Determining Diagnosis Through Response To Parkinsons Medication
If a persons symptoms and neurologic examination are only suggestive of Parkinsons disease or if the diagnosis is otherwise in doubt, the physician may, nevertheless, prescribe a medication intended for Parkinsons disease to provide additional information. In the case of idiopathic Parkinsons, there is typically a positive, predictable response to Parkinsons disease medication; in the case of some related Parkinsonian syndromes, the response to medication may not be particularly robust, or it may be absent entirely.
Unfortunately, there are no standard biological tests for the disease, such as a blood test. However, researchers are actively trying to find biomarkers in blood and other bodily fluids that could help confirm the diagnosis.
Blood Test Would Detect Parkinsons In Early Stages
A group of researchers developed a blood test that would allow neurologists detect Parkinsons disease and track the illness as it progresses.
If successful, we expect our findings will translate into a valuable diagnostic tool for Parkinsons disease, said study co-author Judith Potashkin, professor of cellular and molecular pharmacology at Chicago Medical School, Rosalind Franklin University of Medicine and Science.
According to the Parkinsons Disease Foundation, it is estimated that 60,000 people in the United States are diagnosed with Parkinsons disease each year.; Data from 2013, by the University Center for Health Sciences at the University of Guadalajara, reported more than 500,000 cases of this neurodegenerative condition in Mexico. The same year, an economic model of Parkinsons disease forecasted that cases in the worlds population will double by 2040.
Now days, this disease is still incurable. It can cause tremors and severely hamper movement. Although medications allow controlling the condition, it gets worse over the years and medications do not stop its progression.
The traditional method to diagnose Parkinsons is by analyzing symptoms. Currently, brain scans are available, allowing the analysis of imaging studies to detect the disease; however, the information obtained from these devices may still be somewhat imprecise, Potashkin said.
The study was published in the Feb. 3 online issue of the Proceedings of the National Academy of Sciences.
Parkinsons The Path To Diagnosis
The path to a diagnosis of Parkinsons can be a long and uncertain one. Some people have multiple chronic conditions, making it difficult for doctors to identify whether motor symptoms are caused by a disease or a medication.
Part of the criteria for a Parkinsons diagnosis depends on how symptoms have progressed, when and in what order new symptoms appear, and whether any other condition could be causing them.
Parkinsons is usually diagnosed by a neurologist.Receiving a diagnosis from an experienced specialist in movement disorders lowers the risk of misdiagnosis.
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How Is Parkinsons Diagnosed
Parkinsonism is a syndrome, or collection of symptoms characterized by motor issues bradykinesia , tremors, loss of balance, and stiffness. Parkinsons disease is the most common type of parkinsonism, accounting for 80 percent of cases. Read more about types of parkinsonism.
Diagnosing parkinsonism is the first step. Parkinsonism is diagnosed when a person has bradykinesia and either rest tremor or rigidity. From there, the neurologist decides whether Parkinsons disease is the most likely cause of the Parkinsonism.
Here are some criteria that make a diagnosis of PD seem more likely:
- Dopaminergic drugs , such as Levodopa/Carbidopa, significantly improve symptoms. Improvements increase with higher doses and decrease with lower doses.
- Levodopa/Carbidopa causes the side effect of dyskinesia involuntary swaying, writhing, or head-bobbing movements.
- There is a loss of smell or evidence of certain cardiovascular problems.
Red flags that make PD seem less likely include:
- Motor symptoms are bilateral, appearing equally on both sides.
- Walking difficulties progress rapidly, and you need a wheelchair within five years.
- Motor symptoms do not progress over five years in people who are not medicated.
- Difficulty swallowing or speaking develops within five years.
- Certain respiratory problems are present.
- Urinary problems develop within five years.
Criteria that exclude PD and tell the neurologist to look for other causes include:
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.
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Validating A New Biomarker
Hansson and his colleagues developed a blood test that is, essentially, a variation on an existing test capable of detecting neurofilament light chain protein in spinal fluid. This protein is a component of nerve cells, and when these cells die, it can be detected in both spinal fluid and blood.
Because spinal fluid is not easily obtained by a primary care doctor, this diagnostic test is not very useful, so Hansson developed a blood test and investigated its accuracy in the new study.
When validating a new biomarker for disease, one should always analyze at least two different to make sure that the results are reproducible, said Hansson, who added that participants should also include both early- and late-stage patients established at different clinics.
All told, a total of 244 people with Parkinsons and 79 healthy volunteers serving as a comparison group participated in Hanssons study, along with 181 patients with atypical parkinsonism disorders.
Of these, 88 patients had multiple system atrophy, which impairs the bodys involuntary functions such as heart rate, blood pressure and digestion.
Seventy patients had progressive supranuclear palsy, which affects movement, walking, balance, speech, swallowing, vision, mood and thinking.
And 23 patients had corticobasal degeneration, which causes decreased movement on one side of the body, muscle rigidity, tremor and a disconnection between thought and action.
What Is Essential Tremor And How Is It Different To A Parkinsons Tremor
A tremor is a rhythmical, involuntary movement that affects a part of the body, such as the hand.
Essential tremor is the most common type of tremor. Its most noticeable when your hands are doing something and it usually affects both the right and left sides of the body equally. Essential tremors often lessen when your body is resting.;
Unlike an essential tremor, a Parkinsons tremor is most obvious when the affected body part is resting and tends to be less noticeable with movement. It usually starts on one side of the body and may progress to the other side as Parkinsons develops.
The time it takes to get a diagnosis can vary from person to person. Some people may receive a diagnosis of Parkinsons quite quickly, but for others it may be a long process. This can be due to a number of things, including your medical history, your age and what symptoms you have.
Your specialist may wish to rule out other causes of your symptoms first and see how you respond to treatment. This may take some time, and, as already mentioned, there is currently no definitive test;for Parkinsons.
How you respond to treatment may help your specialist make a diagnosis. Keeping a diary or record of your symptoms will give the specialist more information to guide their decision.
Because the symptoms of Parkinsons are sometimes similar to other forms of parkinsonism, people can sometimes be misdiagnosed.;
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Tests To Rule Out Other Conditions
Blood tests can help rule out other possible causes of the symptoms, such as abnormal thyroid hormone levels or liver damage.
An MRI or CT scan can check for signs of a stroke or brain tumor, which may cause similar symptoms.
Hydrocephalus due to atrophy can occur with some types of dementia and would be visible with one of these imaging tests. If the person has neurologic symptoms but a normal scan result, Parkinsons disease may be present.
The doctor a lumbar puncture to rule out inflammation or a brain infection.
Is Early Diagnosis Possible
Experts are becoming more aware of symptoms of Parkinsons that precede physical manifestations. Clues to the disease that sometimes show up before motor symptoms and before a formal diagnosis are called prodromal symptoms. These include the loss of sense of smell, a sleep disturbance called REM behavior disorder, ongoing constipation thats not otherwise explained and mood disorders, such as anxiety and depression.
Research into these and other early symptoms holds promise for even more sensitive testing and diagnosis.
For example, biomarker research is trying to answer the question of who gets Parkinsons disease. Researchers hope that once doctors can predict that a person with very early symptoms will eventually get Parkinsons disease, those patients can be appropriately treated. At the very least, these advances could greatly delay progression.
Parkinson’s Disease and Movement Disorders Center
Our center provides compassionate and timely treatment to patients with movement disorders, such as dystonia, ataxia, essential tremor and similar conditions. But our mission goes beyond patient care excellence. By offering educational events and support groups, we empower patients and caregivers to become better partners in their health.
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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.
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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How To Test For Parkinson’s Disease
This article was medically reviewed by Erik Kramer, DO, MPH. Dr. Erik Kramer is a Primary Care Physician at the University of Colorado, specializing in internal medicine, diabetes, and weight management. He received his Doctorate in Osteopathic Medicine from the Touro University Nevada College of Osteopathic Medicine in 2012. Dr. Kramer is a Diplomate of the American Board of Obesity Medicine and is board certified.There are 10 references cited in this article, which can be found at the bottom of the page. This article has been viewed 35,437 times.
Parkinsons Disease is a progressive neurodegenerative disorder affecting both motor and non-motor abilities. It afflicts 1% of those over 60 years of age.XResearch sourceJOHN D. GAZEWOOD, MD, MSPH,D. ROXANNE RICHARDS, MD,KARL CLEBAK, MD, Parkinsons An Update, The American Family Physician, 2013 Feb 15;87:267-273 It is a progressive disorder of the central nervous system. PD is caused by a lack of dopamine, a chemical that helps the parts of your brain responsible for motor function communicate with each other. This condition often causes tremors, muscle stiffness, slowness, and poor balance. If you suspect that you, or someone you love, has Parkinsons, it is important to know how you can diagnose this condition. Begin by trying to identify symptoms of the disease at home, and then see your doctor for an appropriate medical diagnosis.
What Are The Signs And Symptoms Of Parkinsons
Parkinsons disease is a progressive condition, and symptoms tend to get worse over time. The rate of progression varies between people.
At first, symptoms tend to be mild enough that they likely wont interfere with your daily life. But people who regularly spend time with you may notice changes in your gait, posture, or facial expressions.
Parkinsons symptoms usually start on
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Testing For Parkinson’s Disease
There are no blood tests or brain scans that can make the diagnosis of Parkinsons disease. Right now, the diagnosis of Parkinsons disease is still made based on the history and the examination.;;
In some cases, a doctor may order medical imaging such as a; or an ;to make sure nothing else is happening, but these scans will not show any changes relating to Parkinsons disease.
In 2012, the FDA approved a special kind of brain scan called a DaT scan. In this scan, people receive an injection of a dye and then pictures show if there is a brain problem relating to the chemical dopamine. However, this scan was approved only to help figure out if someone with tremor has a disease in the Parkinson family or if their tremor might be related to a different disease called familial essential tremor.;
Most of the time, a neurologist especially a movement disorders specialist can know if someone has a disease in the Parkinson family or familial essential tremor without doing this scan. It is also important to know that this scan cannot help a doctor know if a person has Parkinsons disease or one of the other parkinsonisms. Thus, this scan is only used in a few situations. It is not for everyone who might have Parkinsons disease.
In This Section:
How The Levodopa Test Is Conducted
The levodopa test is given at least eight hours after the patients last dose of any medication to boost dopamine levels in the brain and usually takes place in the morning.;Motor functions are analyzed before the test and again 60 to 90 minutes after taking levodopa using part 3 of the unified Parkinsons disease rating;scale .
- Degree of difficulty while rising from a chair
- Gait;
- General posture
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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:
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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
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Bradykinesia: Slowness of movement in the limbs, face, walking or overall body
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Rigidity: Stiffness in the arms, legs or;trunk
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Posture instability: Trouble with balance and possible falls
Once the patient is at the doctors office, the physician:
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Takes a medical history and does a physical examination.
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Asks about current and past medications. Some medications may cause symptoms that mimic Parkinsons disease.
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Performs a neurological examination, testing agility, muscle tone, gait and balance.
The Test Could Eventually Help Provide More Precise Diagnoses For People With Movement Disorders Such As Parkinsons Disease
Researchers at UCLA Health have developed a blood test that can distinguish between two very similar movement disorders, Parkinsons disease and multiple system atrophy . The test, which is currently for research use only, identifies the disease by analyzing the contents of tiny sacs called exosomes that are sent out by brain cells and wind up in the blood.
The researchers report their findings in this months Acta Neuropathologica.
Parkinsons disease can be difficult to distinguish from other neurodegenerative diseases, including MSA, due to similar symptoms such as muscle rigidity and tremors.;Patients who have been incorrectly diagnosed with one or the other disease may feel anxiety when unexpected symptoms occur,;or, in the case of a Parkinsons misdiagnosis, the disease progresses faster than predicted.
If they do have Parkinsons, there are a lot of treatments that can help with the symptoms for a long time, says Gal Bitan, professor of neurology at the David Geffen School of Medicine at UCLA. If they have MSA, which is a very aggressive disease that leads to rapid deterioration, they would want to prepare. They would want to talk with loved ones, and possibly take care of their estate.
Both Parkinsons and MSA patients had elevated alpha-synuclein, but in Parkinsons it mostly came from neurons, while in MSA it came from oligodendrocytes. The researchers could tell the two diseases apart with high accuracy.
Caroline Seydel is the author of this article.
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What Are My Next Steps
If your doctor doesnt diagnose Parkinsons, they can help you find out what the best next step is depending on what condition they suspect. In some cases, treatment may be as simple as changing the dosage of a medication that may be leading to Parkinsons-like symptoms.
Receiving a Parkinsons diagnosis can be overwhelming. If your diagnosis is confirmed, contact a movement disorder specialist as soon as possible. A specialist can help you develop a strategy to delay the onset of more severe disease and manage symptoms youre already experiencing.