How Is Parkinson’s Disease Diagnosed And Assessed

Subanalyses And Ablation Studies

Performance dependence on model subcomponents

Our AI model employs multitask learning and transfer learning . We conducted ablation experiments to assess the benefits of the qEEG auxiliary task, and the use of transfer learning. To do so, we assessed the AUC of the model with and without each of those components. The results show that the qEEG auxiliary task is essential for good AUC, and transfer learning further improves the performance .

Comparison with machine learning baselines

We compared the performance of our model with that of two machine learning models: a support vector machine model, and a basic neural network that employs ResNet and LSTM but lacks our transfer learning module and the qEEG auxiliary task. The results show that both SVM and the ResNet+LSTM network substantially underperform our model .

Performance for different disease durations

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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

How Is Parkinsons 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.

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The Path Towards Early Accurate Diagnosis Of Parkinsons Disease

Like Alzheimers disease and many other neurological diseases, Parkinsons disease begins long before symptoms arise. The benefits of early diagnosis of such diseases are immense and not only affect patients and their families but also the wider society and research community.

Research efforts surrounding Parkinsons disease risk factors, early symptoms, traditional biomarkers, and digital biomarkers will pave the way for an earlier, more accurate diagnosis. Our growing understanding of the factors involved in Parkinsons disease risk, development, and progression opens the door to more robust and sensitive testing and diagnostic approaches.

How Is Parkinsons Disease Tested And Diagnosed

At Banner Health, our neurologists have years of experience in testing and diagnosing Parkinson’s disease. Our team of compassionate experts knows that each patient is different, so we work with you to quickly find the right diagnosis to begin building your treatment plan.

Parkinsons is not simple to diagnose. No test exists to diagnose Parkinsons disease. Doctors test and diagnose Parkinsons based on your medical history, symptoms and neurological and physical exams.

Many times a primary care provider is the first to suspect a Parkinsons diagnosis. If youre experiencing symptoms such as tremors, shaking, slow movement, stiffness and/or trouble with balance, talk to your doctor or seek the opinion of a neurologist. Banner Health neurologists are movement disorder specialists, who have experience and specific training to assess and treat Parkinsons.

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What Is The Prevalence

It is estimated that about 10 million people worldwide are living with PD. The incidence of the disease is higher in industrialized countries.3,4

The incidence of PD increases with age: while PD affects 1 percent of the population over the age of 60, this increases to 5 percent of the population over the age of 85.1

Approximately 5 percent of people with PD are diagnosed before the age of 60.1

Assessing Level Of Rigidity

Healthcare providers 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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Be Honest With Yourself And Your Doctor

It is important to discuss alcohol consumption with your doctor to make sure you are approaching it safely. Elements of PD, including motor symptoms such as bradykinesia and dyskinesia , will vary from person to person, so its important to make decisions based on your medical history.

Taking into account environmental factors such as how central alcohol is to your social life can affect the decisions you make. Be honest with your doctor about your habits and preferences remember, your doctor wants to work with you to make your symptoms as manageable as possible, not to judge or shame you.

As you decide how alcohol may fit into your life post-diagnosis lifestyle, there are many factors to consider, such as the type of alcoholic beverage, your other risk factors, and your neurologists recommendations specific to your medical history. Most importantly, monitor how you feel when you drink alcohol and be willing to have open and honest conversations about drinking with your doctor and other important people in your life.

I am not even a big drinker, but miss the odd one, wrote a MyParkinsonsTeam member. So, I had an alcohol-free beer, which tasted OK, to be honest.

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What Parkinsons Diagnosis Criteria Do Doctors Use

Until the 1980s, there was no formal diagnostic criteria for Parkinsons disease. Beginning with James Parkinsons 1817 article, An Essay on the Shaking Palsy, and Margaret Hoehn and Melvin Yahrs description of the five stages of motor progression in 1967, scientists focused on the unique ways Parkinsons disease affects movement. A few scientists also noted non-motor symptoms like issues with automatic body functions, such as heart rate and blood pressure.

With the discovery in the 1950s of levodopa, a drug that gets turned into dopamine in your brain and thus replaces some of the dopamine that is lost due to PD, and the discovery of how dramatically levodopa improves motor symptoms, the medical community continued to focus more of their efforts on defining and treating Parkinsons as a motor condition.7

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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.

Assessment Of Symptomatic Effects

Ratings such as the UPDRS, either in its entirety or with motor subscale 3 alone, have been used to assess symptomatic benefit from therapeutic interventions. A critical factor in longitudinal studies is to try to control the variables in the temporal responses to individual doses of medication. Ideally, repeated ratings should be done at the same time of day, at the same time after the last dose of medication, and by the same rater. Other factors also may influence these ratings, such as diet, fatigue, or other potential stresses that may alter PD manifestations.

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Pioneering Precision Neurology To Drive Early Accurate Diagnosis

At Altoida, we are dedicated to providing a reliable, affordable, and highly accurate way to measure and monitor brain health. We are building the worlds-first Precision Neurology platform and app-based medical devicebacked by 11 years of clinical validationto accelerate and improve drug development, neurological disease research, and patient care.

By completing a 10-minute series of and motor activities designed to simulate complex Activities of Daily Living on a smartphone or tablet, Altoidas device extracts and provides robust measurements of neurocognitive function across 13 neurocognitive domains. Our device measures and analyzes nearly 800 multimodal cognitive and functional digital biomarkers. Through the collection of highly granular data from integrated smartphone or tablet sensors, Altoidas device produces comprehensive neurocognitive domain scores. This data can be tracked longitudinally to reveal trends and patterns while flagging concerning ones.

This method, along with our innovative artificial intelligence, will pioneer fully digital predictive neurological disease diagnosis. Recently receiving Breakthrough Device designation by the FDA, Altoida’s platform has demonstrated ability to predict conversion from Mild Cognitive Impairment to Alzheimer’s disease with a high degree of accuracy.

To learn more about if there is a test for Parkinsons disease or about utilizing Altoidas Precision Neurology platform, contact us today.

User Interface Of The Assessment Tests

The setting of the user interface of the Assessment Tests of the iPrognosis Games environment is depicted in Figure 2. As it is clear from the latter, it is possible to select one of the six aforementioned motor Assessment Tests out of a dropdown menu and push play button , in order to view the corresponding tutorial video. Moreover, while PD patients watch the videos, they can synchronously perform the selected Assessment Test and receive an instant, real-time, evaluation after its completion . The UI of the motor Assessment Test presents the users performance on the right side and the experts performance on the left, so the players can easily synchronize their movement along with the experts and detect misfires .

Figure 2. User Interface of the Assessment Test 1 of the iPrognosis Games. The users performance and the experts performance , so the players easily synchronize their movement along with the experts movement. The general score of the user is displayed in real-time, as well as intermediate metrics . The MentorAge® tracking system sensor allows to display the skeleton of the user and corresponding joints . .

During the realization of each motor Assessment Test, PD patients can receive helpful guidelines and instructions to execute the tests in a successful manner, and they can also follow its progress via the slider on the top left of the screen, informing them about the time left to finish the selected Assessment Test .

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Use Of Rating Scales For Screening For Parkinsonism

Although the UPDRS was not developed for diagnostic use, it has been applied for mass screenings for parkinsonism . Note the use of the term parkinsonism rather than PD. Parkinsonism refers to the clinical manifestations, but makes no specific inference regarding the pathophysiology or etiology of the condition. Thus, these types of mass screenings attempt to identify the more general condition parkinsonism that may include drug-induced parkinsonism, multisystems atrophy, or progressive supranuclear palsy, as well as Parkinson disease. Furthermore, ratings on the UPDRS can reflect nonparkinsonian conditions. A hemiparesis due to a stroke may enhance or produce bradykinesia in a limb that is not distinguished from parkinsonism on the rating scale. Nevertheless, there have been several attempts to use modified forms of UPDRS subscale 3 as a screening for parkinsonism . In fact, mass screenings can include blinded videotape-based ratings that exclude assessment of rigidity, since that must be done in person. The key feature is to determine what value of UPDRS subscale 3 indicates parkinsonism. A score of nine on subscale 3 has been demonstrated to have 100% sensitivity and 81% specificity in identification of parkinsonism in a large video-based screening of more than 2000 people with welding exposure, an environmental factor under investigation for its potential relationship to the development of parkinsonism.

What Is A Datscan And What Role Does It Play In A Parkinsons Diagnosis

In 2011, the FDA approved the use of a scan called a dopamine transporter scan . A DaTscan is an imaging technology that allows visualization of the dopamine system in the brain. It is similar to an MRI, but looks at the function of the brain rather than the structure.

A DaTscan involves injection of a small amount of a radioactive drug that is then measured by a single-photon emission computed tomography scanner . The SPECT scanner measures the levels and location of the drug in the brain.

It is important to know that a negative DaTscan does not rule out PD, especially early in the disease, but a positive DaTscan can help confirm it. A positive DaTscan can differentiate PD from essential tremor as there is no dopamine deficiency in the latter. However, DaTscan abnormalities can be seen in PD as well as other forms of atypical parkinsonism that cause a loss of dopamine . This means that a positive result does not differentiate Parkinsons disease from other forms of atypical parkinsonism.

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Age And Gender Effect

In order to examine if age and gender had any effect on the FinalScore, a linear regression analysis was performed between the and the Timed , since these metrics have exhibited the highest absolute correlation with the corresponding UPDRS Part III Items . The linear regression analysis has resulted, for all cases, in p> 0.05 values, i.e., . These results clearly indicate that the proposed metrics are not affected by the age and gender of the PD patient.

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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.

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The Diagnosis Of Idiopathic Parkinsons Disease

The first component to the diagnosis of PD is establishing that the patient has parkinsonism. This is a clinical diagnosis and relies on three key elements: bradykinesia, tremor, and rigidity. Of these, bradykinesia must be present, with at least one of the other two. PD is an asymmetrical condition, so during the clinical assessment, the parkinsonism should be more apparent on one side and may be purely unilateral in early disease . is a classical illustration of parkinsonism, with a description by William Gowers.

A case of Parkinsons disease as described and illustrated by William Gowers: the aspect of the patient is very characteristic. The head is bent forward, and the expression of the face is anxious and fixed, unchanged by any

Frontotemporal Dementia With Parkinsonism

Parkinsonism in frontotemporal dementia is usually seen in the behavioral variant, rather than in association with primary progressive aphasia, and can develop either before or during the development of the classical FTD syndrome. It can closely mimic idiopathic PD or have features suggestive of PSP or CBS. It is seen in association with underlying tau, TDP-43, or FUS pathology, as well as corresponding mutations in several genes, which include MAPT, PGRN, C9ORF72, FUS, and TARDBP. Rigidity and bradykinesia tend to be the more prominent parkinsonian features, with rest tremor occurring rarely. There is variable responsiveness to levodopa .

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How It All Fits Together

Diagnosing Parkinsons disease can be tricky. The process relies heavily on your doctors judgment. In addition, the causes and risk factors of Parkinsons are not entirely clear yet, which contributes to the difficulty in diagnosing this condition.

However, there have been efforts to try and detect this disease earlier. For instance, clinicians have started focusing more on prodromal symptoms, which are early symptoms that appear before movement-related difficulties begin.

These symptoms include:

• Loss of smell, which can sometimes occur years before other symptoms
• Chronic constipation, without any other explanation
• Rapid eye movement behavior disorder, which causes sleep disturbances

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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