What Is Parkinson’s Disease
Parkinsons disease is the deterioration of brain nerves that control movement. The symptoms of Parkinsons disease have a slow onset and get worse over time. You may experience a gradual onset of symptoms, or notice several changes all at once.
Perhaps the most well-known symptom of Parkinsons disease is the development of a tremor. You may notice that your fingers, hands, or chin shake uncontrollably. Other symptoms include:
- Change in handwriting specifically smaller handwriting
- Changes in your tone of voice specifically speaking more quietly
- Lack of facial expressions
- Dizziness and fainting
- Beginning to walk with a hunched back
It is important to keep in mind that medications and other medical conditions can cause symptoms similar to those listed above. But, if you are experiencing a combination of these symptoms, it may be a sign of Parkinsons disease.
While there is not currently a cure for Parkinsons disease, many treatment options are available that can help ease your symptoms. Treatments may include medicine, therapy, and even surgery. Each case of Parkinsons disease is unique, and your treatment plan should be, too.
Taking Medicine With Food
Early in the disease, it might be helpful to take pills with food to help with nausea, which may be caused by some of the medicines for Parkinson’s disease.
Later in the disease, taking the medicines at least 1 hour before meals may help them work best.
Some medicines for Parkinson’s disease don’t work as well if you take them at the same time you eat food with protein in it, such as meat or cheese. The protein can block the medicine and keep it from working as well as it should.
What Are The Pitfalls Of Datscan
DaTscan will appear abnormal in any disease in which there is a loss of dopamine nerve endings in the striatum. Therefore, Parkinson-plus syndromes, discussed in a prior blog, such as Progressive supranuclear palsy , Corticobasal ganglionic degeneration and Multiple system atrophy all typically demonstrate abnormal DaTscans. DaTscan therefore cannot be used to distinguish between these syndromes.
Every medical test has a false positive and a false negative rate. This means, that it is inevitable that in a certain percentage of people who have PD, the DaTscan will be read as normal and in a certain percentage of people without PD, the DaTscan will be read as abnormal. Results of any medical test that is performed, must therefore be considered within the entire clinical context.
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Diagnosis Of Parkinsons Via Datscan And Clinical Exam Are Similarly Accurate
Despite the DaTscan being available to help diagnose Parkinsons, in most clinical situations, a DaTscan will not add information to what can be gleaned from the clinical exam. One study actually demonstrated that the accuracy of diagnosis in early PD was the same whether the diagnosis was reached using clinical exam or using DaTscan.
Tests Reveal Incredible Accuracy In Detecting Parkinsons
Researchers conducted a blind study of 50 skin samples, including 25 Parkinsons patients and 25 people without neurological disorders. Using a protein chemical assay, the skin test correctly diagnosed 24 out of 25 Parkinsons patients. Only one of the 25 control samples tested positive for protein clumping.
These results indicate tremendously high sensitivity and specificity which is critical for a diagnostic test, Dr. Charles Adler, a professor of neurology at Mayo Clinic Arizona says.
The clinical diagnostic accuracy for early-stage PD has been quite poor, only around 50-70%. And since clinical trials really need to be done at an early stage to avoid further brain damage, they have been critically hampered because they have been including large percentages of people who may not actually have the disease, study co-investigator Dr. Thomas Beach explains. Improving clinical diagnostic accuracy is, in my view, the very first thing we need to do in order to find new useful treatments for PD.
Kanthasamy says the results show great promise which could lead to a reliable way to detect Parkinsons. Early detection can also help other researchers get their therapeutic treatments to patients faster potentially stopping the disease before it advances.
The study appears in the journal Movement Disorders.
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What Causes Parkinson’s Disease
Parkinson’s disease is the result of the loss of the brain chemical dopamine. When nerve cells, called neurons, in an area of the brain that controls movement become impaired and/or die, the amount of dopamine they normally produce decreases. This loss of dopamine causes the movement problems seen in people with PD.
Parkinson’s Disease Is A Movement Disorder
Parkinson’s disease is a movement disorder that is degenerative and chronic, and symptoms continue and generally worsen over time. The National Institute of Neurological Disorders and Stroke estimates about 50,000 people are diagnosed with PD each year in the U.S. The cause of PD is unknown. There is currently no cure, but there are several treatment options available to manage symptoms including medications and surgery.
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There Are No Laboratory Tests To Diagnose Parkinson’s Disease
Currently there are no laboratory tests that can diagnose Parkinson’s disease. This can make it difficult to accurately diagnose because PD resembles other movement disorders. In order to diagnose PD, a physician will take a complete medical history and perform a neurological exam. Additional testing may be done simply to rule out other neurological conditions that may resemble Parkinson’s.
Causes Of Parkinson’s Disease
The causes of Parkinsons disease are still greatly unknown. Scientists who have studied this disorder estimate that 10-15% of cases come from genetics after seeing a series of genetic mutations that were common in Parkinsons patients.
Doctors suspect that environmental factors and lifestyle choices may have effects on the severity of Parkinsons disease symptoms. Exposure to chemicals like pesticides may increase the likelihood of developing Parkinsons disease. On the other hand, a good diet and regular exercise may decrease your chances.
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What Are Lewy Bodies
Lewy bodies are abnormal protein deposits found in the brain. Researchers do not know exactly why Lewy bodies form or what role they may play in Parkinson’s disease, but they seem to be linked to certain types of dementia associated with both PD and Alzheimer’s disease. Lewy body dementia is a degenerative disease and symptoms range from parkinsonian symptoms such as bradykinesia, rigidity, tremor, and shuffling walk, to symptoms similar to those of Alzheimer’s disease . Symptoms may fluctuate, even from day to day. In later stages patients may develop hallucinations.
Datscan: A Test To Help In The Diagnosis Of Parkinsons
In 2011, the Food and Drug Administration approved an imaging test to help diagnose PD. In this test, a radioactive tracer, Ioflupane 123I, also known as DaTscan, is injected into the blood, where it circulates around the body and makes its way into the brain. It attaches itself to the dopamine transporter, a molecule found on dopamine neurons. Several hours after the tracer has been injected, special imaging equipment scans the head to detect the presence of DaTscan.
People with PD will typically have a smaller signal in a part of the brain called the striatum, where the ends of the dopamine neurons are meant to be. Here is a normal scan on the left, which would indicate a healthy dopamine system, next to an abnormal scan on the right, which would indicate an unhealthy dopamine system.
It is important to note that conventional MRI imaging will appear normal in PD and is therefore not helpful in confirming the diagnosis. Other atypical parkinsonian conditions, such as vascular parkinsonism however, can have abnormalities on MRI, so the test may be done to rule out other diagnoses.
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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
What Are The Symptoms
The four main symptoms of Parkinson’s are:
- Tremor, which means shaking or trembling. Tremor may affect your hands, arms, or legs.
- Stiff muscles.
- Slow movement.
- Problems with balance or walking.
Tremor may be the first symptom you notice. It’s one of the most common signs of the disease, although not everyone has it.
More importantly, not everyone with a tremor has Parkinson’s disease.
Tremor often starts in just one arm or leg or on only one side of the body. It may be worse when you are awake but not moving the affected arm or leg. It may get better when you move the limb or you are asleep.
In time, Parkinson’s affects muscles all through your body, so it can lead to problems like trouble swallowing or constipation.
In the later stages of the disease, a person with Parkinson’s may have a fixed or blank expression, trouble speaking, and other problems. Some people also lose mental skills .
People usually start to have symptoms between the ages of 50 and 60. But sometimes symptoms start earlier.
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Your Home And Lifestyle
- Modify your activities and your home. For example, simplify your daily activities, and change the location of furniture so that you can hold on to something as you move around the house.
- Eat healthy foods, including plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, and low-fat dairy products.
- Exercise and do physiotherapy. They have benefits in both early and advanced stages of the disease.
Mood And Mental Problems
- Deal with depression. If you are feeling sad or depressed, ask a friend or family member for help. If these feelings don’t go away, or if they get worse, talk to your doctor. He or she may be able to suggest someone for you to talk to. Or your doctor may give you medicine that will help.
- Deal with dementia. Dementia is common late in Parkinson’s disease. Symptoms may include confusion and memory loss. If you notice that you are confused a lot or have trouble thinking clearly, talk to your doctor. There are medicines that can help dementia in people with Parkinson’s disease.
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If You Have Parkinson’s Disease
If you have been diagnosed with Parkinson’s, call your doctor if:
- You notice any significant change in your symptoms, such as severe episodes of freezingâa sudden loss of mobilityâwhich may affect walking.
- Your response to your medicine changes.
- Any other symptoms occur, such as constipation, sexual problems, or incontinence.
- You have symptoms of depression, such as feeling sad or hopeless and losing interest in daily activities.
- You or your family notice that you have problems with memory and thinking ability.
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.
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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.
Testing For Parkinsons Disease
There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.
A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.
The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.
The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.
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The Problem Of Missed Diagnosis Or Misdiagnosis
If widely circulated, this skin test could potentially cause a spike in the number of successful diagnoses made every year.
Parkinsons disease is not straightforward to diagnose because diagnosis is based on clinical evaluation, meaning the patient history and physical exam, Miocinovic says. So one has to suspect Parkinsons disease in order to ask the right questions and test for specific disease signs. And early on, symptoms may not clearly point to Parkinsons disease.
Many early symptoms of Parkinsons are dismissed as byproducts of the aging process. In some cases, they are even attributed to another epidemiological cause entirely. Some of these symptoms include:
- Constipation
- Restless leg syndrome
- Reduced sense of smell
Sometimes other disorders early on can mimic Parkinson’s, with a couple of the disorders that commonly are mistaken for Parkinson’s being progressive supranuclear palsy, or PSP, or multiple system atrophy, or MSA, because sometimes early in the course, they can look very similar to Parkinson’s, Simon says. Even movement disorder specialists who think it’s Parkinson’s early in the course aren’t right as often as we’d like to think we are.
This wide margin of error has immense ramifications for the work of the neuroscientists who study the disease in the hope of developing successful treatments.
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.
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How Will Parkinson’s Disease Affect Your Life
Finding out that you have a long-term, progressive disease can lead to a wide range of feelings. You may feel angry, afraid, sad, or worried about what lies ahead. It may help to keep a few things in mind:
- Usually this disease progresses slowly. Some people live for many years with only minor symptoms.
- Many people are able to keep working for years. As the disease gets worse, you may need to change how you work.
- It is important to take an active role in your health care. Find a doctor you trust and can work with.
- Depression is common in people who have Parkinson’s. If you feel very sad or hopeless, talk to your doctor or see a counsellor.
- It can make a big difference to know that you’re not alone. Ask your doctor about Parkinson’s support groups, or look for online groups or message boards.
- Parkinson’s affects more than just the person who has it. It also affects your loved ones. Be sure to include them in your decisions.