How Is Parkinson’s Disease Diagnosed
Diagnosis is difficult at every stage of the disease, but particularly in the early stages. No single test can provide a diagnosis. A diagnosis will likely involve physical and neurological examinations, conducted over time to assess changes in reflexes, coordination, muscle strength, and mental function. Your doctor might also see how you respond to medicine.
You may need to have brain imaging tests to rule out other conditions that might be causing your symptoms. Such tests could include MRI and CT scans and possibly some other types of scans. Blood tests may also be done to exclude other illnesses.
What Is Parkinsons 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 Parkinsons 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 Parkinsons 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 Parkinsons.
How Does This Condition Affect My Body
Parkinsons disease causes a specific area of your brain, the basal ganglia, to deteriorate. As this area deteriorates, you lose the abilities those areas once controlled. Researchers have uncovered that Parkinsons disease causes a major shift in your brain chemistry.
Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells communicate with each other. When you have Parkinsons disease, you dont have enough dopamine, one of the most important neurotransmitters.
When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements using cells that require dopamine. Thats why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson’s disease.
As Parkinson’s disease progresses, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.
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Surgical Options For Parkinsons Disease
As of 2019, there are two surgeries prescribed to treat Parkinsons. These are only ordered if medications previously helped control movement symptoms but are no longer effective.
The first is called deep brain stimulation. The surgeon inserts a wire, or lead, into the subthalamic nucleus, which is the part of the brain that controls movement. The wire extends to an external device called a neurostimulator. This sends electrical pulses through the lead to stimulate the subthalamic nucleus.
The second surgery is prescribed in cases where the patient suffers too many side effects from the levodopa or requires too strong a dose. A surgeon inserts a tube in the small intestine, through which the patient receives doses of carbidopa. This enhances the effect of levodopa, allowing the patient to receive a smaller dose.
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Medicines For Parkinsons Disease
Medicines can help treat the symptoms of Parkinsons by:
- Increasing the level of dopamine in the brain
- Having an effect on other brain chemicals, such as neurotransmitters, which transfer information between brain cells
- Helping control non-movement symptoms
The main therapy for Parkinsons is levodopa. Nerve cells use levodopa to make dopamine to replenish the brains dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy such as nausea, vomiting, low blood pressure, and restlessness and reduces the amount of levodopa needed to improve symptoms.
People living with Parkinsons disease should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, like being unable to move or having difficulty breathing.
The doctor may prescribe other medicines to treat Parkinsons symptoms, including:
- Dopamine agonists to stimulate the production of dopamine in the brain
- Enzyme inhibitors to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain
- Amantadine to help reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
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How Common Is Cognitive Decline In Parkinsons
A new study finds that cognitive impairment is a frequent and rapidly progressing symptom of Parkinsons disease . About half of the participants who had PD for an average of five years and had normal cognition at the beginning of the study developed mild cognitive impairment within six years about 11 years after PD diagnosis. Those few who developed MCI progressed to dementia within five more years. The results appear in the September 11 online edition of Neurology.
With a diagnosis of PD, most people and their physicians focus on treating and coping with movement symptoms. Yet even early in the course of disease, people with PD may have difficulty multitasking, or feel that their thinking abilities are just not the same.
To better understand the rate at which cognitive impairment develops, and identify risk factors for the development of cognitive impairment, researchers led by Daniel Weintraub, M.D., recruited 141 people with PD to participate in the study. All were receiving treatment at the University of Pennsylvanias Udall Center for Parkinsons Disease Research. On average they were 69 years old and had been living with PD for five years 63 percent were men. All participants had normal cognition based on a battery of standard tests for people with PD. The researchers re-evaluated study participants cognition each year for up to six years.
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Tremor In Other Conditions
While tremor is a common symptom of PD, it can also be a symptom of other conditions, most notably essential tremor. The main difference between Parkinsons tremor and most other types of tremor is that in PD resting tremor is most common. Other conditions are usually characterized by action tremor, which tends to lessen at rest and increase when youre doing something, like trying to make a phone call or take a drink. Tremors of the head and voice are also common in essential tremor but rare in PD.
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Stiffness And Slow Movement
Parkinsons disease mainly affects adults older than 60. You may feel stiff and a little slow to get going in the morning at this stage of your life. This is a completely normal development in many healthy people. The difference with PD is that the stiffness and slowness it causes dont go away as you get up and start your day.
Stiffness of the limbs and slow movement appear early on with PD. These symptoms are caused by the impairment of the neurons that control movement. A person with PD will notice jerkier motions and move in a more uncoordinated pattern than before. Eventually, a person may develop the characteristic shuffling gait.
Is Parkinsons Disease Fatal
Parkinsons disease itself doesnt cause death. However, symptoms related to Parkinsons can be fatal. For example, injuries that occur because of a fall or problems associated with dementia can be fatal.
Some people with Parkinsons experience difficulty swallowing. This can lead to aspiration pneumonia. This condition is caused when foods, or other foreign objects, are inhaled into the lungs.
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Apda In Your Community
This article was written at the request of a Parkinsons patient who wanted to know how patients die from PD.
Most patients die with Parkinsons Disease and not from it. The illnesses that kill most people are the same as those that kill people with PD. These are heart conditions, stroke and cancer. As we age we become increasingly aware that more than one bad thing can happen to our bodies.
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Deep Brain Stimulation For Parkinson’s: Am I A Candidate
Deep brain stimulation is not a cure, but it can relieve your symptoms from Parkinson’s disease when medications are not an option. Only you and your doctor can decide if this surgical procedure is right for you. You may be a candidate for deep brain stimulation if:
- You have idiopathic Parkinson’s disease. Patients with atypical parkinsonism are not candidates.
- You have good motor function and independence during your best “on” state when taking the drug Sinemet.
The #1 Cause Of Parkinsons According To Science
According to the Parkinsons Foundation, nearly one million people in the U.S. are living with Parkinsons disease more than the total number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrigs disease . Every year, an additional 60,000 Americans are diagnosed with the neurodegenerative disorder. Who
Managing Loss Of Smell
There are not any treatments for lost sense of smell. However, if reduced ability to smell is affecting your appetite and you find yourself gaining or losing weight, you may want to learn more about diet and nutrition. You can also call our Helpline for tips: 1-800-4PD-INFO .
Page reviewed by Dr. Addie Patterson, Movement Disorders Neurologist at the Norman Fixel Institute for Neurological Diseases at the University of Florida, a Parkinsons Foundation Center of Excellence.
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How Is Parkinsons Disease Diagnosed
There arent any specific tests to diagnose someone with Parkinsons disease.
Doctors typically make a diagnosis based on the following:
- Medical history
- Blood and lab tests
Sometimes, people who have a known inherited form of Parkinsons disease can take a gene test to determine their risk for developing the disease.
Support For People Living With Parkinsons Disease
While the progression of Parkinsons is usually slow, eventually a persons daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinsons disease, their families, and caregivers. The organizations listed below can help people find local support groups and other resources in their communities.
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Genetic And Environmental Interactions
Although several genetic mutations have been identified to be associated with a higher risk of developing Parkinson’s disease most people do not have these genetic variations.
On the other hand, even though pesticides and head traumas are associated with PD, most people do not have any obvious exposure to these environmental factors.
Parkinson’s is caused by a combination of genes, environmental and lifestyle influences. The interaction of all three components determines if someone will develop Parkinson’s. Parkinsons-specific research is critical to better understanding how these components interact to cause PD and how to prevent it.
Page reviewed by Dr. Lauren Fanty, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.
Living With Parkinson’s Disease
As Parkinson’s develops, a person who has it may slow down and won’t be able to move or talk quickly. Sometimes, speech therapy and occupational therapy are needed. This may sound silly, but someone who has Parkinson’s disease may need to learn how to fall down safely.
If getting dressed is hard for a person with Parkinson’s, clothing with Velcro and elastic can be easier to use than buttons and zippers. The person also might need to have railings installed around the house to prevent falls.
If you know someone who has Parkinson’s disease, you can help by being a good friend.
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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.
What Are The Symptoms Of End
Stage four for Parkinsons disease is often called advanced Parkinsons disease because people in this stage experience severe and incapacitating symptoms. This is when medication doesnt help as much and serious disabilities set in.
Theres an increased severity in:
- How you speak a softer voice that trails off.
- Falling and trouble with balance and coordination.
- Freezing a sudden, but temporary inability to move, when you start to walk or change direction.
- Moving without assistance or a wheelchair.
- Other symptoms such as constipation, depression, loss of smell, low blood pressure when going to stand up, pain, and sleep issues.
Many times someone with advanced PD cant live on their own and needs help with daily tasks.
Stage five is the final stage of Parkinsons, and assistance will be needed in all areas of daily life as motor skills are seriously impaired. You may:
- Experience stiffness in your legs. It may make it impossible to walk or stand without help.
- Need a wheelchair at all times or are bedridden.
- Need round-the-clock nursing care for all activities.
- Experience hallucinations and delusions.
As Parkinsons disease progresses into these advanced stages, its symptoms can often become increasingly difficult to manage. Whether you or your loved one with end-stage Parkinsons lives at home, in an assisted living facility or a nursing home, hospice services can optimize your quality of life and that of your family members as well.
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Drugs And Medication Used To Treat Parkinsons Disease
A number of different drugs can be used to treat Parkinsons.
Levodopa is the most common treatment for Parkinsons. It helps to replenish dopamine.
About 75 percent of cases respond to levodopa, but not all symptoms are improved. Levodopa is generally given with carbidopa.
Carbidopa delays the breakdown of levodopa which in turn increases the availability of levodopa at the blood-brain barrier.
Dopamine agonists can imitate the action of dopamine in the brain. Theyre less effective than levodopa, but they can be useful as bridge medications when levodopa is less effective.
Drugs in this class include bromocriptine, pramipexole, and ropinirole.
Anticholinergics are used to block the parasympathetic nervous system. They can help with rigidity.
Benztropine and trihexyphenidyl are anticholinergics used to treat Parkinsons.
Amantadine can be used along with carbidopa-levodopa. Its a glutamate-blocking drug . It offers short-term relief for the involuntary movements that can be a side effect of levodopa.
Catechol O-methyltransferase inhibitors prolong the effect of levodopa. Entacapone and tolcapone are examples of COMT inhibitors.
Tolcapone can cause liver damage. Its usually saved for people who do not respond to other therapies.
Ectacapone does not cause liver damage.
Stalevo is a drug that combines ectacapone and carbidopa-levodopa in one pill.
- St. Johns wort
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.
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How To Tell The Difference
While a primary care physician or internist may be the first doctor to see a patient with tremors, he or she is generally not the most qualified person to issue a diagnosis. Instead, a referral is made to a specialist called a neurologist who is trained and experienced in movement disorders. Since there are many things that can cause uncontrollable shakiness, the neurologists initial concern is ruling out a disease, especially PD. Since there are no lab tests that can confirm the diagnosis, the initial consultation usually consists of the following:
- Personal medical history, including any past or current medications
- Observation of physical symptoms, e.g. tremor, facial expression, walking, balance
- Testing reflexes, motor coordination, and muscle rigidity
- Writing tasks (handwriting sample, tracing a spiral shape
- Also ruling out PD based on pre-symptom experience, e.g. loss of sense of smell within the previous 10 years is a tell-tale sign of PD though it doesnt occur in every patient)
Early Signs Of Parkinsons
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
- 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.
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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.