What Makes Pd Hard To Predict
Parkinsonâs comes with two main buckets of possible symptoms. One affects your ability to move and leads to motor issues like tremors and rigid muscles. The other bucket has non-motor symptoms, like pain, loss of smell, and dementia.
You may not get all the symptoms. And you canât predict how bad theyâll be, or how fast theyâll get worse. One person may have slight tremors but severe dementia. Another might have major tremors but no issues with thinking or memory. And someone else may have severe symptoms all around.
On top of that, the drugs that treat Parkinsonâs work better for some people than others. All that adds up to a disease thatâs very hard to predict.
Conditions That Mimic Shuffling Gait Seen In Parkinsons:
Please read the article on shuffling gait. It describes 5 causes of shuffling of gait.
The most crucial mimic to remember is Normal Pressure Hydrocephalus .
The person with NPH feels like he is stuck to the ground. This is a magnetic gait. It is easy to mistake this for Parkinsons disease.
For example, see this video posted by the Hydrocephalus Association of America on youtube:
NPH can be treated by implanting a small shunt pipe. This shunt drains excess water around the brain into the abdomen.
What Is Lyme Disease
LD is a bacterial infection that is transmitted by a tick bite. It can lead to many health problems. These problems may include rashes, swelling in the heart, and joint pain in multiple joints at once.1 Sometimes, LD can lead to brain issues. Some of these brain issues are dementia-like symptoms, swelling in the brain, shaking in the hands, and memory loss.1,2,3,4 Patients may also have symptoms of LD months to years after the initial tick bite and treatment. These symptoms are called Post-treatment Lyme Disease Syndrome or sometimes called chronic Lyme disease.5
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Lewy Body Dementia: A Common Yet Underdiagnosed Dementia
While its not a household word yet, Lewy body dementia is not a rare disease. It affects an estimated 1.4 million individuals and their families in the United States. Because LBD symptoms can closely resemble other more commonly known disorders like Alzheimers disease and Parkinsons, it is often underdiagnosed or misdiagnosed. In fact, many doctors or other medical professionals still are not familiar with LBD.
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.
Results
References
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Lyme Disease And Alzheimers Disease By Location
Two groups of researchers wondered if there were any links between deaths from Alzheimers disease and LD. If there was a link between AD and LD, then states that have the highest numbers of cases of LD should also have the highest numbers of AD deaths.2,3 The information was easy to find. States keep records of the number of cases of LD that are diagnosed each year. States also keep records of the cause of death on a persons death certificate. The researchers looked at states where the cases of LD were the highest and states where the cases of LD are the lowest. They looked at the number of deaths caused by AD in those same states.3 They found that there was no link between the deaths because of AD and the number of cases of LD. In fact, the number of deaths from AD was actually higher in many states with the lowest number of cases of LD.2,3
No research is perfect. The researchers know that their information doesnt take into consideration people who have LD that may have moved to different states after they are diagnosed. It also cant account for how different states record the cause of death on a certificate.2 Both of these factors have the potential to change some of the results. Even with these problems, these studies do show that there is very little link between Lyme and deaths due to AD.2,3
What Is Lewy Body Dementia
Lewy body dementia is not a single disorder but rather a spectrum of closely-related disorders involving disturbances of cognition, behavior, sleep, movement and autonomic function.
In these progressive disorders, Lewy bodies build up in the brain. Lewy bodies in the brain stem cause a disruption in the production of chemical messengers called dopamine. Too little dopamine can cause parkinsonism, a clinical syndrome thats characterized by tremor, bradykinesia , rigidity and postural instability. Parkinsonism can be caused by Parkinsons disease itself as well as by other underlying neurological conditions such as LBD.; These Lewy bodies are also found throughout other areas of the brain, including the cerebral cortex. The neurotransmitter acetylcholine is also depleted, causing disruption of perception, thinking and behavior.
A German neurologist, Friederich H. Lewy, first discovered the abnormal protein deposits in the early 1900s as he was conducting research on Parkinsons disease.
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Molecular Imaging And Parkinsons Disease
Because multiple neurological disorders mimic Parkinsons disease and there can be overlaps in multiple conditions, it can be difficult to diagnose. SPECT scanning with the FDA approved radiotracer I-123-ioflupane injection may allow for earlier and more accurate diagnosis of Parkinsons disease. A scan using DaTscan is able to detect dopamine transporters . The distribution of DaTs is abnormal in patients with Parkinsonian syndromes but normal in patients with other conditions, such as essential tremor and Alzheimers disease.
PET scanning with the radiotracer fluorine-18-dihydroxyphenylalanine is a marker of dopamine activity. By revealing a dopamine deficiency, F-18-DOPA PET scanning is used to help diagnose Parkinsons disease and distinguish it from other neurological conditions. PET with F-18-DOPA has also been used to measure the effectiveness of dopamine-producing stem cell transplantation. F-18 DOPA is used in clinical trials but is not FDA-approved.
What Causes The Condition
First described in 1917 by James Parkinson as the shaking palsy, PD is characterized by a loss of neurons in the substantia nigra portion of the brain. A buildup of the protein alpha-synuclein causes dopamine producing cells to fail and die. There is no known specific cause of PD but it is considered to be a combination of genetic and environmental factors just like PSP.
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A Case Of Lyme Disease And Parkinsons Disease
Some people with LD will have symptoms of brain problems after their diagnosis. These problems can include memory loss and shaking of the hands and feet. Most of these problems go away after the person takes medications to treat LD.3 There is one time that a person had symptoms of Parkinsons disease after his treatment for LD. These symptoms continued to get worse until the person eventually passed away.1 This is the only case that doctors know of someone who developed Parkinsons disease from LD. This case of Parkinsons disease was verified by an autopsy. This person had no brain symptoms before his LD diagnosis. Researchers dont know if the LD caused the Parkinsons disease symptoms, or if this person would have developed Parkinsons disease without having LD.
What Health Conditions Mimic The Symptoms Of Parkinson’s Disease
Parkinsonism is a medical term that refers to the symptoms experienced by people with the disease, which include slowness of movements, stiffness of the joints, as well as tremor and imbalance. However, there are a series of conditions whose symptoms are very similar to those of Parkinson’s disease, which is why so many people are misdiagnosed.
Being aware of these health conditions is essential if you have a history of exposure to paraquat, as it may facilitate the assignment of a correct diagnosis. The following are some of the conditions that mimic the symptoms of Parkinson’s disease:
If you have a history of exposure to paraquat and were diagnosed with one of the above conditions, we strongly advise you to seek a second opinion from a specialist, as you may be in fact struggling with Parkinson’s disease, which qualifies you for compensation.
It is essential to receive a correct and precise diagnosis, as it will not only help you obtain the money you deserve from the liable companies but will also improve your quality of life.
For over 35 years, the team of experts at Atraxia Law has been helping people recover the compensation they were eligible for by evaluating their personal injury or product liability claims and are ready to provide you with quality assistance as well if your health was affected by exposure to paraquat.
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Which Test Can Be Done When The Diagnosis Is In Doubt
I request a small set of tests on almost all patients I diagnose with Parkinsons. These detect some mimics of Parkinsons disease.
Some doctors dont request all these tests. And for a good reason.
The diagnosis of Parkinsons mimics is primarily based on a careful history and examination.; Even in my practice, these tests change the diagnosis only in a minority of patients.
I like the additional confirmation provided by these tests. They also have other benefits. For example, they help me determine the proper dosages of medications like Amantadine.
| Simple tests to detect Parkinsons Mimics |
|---|
| 1. MRI-Brain with size measurements of brain parts called the midbrain and pons. I usually also request a unique picture called SWI, which shows iron inside the brain.
2. Blood tests: |
But when the diagnosis s really in doubt, there is another brain scan that can be done.
A Trodat scan. Or even better an F-DOPA scan. Both these scans measure dopamine activity inside the brain.
You can read more about Trodat & F-DOPA scans by clicking here.
These scans are not perfect. Let me tell you why very quickly:
In Parkinsons disease, dopamine activity inside the brain is deficient. This deficiency produces an abnormal scan. If the Trodat/F-DOPA scan is normal, it is unlikely that you have Parkinsons disease.
What Is The Prognosis And Life Expectancy For Parkinsons Disease
The severity of Parkinsons disease symptoms and signs vary greatly from person to peson, and it is not possible to predict how quickly the disease will progress. Parkinsons disease itself is not a fatal disease, and the average life expectancy is similar to that of people without the disease. Secondary complications, such as pneumonia, falling-related injuries, and choking can lead to death. Many treatment options can reduce some of the symptoms and prolong the quality of life.
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Parkinson Disease & Mimics
Parkinson disease is a complex progressive neurological disease involving the loss of neurons in a part of the brain called the substantia nigra. This results in a reduction in the amount of dopamine, a chemical messenger or neurotransmitter. When this important chemical in the brain is depleted, the symptoms of Parkinsons disease develop.
There are two types of symptoms: motor and non-motor . Common motor symptoms include: essential tremor, slowness of movement, stiffness and impairment of balance later.
Non-motor symptoms vary from person-to-person and more so than the motor symptoms. They can include, low-blood pressure, constipation, speech difficulties , depression, Fatigue, Sleep problems, osteoporosis etc
Living With Parkinsons Disease
Coping with Parkinsons disease, the motor system disorder, can be frustrating because of its common symptomstrembling, stiffness , slow movements, and the loss of balance and coordination. A good deal of that frustration comes from the loss of control that you once had over your body. It can also be emotionally overwhelming to know that there is currently no cure for the disease.
Nonetheless, people have a number of tools at their disposal for better managing the symptoms of Parkinsons disease and living a healthy, enjoyable life.
Heres what can help:
- Speaking and communicating with others
- Being able to solve problems
- Understanding abstract concepts
Also Check: When To Start Levodopa Therapy For Parkinson’s Disease
Is A Dat Scan Or F
No! Not at all!
First, the diagnosis of Parkinsons disease is obvious in most patients.
The proof of the pudding is in the eating. If you improve significantly with levodopa you have parkinsonism.
If this improvement is consistent for many years you probably have Parkinsons disease.
Second, while these scans are useful in differentiating some diseases like Essential tremor from Parkinsons disease, they are not very useful in identifying mimics .
The Nervous System & Dopamine
To understand Parkinson’s, it is helpful to understand how neurons work and how PD affects the brain .
Nerve cells, or neurons, are responsible for sending and receiving nerve impulses or messages between the body and the brain. Try to picture electrical wiring in your home. An electrical circuit is made up of numerous wires connected in such a way that when a light switch is turned on, a light bulb will beam. Similarly, a neuron that is excited will transmit its energy to neurons that are next to it.
Neurons have a cell body with branching arms, called dendrites, which act like antennae and pick up messages. Axons carry messages away from the cell body. Impulses travel from neuron to neuron, from the axon of one cell to the dendrites of another, by crossing over a tiny gap between the two nerve cells called a synapse. Chemical messengers called neurotransmitters allow the electrical impulse to cross the gap.
Neurons talk to each other in the following manner :
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What Treatments Are Available
Many Parkinson’s patients enjoy an active lifestyle and a normal life expectancy. Maintaining a healthy lifestyle by eating a balanced diet and staying physically active contributes to overall health and well-being. Parkinson’s disease can be managed with self-care, medication, and surgery.
Self careExercise is as important as medication in the treatment of PD. It helps maintain flexibility and improves balance and range of motion. Patients may want to join a support group and continue enjoyable activities to improve their quality of life. Equally important is the health and well being of the family and caregivers who are also coping with PD. For additional pointers, see Coping With Parkinsons Disease.
These are some practical tips patients can use:
Medications There are several types of medications used to manage Parkinson’s. These medications may be used alone or in combination with each other, depending if your symptoms are mild or advanced.
After a time on medication, patients may notice that each dose wears off before the next dose can be taken or erratic fluctuations in dose effect . Anti-Parkinsons drugs can cause dyskinesia, which are involuntary jerking or swaying movements that typically occur at peak dosage and are caused by an overload of dopamine medication. Sometimes dyskinesia can be more troublesome than the Parkinsons symptoms.
Parkinsons Disease Caused By Stroke: Vascular Parkinsonism
A stroke involving the substantia nigra or basal ganglia is called vascular Parkinsonism. Similar to other strokes, damage is caused primarily by a lack of blood supply to these regions of the brain. Generally, the strokes associated with Parkinsonism are termed small vessel strokes as they arent normally catastrophic. Diagnosis of small vessel strokes can be confirmed with diagnostic tests such as CT or MRI of the brain.
It typically takes several small strokes to produce the symptoms of vascular Parkinsonism. In some cases, small vessel strokes can also produce a type of dementia called vascular dementia. As such, it is not unusual for people who have vascular Parkinsonism to also have vascular dementia.
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Lewy Body Dementia Vs Parkinsons Disease Dementia
Diagnoses of Lewy body dementia include dementia with Lewy bodies and Parkinsons disease dementia. Symptoms in both of these diagnoses can be similar.
Lewy body dementia is a progressive dementia caused by abnormal deposits of a protein called alpha-synuclein in the brain. Lewy bodies are also seen in Parkinsons disease.
The overlap in symptoms between Lewy body dementia and Parkinsons disease dementia include movement symptoms, rigid muscles, and problems with thinking and reasoning.
This seems to indicate that they could be linked to the same abnormalities, though more research is needed to confirm that.
The later stages of Parkinsons disease have more severe symptoms that may require help moving around, around-the-clock care, or a wheelchair. Quality of life can decline rapidly.
Risks of infection, incontinence, pneumonia, falls, insomnia, and choking increase.
Hospice care, memory care, home health aides, social workers, and support counselors can be a help in later stages.
Parkinsons disease itself isnt fatal, but complications can be.
Research has shown a median survival rate of about
Parkinson’s Disease Is Often Misdiagnosed In People With Paraquat Exposure
by Legal Staff
Because the symptoms of Parkinson’s disease are very similar to those of other health problems, it is often misdiagnosed in people with a history of exposure to paraquat, which prevents victims of toxic exposure from recovering the financial compensation they deserve. According to medical studies, Parkinson’s disease is misdiagnosed in up to 30% of cases and the rate of misdiagnosis is even higher in people whose disease is in the early stages. 1 in 4 people with Parkinson’s disease will receive a wrong diagnosis
Therefore, seeking a second and even a third opinion is essential in being assigned a correct and accurate diagnosis. It is a known fact that frequent exposure to paraquat in agricultural workers increases the risk of developing Parkinson’s disease by 250%.
Thereby, if you have a history of paraquat exposure, it is crucial to keep a close eye on your health for the symptoms of Parkinson’s disease.
A poll from the American Journal of Managed Care found that over 26% of people with Parkinson’s disease were initially misdiagnosed and 21% had to see their general healthcare provider 3 times before being referred to a specialist to have their health problem correctly diagnosed.
What is more alarming is that 48% of the participants received treatment for the wrong health condition, with 36% being prescribed medication and 6% undergoing surgical procedures. Consequently, a significant decline in the quality of life was noted in the misdiagnosed patients.
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