Understanding Parkinsons Disease: Getting A Parkinsons Diagnosis
Once you start noticing some changes in your body that impact your daily life or are just simply bothersome, you should begin the process of figuring out if you have Parkinsons disease. It may seem like a daunting undertaking, but dont let fear stop you. Once you are diagnosed, you can start treating your symptoms and learning strategies that will help you feel better.
Ruling Out Other Conditions
The process of ruling out similar conditions is referred to as differential diagnosis. Parkinsons has symptoms in common with Alzheimers disease, frontotemporal dementia, and Huntington disease. Parkinsons symptoms can be caused by medications such as antipsychotics that may be taken for depression or schizophrenia. Parkinsonism can also be caused by another disease this is known as secondary parkinsonism. Conditions that can cause secondary Parkinsonism include hydrocephalus , some types of brain tumors, Wilsons disease, problems with the parathyroid gland, chronic liver failure, issues with the blood supply to the brain, and infections such as HIV, neurosyphilis, toxoplasmosis, and progressive multifocal leukoencephalopathy .
Your doctor may be able to quickly rule many of these conditions based on your medical and family history or simple blood tests. Other disorders may require time and repeated tests before they can be confirmed or ruled out. The presence of other diseases in addition to Parkinsons may complicate the differential diagnosis and eventually result in multiple diagnoses.
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
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What Are The Secondary Symptoms Of Parkinsons Disease
The primary symptoms of the Parkinsons disease have to be obviously movement related and lose of muscles control. Since it is a neurodegenerative disease, continued damage to brain leads to secondary symptoms which vary in severity and people-
- Feelings of insecurity, anxiety and stress.
- Loss of memory, confusion and dementia.
- Erectile dysfunction or ED in men.
- Speech problems.
Referral To A Specialist
If your GP suspects Parkinson’s disease, you’ll be referred to a specialist.
This will usually be:
- a neurologist, a specialist in conditions affecting the brain and nervous system
- a geriatrician, a specialist in problems affecting elderly people
The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement.
A diagnosis of Parkinson’s disease is likely if you have at least 2 of the 3 following symptoms:
- shaking or tremor in a part of your body that usually only occurs at rest
- slowness of movement
- muscle stiffness
If your symptoms improve after taking a medication called levodopa, it’s more likely you have Parkinson’s disease.
Special brain scans, such as a single photon emission computed tomography scan, may also be carried out in some cases to try to rule out other causes of your symptoms.
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Gauging Speed Of Movement
Bradykinesia occurs in most people who have Parkinson’s. It may cause a lack of spontaneous facial expression and fewer eye blinks per minute than usual, and your doctor will look for these signs in your physical exam.
Your doctor also may assess your speed of movement by asking you to open and close each hand or tap your index finger against your thumb repeatedly, making large movements as quickly as possible. In people with Parkinson’s disease, the movement may start off fast and precise, but it will deteriorate quickly, becoming slow and limited.
Gait is also another way to test for this. Observing a patient while they walk, noting the length of their stride as well as the speed at which they move, can tell doctors quite a bit. Lack of arm swing is also a feature that appears fairly early in those with Parkinson’s.
Managing Depression In Parkinsons Disease
People with Parkinsons, family members and caregivers may not always recognize the signs of depression and anxiety. If you are experiencing depression as a symptom of Parkinsons, it is important to know it can be treated.
Here are some suggestions:
- For information and support on living well with Parkinsons disease, contact our Information and Referral line.
- As much as possible, remain socially engaged and physically active. Resist the urge to isolate yourself.
- You may want to consult a psychologist and there are medications that help relieve depression in people with Parkinsons, including nortriptyline and citalopram .
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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 .
Living With Parkinson Disease
These measures can help you live well with Parkinson disease:
- An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
- High protein meals can benefit your brain chemistry
- Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
- If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.
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What Are The Symptoms Present To Confirm Parkinsons Disease
In order to medically diagnose Parkinsons disease, a minimum of two to four symptoms must be present. The four main symptoms include-
- Acute slowness of movement called Bradykinesia.
- Stiffness or rigidity of the arms, legs and trunk.
- Problems with maintaining body balance and posture which result in falls called postural instability.
What To Expect At The Appointment
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
Parkinsons Disease In Dogs
Canine Parkinsons disease manifests in many similar symptoms to humans, such as tremors and a loss of balance. However, there are some key differences too.
In this guide, Ill break down the differences between Parkinsons disease in humans and dogs and the signs you should look out for. There are also some tips on how to care for your dog if they have unfortunately been diagnosed with Parkinsons disease and neurological disorders.
Before we get into it, its important I stress that I am not a veterinarian. I am just a dog owner and lover. Please consult your professional veterinarian to verify any and all information in this article.
What Causes Parkinson Disease
Parkinson disease arises from decreased dopamine production in the brain. The absence of dopamine makes it hard for the brain to coordinate muscle movements. Low dopamine also contributes to mood and cognitive problems later in the course of the disease. Experts don’t know what triggers the development of Parkinson disease most of the time. Early onset Parkinson disease is often inherited and is the result of certain gene defects.
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How To Cope Up With Parkinsons Disease
Parkinsons disease is progressive and eventually affects every aspect of life from social engagements to work and normal life routines. The gradual loss of independence may be difficult, but being well informed about the disease may reduce the anxiety to a large extent. There are various support groups that offer valuable information to patients with such disease and how to cope with the same. These groups provide emotional support and also advice the patients with regard to finding experienced doctors, therapists and other related information.
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
What Is Parkinson Disease
Parkinson disease is a movement disorder. It can cause the muscles to tighten and become rigid This makes it hard to walk and do other daily activities. People with Parkinsons disease also have tremors and may develop cognitive problems, including memory loss and dementia.
Parkinson disease is most common in people who are older than 50. The average age at which it occurs is 60. But some younger people may also get Parkinson disease. When it affects someone younger than age 50, it’s called early-onset Parkinson disease. You may be more likely to get early-onset Parkinson disease if someone in your family has it. The older you are, the greater your risk of developing Parkinson disease. It’s also much more common in men than in women.
Parkinson disease is a chronic and progressive disease. It doesn’t go away and continues to get worse over time.
To Support The Parkinsons Diagnosis Your Healthcare Provider Will Also Look For Other Symptoms:
- Reduced facial expression
- or leg drag on one side of the body while walking
Symptoms such as shoulder pain, depression, sleep problems, constipation and loss of sense of smell can begin long before any of the motor symptoms appear. Because symptoms like these can be subtle at first, they are not always evident or meaningful before diagnosis. It is common after a Parkinsons diagnosis to look back and realize symptoms had been coming on gradually for months or even years. Often people explore other treatment avenues for early symptoms, like physical therapy or even surgery for pain, only to discover later it was actually connected to Parkinsons.
Since doctors diagnose other medical conditions using sophisticated technology, many are surprised to learn a Parkinsons diagnosis is based on your medical history and a simple examination. While your healthcare provider may take other steps, such as order blood and urine tests, check copper levels and order a brain scan, such as an MRI or CT or DaTscan that measures dopamine, these tests do not a Parkinsons diagnosis. They are used to either confirm the diagnosis or determine if another medical condition is causing your symptoms.
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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.
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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Other Diseases That Have Similar Symptoms To Parkinsons Disease
Now, I just want to address something you may have noticed here. Many of these symptoms and signs could also apply to other diseases. Is it an overreaction to assume that if your dog twitches a bit it is definitely Parkinsons disease?
Well yes and no. Certainly, all of these symptoms could indicate other ailments.
Lets go through a few now:
- Generalized tremor syndrome: Yep, its a thing! Your dog may tremor for no real reason. This doesnt have the same stiffness and limited joint mobility that Parkinsons does.
- Kidney disease: Kidney disease can cause depression, anxiety, and tremoring. Youll most likely see vomiting and infrequent urination come with this and can lead to euthanasia.
- Arthritis: A friend of mine has an arthritic dog and stiffness is a real problem. Having inflexible joints can also cause your dog to limp. Arthritis is differentiated by joint pain so your dog may be more vocal if this is what they are suffering.
- Seizure disorders: Did you know that dogs can suffer from epilepsy? Seizures can be caused by all kinds of things. They can also be the entire ailment all by themselves.
As you can see, the signs of Parkinsons in dogs could belong to an entirely different diagnosis. So, if you notice stiffness or tremoring, it is best to have your professional veterinarian make a formal diagnosis.
Stooping Or Hunching Over
Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease .
What is normal?If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.
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Symptoms Of Parkinsons Disease
Parkinson’s disease has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Symptoms of Parkinsons and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson’s as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.
Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
Should You Put Your Dog Down If Their Parkinsons Is Bad
I cannot answer that question for you. Your decision to euthanize a dog with Parkinsons disease is highly personal. If your dogs quality of life is truly poor, with no independence at all, the kinder thing may be to put them down.
Its a decision we never want to make, but sometimes it really is the best thing for them.
Consult your veterinarian for advice on how long your dog can expect to remain mobile and when euthanasia may be the sole solution.
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Complementary And Alternative Therapies
Some people with Parkinson’s disease find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinson’s disease.
However, there’s no clinical evidence they’re effective in controlling the symptoms of Parkinson’s disease.
Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldn’t be used instead of the medicines prescribed by your doctor.
Some types of herbal remedies, such as St John’s wort, can interact unpredictably if taken with some types of medication used to treat Parkinson’s disease.
If you’re considering using an alternative treatment along with your prescribed medicines, check with your care team first.