Medical History And Physical Exam
The process of diagnosing Parkinsons usually begins with the neurologist evaluating your medical history and performing a physical exam. For a formal diagnosis to be made, you need to have a general slowness of movement with either a resting tremor or rigidity.
During the physical exam, your doctor will have you perform a series of tests to monitor your movement. An example of a test they might use is a finger tap, where they measure how many times you can tap your finger in 10 to 15 seconds.
They will also look for signs that you may have another condition. A group of movement disorders collectively called parkinsonisms can produce symptoms that are indistinguishable from those of Parkinsons but are not the same. Usually, additional tests are needed to rule out these conditions as well.
Blood Test May Distinguish Parkinsons From Multiple System Atrophy
A highly sensitive and specific blood test has been developed that can distinguish Parkinsons disease from multiple system atrophy , a team at the University of California, Los Angeles Health reported.
The test examines the levels of a protein called alpha-synuclein in exosomes tiny vesicles released by cells that end up in the blood. In Parkinsons, alpha-synuclein comes from neuron-derived exosomes, while in MSA it comes from exosomes released by oligodendrocytes, another type of brain cell.
Based on the content and origin of the exosomes, this test can help discriminate between Parkinsons disease and MSA.
This is a major breakthrough, because it allows us to analyze whats going on in the brain using a blood test, Gal Bitan, PhD, the studys senior author and a professor of neurology at the David Geffen School of Medicine at UCLA, said in a university press release.
The study, -Synuclein in blood exosomes immunoprecipitated using neuronal and oligodendroglial markers distinguishes Parkinsons disease from multiple system atrophy, was published in Acta Neuropathologica.
Parkinsons and neurodegenerative diseases such as MSA have several symptoms in common, including muscle rigidity and tremors. Because of this overlap in symptoms, many cases are misdiagnosed.
Incorrect diagnoses can also affect clinical trial results, as potential treatments would be tested in people without the disorder under evaluation.
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 healthcare provider will look for these signs in your physical exam.
Your practitioner 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 healthcare providers quite a bit. Lack of arm swing is also a feature that appears fairly early in those with Parkinson’s.
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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.
Looking For Signs Of Parkinsons
Your specialist will examine you to look for common signs of Parkinsons. You may be asked to:
- write or draw to see if your writing is small or gradually fades
- walk to see whether theres a reduction in the natural swing of your arm or in your stride length and speed
- speak to see if your voice is soft or lacks volume
The specialist will also look at and ask you about your:
- face to see if there is a masked look or if you have difficulty with facial expressions
- limbs to see if you have a tremor, any stiffness or slowness of movement
As well as examining you for any of the typical signs of Parkinsons, the specialist will also look for signs that may suggest a different diagnosis.
It may be helpful to take someone with you for support when seeing a specialist. Taking a list of questions you want to ask can also be useful so you dont forget to mention something you want to know about. If a healthcare professional says something you dont understand, dont be afraid to ask them to explain what they mean.
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Simple Blood Tests For Parkinson’s Disease Derived From Genome
The diagnosis of Parkinson’s disease relies on expert opinion. Autopsy studies, however, have demonstrated that even experienced neurologists misdiagnose Parkinson’s disease in about a quarter out of a hundred cases. Diagnostic accuracy at disease onset, when neuroprotective treatment is anticipated to be most effective, is even lower. Thus, there is a crucial need for biomarkers that are disease-specific and which precisely identify early disease stages.
Traditional studies of blood from Parkinson’s disease patients have analyzed expression levels of one gene or gene product at a time. We plan to take advantage of ‘gene chip’ technology allowing expression analysis of up to 22,000 genes on a single glass slide, known as microarray. We hypothesize that a comparison of the gene chip analyses of blood samples from Parkinson’s disease patients and normal controls or patients with other neurological diseases will identify a set of signature genes with characteristic expression in patients with Parkinson’s disease. These key genes will provide a ‘molecular fingerprint’ of Parkinson’s disease in blood.
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Up until now, many diseases have been diagnosed based on symptoms, with patients asking, How do you know I have this? Meanwhile, doctors are not always correct, Wright said. This is true even of Parkinsons, which is diagnosed based on symptoms, a patients history, neurological exams, a patients response to medicine and, in some cases, brain imaging tests.
Still, Wright is hopeful and believes a biomarker test for Parkinsons will be down the line. In general, researchers are looking for biomarkers of disease.
Specialists and sub-specialists are available only in big cities, Wright said, and access to a simple blood test would enable a correct diagnosis in a primary care office.
We always assume theres luxury, Wright said. But thats not really whats real in most of the country.
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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.
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 healthcare provider 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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Brain Imaging And Other Tools To Aid Diagnosis Of Parkinsons
In addition to taking a history and performing a detailed neurologic examination, physicians sometimes use brain imaging to help support a particular diagnosis. However, these studies have their limitations in the diagnosis of Parkinsons disease and are typically used only in select patients. Brain imaging is not routinely performed by neurologists or movement disorder specialists when they are considering a diagnosis, especially if the persons symptoms strongly suggest to the physician that idiopathic Parkinsons disease is the correct diagnosis.
Helping diagnose Parkinsons with DaTscan and other tests
Rather, use of imaging is most helpful when the diagnosis is uncertain, or when physicians are looking for changes in the brain that are more typical of one of several Parkinsonian syndromes and other conditions that can mimic Parkinsons. Imaging studies to evaluate Parkinsons disease and Parkinsonian syndromes include magnetic resonance imaging , which examines the structure of the brain, and DaTscan, an imaging test approved by the Food and Drug Administration to detect the dopamine function in the brain. A DaTscan may help differentiate idiopathic Parkinsons disease from certain other neurologic disorders. Most physicians offices will have access to MRI however, DaTscan imaging may only be available at larger hospitals or medical centers.
Blood Test To Detect Parkinson’s Disease Could Lead To Earlier Treatment
Australian researchers hope discovery can be used to diagnose disorder now done through process of elimination
Researchers have developed the worlds first blood test that can detect the abnormal metabolism of blood cells in people with Parkinsons disease, which means the blood test could be used to diagnose the disorder.
At present the only way to diagnose Parkinsons disease, a degenerative neurological condition, is through ordering a range of tests and scans to rule out other disorders, combined with examining symptoms.
Patients are often diagnosed only after they have developed symptoms and brain cells have already been destroyed. While there is no cure for Parkinsons, early detection allows treatment with medication and physiotherapy to begin, which may slow the deterioration of motor functions in patients.
Because diagnosing the disease is a process of elimination, and the symptoms mimic those of other neurological disorders, patients are also at risk being diagnosed and treated for the wrong disease.
The group of Australian researchers from La Trobe University believe their blood test will enable doctors to detect Parkinsons disease with unprecedented reliability and lead to earlier treatment. Their findings are under review by an international medical journal.
The lead researcher on the study, Prof Paul Fisher, said the discovery turned conventional understanding about Parkinsons on its head and had shocked the researchers.
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What Should You Know About At
Genetic tests are not a substitute for a Parkinson’s diagnosis. Most at-home genetic tests do not provide genetic counseling services to help interpret the results. Always consult with a genetic counselor and your doctor before and after taking a genetic test. Most at-home genetic tests check for a limited number of gene mutations associated with Parkinson’s. This can be misleading since these tests may not be comprehensive.
Since scientists are still discovering more PD-associated genes, it is important to consult your doctor about comprehensive genetic testing options, like the PD GENEration study, which provides a free comprehensive genetic test identifying all possible variants in the two most common PD genes.
Even if you or a loved-one test positive for a Parkinson’s gene, it does not mean either of you will develop it. Having a genetic mutation only means that you may be at increased risk to develop PD. Environmental factors and lifestyle choices will help determine whether someone will get Parkinson’s.
Response To Parkinsons Drugs
After examining you, and depending on the severity of your symptoms, your specialist may suggest you take medication for Parkinsons. If your symptoms improve after taking Parkinsons medication for a few weeks or months, your specialist may confirm a Parkinsons diagnosis. However, some people with other forms of parkinsonism will also respond well to these drugs.
Your specialist may suggest you have a scan to help make a diagnosis. However, scans alone cant make a definite diagnosis of Parkinsons, so they are not commonly used.
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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
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.
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Who Should Consider A Genetic Test For Parkinsons
There are two groups of people who might consider getting genetic testing and we will discuss each group separately.
Genetic testing for PD is a common request and a number of commercial labs perform panels of genetic testing for PD. You may ask: How can I test myself for Parksinons? Whether youre considering getting a genetic test through your doctor, or performing one at home, its important to note that at-home test dont map the entire gene for mutations. Genetic testing through your doctor will test for GBA, PARK7, SNCA, LRRK2, parkin and PINK1.
Both groups are faced with two questions: Should I get genetic testing? And if so, what should I do with the results? Before we address these two questions, we need to learn more about the complexity of genetic testing in PD.
What Are The Symptoms Of Parkinson’s Disease
The main symptoms of Parkinson’s disease are:
- tremor or shaking, often when resting or tired. It usually begins in one arm or hand
- muscle rigidity or stiffness, which can limit movement and may be painful
- slowing of movement, which may lead to periods of freezing and small shuffling steps
- stooped posture and balance problems
The symptoms of Parkinson’s disease vary from person to person as well as over time. Some people also experience:
- loss of unconscious movements, such as blinking and smiling
- difficulties with handwriting
- drop in blood pressure leading to dizziness
- difficulty swallowing
- sweating
Many of the symptoms of Parkinson’s disease could be caused by other conditions. For example, stooped posture could be caused by osteoporosis. But if you are worried by your symptoms, it is a good idea to see your doctor.
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Is It Parkinson’s Disease Blood Test Might Tell
But new technique needs more study, researchers say
HealthDay Reporter
WEDNESDAY, Feb. 8, 2017 — Measuring a particular blood protein might help doctors easily distinguish Parkinson’s disease from some similar disorders, a new study suggests.
The potential blood test is “not ready for prime time,” Parkinson’s disease experts said. But, it marks progress in the quest for an objective way to diagnose Parkinson’s and similar conditions known as atypical parkinsonian disorders, they noted.
Parkinson’s disease is a movement disorder that affects nearly 1 million people in the United States alone, according to the Parkinson’s Disease Foundation.
The root cause is unclear, but as the disease progresses, the brain loses cells that produce dopamine — a chemical that regulates movement. As a result, people suffer symptoms such as tremors, stiff limbs, and balance and coordination problems that gradually worsen over time.
Right now, there is no blood test, brain scan or other objective measure that can definitively diagnose Parkinson’s, said James Beck, vice president of scientific affairs for the Parkinson’s Disease Foundation.
“In general, Parkinson’s disease is diagnosed with a clinical exam,” Beck explained.
The best person to make that call is a neurologist with expertise in movement disorders, according to Beck.
“But,” he said, “even highly trained doctors initially get it wrong about 10 percent of the time.”
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