How Do Doctors Test For Parkinson’s

November 18, 2021

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What To Expect At The Appointment

Approach to the Exam for Parkinson’s Disease

To make a Parkinsons diagnosis, your doctor will look for the three main motor symptoms: bradykinesia , tremor and rigidity. Remember, not everyone with Parkinsons disease has a tremor. They will also ask questions and examine you to see if there are possible other explanations for your symptoms besides Parkinsons.

The doctor will ask you questions and look for Parkinsons signs like:

If you have a resting tremor, meaning your tremor appears when your limb like an arm or leg is still
If your tremor and/or other movement issues occur on one side of your body only
If your handwriting has become very small
If you have issues with balance
If the way you walk has changed for example, you are taking small steps or having trouble turning
If you have stiffness, aka rigidity, in your arms or legs for example, you dont swing your arm when you walk
If you have difficulty with fine motor movements like combing your hair or brushing your teeth
If your voice has become softer or more difficult for others to hear

To assess your non-motor symptoms, your doctor may ask you questions about:

If youve lost your sense of smell
If you experience constipation
If you talk or act out dreams while you sleep

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.

Ological Limitations Of The Diagnostic Studies

When interpreting the literature about diagnosis, the following methodological issues should be considered:

lack of long-term prospective clinical and pathological as a reference standard
lack of operational definitions such as defining specialists or clinical diagnostic criteria
unclear whether investigators were blinded to initial diagnosis
sample sizes necessarily limited by the number of cases available with neuropathological outcomes
trial age groups are often young as studies were performed by neurologists who see a younger population of people with PD
most studies included people with established disease lasting some years
varying geographical locations
some studies are in specialised units and may not reflect the diagnostic accuracy of other units in the UK
exclusion of some studies using magnetic resonance volumetry and magnetic resonance spectroscopy as they lacked appropriate population, intervention and outcome criteria
lack of statistical details of diagnostic accuracy such as sensitivity, specificity and positive predictive values
lack of economic evaluations of SPECT.

Surgery For People With Parkinsons Disease

Deep brain stimulation surgery is an option to treat Parkinsons disease symptoms, but it is not suitable for everyone. There are strict criteria and guidelines on who can be a candidate for surgery, and this is something that only your doctor and you can decide. Surgery may be considered early or late in the progression of Parkinsons. When performing deep-brain stimulation surgery, the surgeon places an electrode in the part of the brain most effected by Parkinsons disease. Electrical impulses are introduced to the brain, which has the effect of normalising the brains electrical activity reducing the symptoms of Parkinsons disease. The electrical impulse is introduced using a pacemaker-like device called a stimulator. Thalamotomy and pallidotomy are operations where the surgeon makes an incision on part of the brain. These surgeries aim to alleviate some forms of tremor or unusual movement, but they are rarely performed now.

What Is Parkinson’s Disease

Parkinsons disease occurs when brain cells that make dopamine, a chemical that coordinates movement, stop working or die. Because PD can cause tremor, slowness, stiffness, and walking and balance problems, it is called a movement disorder. But constipation, depression, memory problems and other non-movement symptoms also can be part of Parkinsons. PD is a lifelong and progressive disease, which means that symptoms slowly worsen over time.

The experience of living with Parkinson’s over the course of a lifetime is unique to each person. As symptoms and progression vary from person to person, neither you nor your doctor can predict which symptoms you will get, when you will get them or how severe they will be. Even though broad paths of similarity are observed among individuals with PD as the disease progresses, there is no guarantee you will experience what you see in others.

Parkinsons affects nearly 1 million people in the United States and more than 6 million people worldwide.

For an in-depth guide to navigating Parkinsons disease and living well as the disease progresses, check out our Parkinsons 360 toolkit.

What Is Parkinson’s Disease?

Dr. Rachel Dolhun, a movement disorder specialist and vice president of medical communications at The Michael J. Fox Foundation, breaks down the basics of Parkinson’s.

Also Check: Can Essential Tremor Turn Into Parkinson’s

How Parkinsons Disease Is Diagnosed

How It All Fits Together

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.

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?

Can Parkinsons Disease Be Prevented

Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.

What Causes Parkinsons Disease

Is there a test my physician can do to confirm a Parkinson’s disease diagnosis?

Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.

People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.

Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.

Also Check: What Are Early Warning Signs Of Parkinson’s Disease

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.

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.

Recommended Reading: Is Parkinson’s Inherited

How A Diagnosis Is Made

The bedside examination by a neurologist remains the first and most important diagnostic tool for Parkinsons disease . Researchers are working to develop a standard biological marker such as a blood test or an imaging scan that is sensitive and specific for Parkinsons disease.

A neurologist will make the diagnosis based on:

A detailed history of symptoms, medical problems, current and past medications. Certain medical conditions, as well as some medications, can cause symptoms similar to Parkinsons.
A detailed neurological examination during which a neurologist will ask you to perform tasks to assess the agility of arms and legs, muscle tone, gait and balance, to see if:
Expression and speech are animated.
Tremor can be observed in your extremities at rest or in action.
There is stiffness in extremities or neck.
You can maintain your balance and examine your posture.

You may notice that a neurologist records your exam into a table, called Unified Parkinsons Disease Rating Scale . This is a universal scale used by neurologists and movement disorder specialists to comprehensively assess and document the exam of a person with PD at a baseline, judge the effect of medication and track the progression of disease during future visits.

Most commonly, people with PD respond well to dopaminergic medications. Lack of response to medications may prompt the doctor to seek an alternative diagnosis such as atypical parkinsonism and order further testing such as an MRI of the brain.

Blood Tests And Spinal Fluid Tests

A blood test or spinal fluid test cant be used to diagnose Parkinsons. But they can be used to search for certain proteins that indicate you may have another neurodegenerative condition with similar symptoms.

The presence of elevated levels of a nerve protein called neurofilament light chain protein may indicate that you have another movement disorder, such as:

multiple system atrophy
corticobasal degeneration

Also Check: What Are Early Warning Signs Of Parkinson’s Disease

Further Testing In Parkinson’s

In other situations, where perhaps the diagnosis is not as clear, younger individuals are affected, or there are atypical symptoms such as tremor affecting both hands or perhaps no tremor at all, further testing may help. For example, imaging can play a role in differentiating between essential tremor and Parkinsons. It can also be important to confirm what is initially a clinical diagnosis of Parkinsons prior to an invasive treatment procedure such as surgical DBS

There Are : : : : : Stages Of Parkinson’s Disease

There are five stages of Parkinson’s disease, described with the most commonly used Hoehn and Yahr scale: – Stage one: Symptoms such as tremors or shaking on one side of the body- Stage two: Tremors or shaking one or both sides of the body possible imbalance- Stage three: Noticeable balance impairment and slowing of motion- Stage four: Severe symptoms, disability patient likely needs assistance- Stage five: Patient may be bedridden or wheelchair bound needs constant care Another scale that may be used to describe symptoms of Parkinson’s disease is called the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale . It is a four-part scale that measures motor movement in PD: non-motor experiences of daily living, motor experiences of daily living, motor examination, and motor complications.

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.

Mri In Parkinson’s Testing

How does a physician arrive at a Parkinson’s disease diagnosis?

One of the more common tests done during a neurologic workup is an MRI scan and one may think that in the investigation of a disease that affects the brain such as Parkinsons, this imaging test would be a necessity. In the context of Parkinsons disease, however, an MRI is not particularly helpful. It looks at the structure of the brain which, for all intents and purposes, appears normal in this disease. An MRI may, however, be indicated when symptoms appear in younger people or if the clinical picture or the progression of symptoms is not typical for Parkinsons. In these situations, MRI can be used to rule out other disorders such as stroke, tumors, hydrocephalus , and Wilsons Disease .

Read Also: Parkinson’s Plus Life Expectancy

What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

New Diagnostic Standards For Parkinsons

Until recently, the gold-standard checklist for diagnosis came from the U.K.s Parkinsons Disease Society Brain Bank. It was a checklist that doctors followed to determine if the symptoms they saw fit the disease. But thats now considered outdated. Recently, new criteria from the International Parkinson and Movement Disorder Society have come into use. This list reflects the most current understanding of the condition. It allows doctors to reach a more accurate diagnosis so patients can begin treatment at earlier stages.

What Causes Parkinson’s Disease

Parkinson’s disease is the result of the loss of the brain chemical dopamine. When nerve cells, called neurons, in an area of the brain that controls movement become impaired and/or die, the amount of dopamine they normally produce decreases. This loss of dopamine causes the movement problems seen in people with PD.

What Are The Diagnostic Criteria For Parkinsons

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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.

The Diagnostic Criteria Used Today

In 2015, a Movement Disorder Society task force proposed a set of criteria that became known as the Movement Disorder Society United Parkinsons Disease Rating Scale , which includes non-motor symptoms in its criteria.9

The new criteria requires you to have slowness of movement, plus either a rest tremor or rigidity. It also requires that you do not meet any criteria in a list called absolute exclusion criteria. This list of symptoms indicates you most likely do not have PD or that you may have an atypical parkinsonism disorders that resemble Parkinsons disease but are ultimately different. If you meet any of those requirements, PD is ruled out. For example, one absolute exclusion criteria is if you are taking a drug that is known to cause Parkinsons-like side effects.

Next, you must meet at least two of the following four criteria:

Dramatic improvement of motor symptoms when you take the gold-standard Parkinsons medication called levodopa
The presence of dyskinesia as a result of taking levodopa dyskinesia is a possible side effect of levodopa among people with PD
Rest tremor, meaning your tremor occurs when the body part is at rest
Loss of smell, or if you have a test called MIBG scintigraphy and it indicates that you have autonomic dysfunction, which is when your autonomic nervous system doesnt work correctly, leading to issues with things like heart rate and blood pressure.

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