parkinsons Diagnosed
Doctors use your medical history and physical examination to diagnose Parkinson’s disease . No blood test, brain scan or other test can be used to make a definitive diagnosis of PD.
Researchers believe that in most people, Parkinson’s is caused by a combination of environmental and genetic factors. Certain environmental exposures, such as pesticides and head injury, are associated with an increased risk of PD. Still, most people have no clear exposure that doctors can point to as a straightforward cause. The same goes for genetics. Certain genetic mutations are linked to an increased risk of PD. But in the vast majority of people, Parkinsons is not directly related to a single genetic mutation. Learning more about the genetics of Parkinsons is one of our best chances to understand more about the disease and discover how to slow or stop its progression.
Aging is the greatest risk factor for Parkinsons, and the average age at diagnosis is 60. Still, some people get PD at 40 or younger.
Men are diagnosed with Parkinsons at a higher rate than women and whites more than other races. Researchers are studying these disparities to understand more about the disease and health care access and to improve inclusivity across care and research.
Aging is the greatest risk factor for Parkinsons, and the average age at diagnosis is 60. Still, some people get PD at 40 or younger.
The Michael J. Fox Foundation has made finding a test for Parkinsons disease one of our top priorities.