Parkinson’s Disease How To Diagnose

Obtaining A Parkinsons Disease Diagnosis

During the exam, the neurologist will look for cardinal symptoms of the disease. Facial expressions and features will be assessed. The doctor will look for signs of tremor while the patient is at rest. The doctor may watch how easily the patient stands up from sitting in a chair. The doctor may also stand behind the patient and gently pull back on the patients shoulders and look for how easily the patient can regain balance. Good responsiveness to levodopa also helps support the diagnosis of PD. However, taking levodopa may exclude patients from clinical studies that need to recruit recently diagnosed patients who have not yet had treatment . Participation in a clinical trial should be discussed with the doctor.

PD can be challenging to accurately diagnose, particularly in early stages of the disease, which is why a neurologist trained in movement disorders is critical. Approximately 5-10% of patients with PD are misdiagnosed, as many of the symptoms of PD are similar to other diseases. If the patient thinks that he or she has been misdiagnosed, a second opinion may help.1,2

Support For People Living With Parkinsons Disease

While the progression of Parkinsons is usually slow, eventually a persons daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinsons disease, their families, and caregivers. The organizations listed below can help people find local support groups and other resources in their communities.

Where Can You Find Support For Parkinsons

A chronic condition such as Parkinsons can be overwhelming to manage. Its important to have support. Here are some useful resources where you can find educational materials, support groups, and more.

• The Michael J. Fox Foundation: The Michael J. Fox Foundation offers advocacy, educational materials, and community for people with Parkinsons.
• The American Parkinson Disease Association: You can connect with The American Parkinson Disease Association to find wellness programs and other support in your community.
• The Parkinsons Foundation:The Parkinsons Foundation provides online support, a resource library, and connections to local community-based support.
• The Davis Phinney Foundation fro Parkisons: You can learn more about managing Parkinsons through The Davis Phinney Foundation for Parkinsons events, blog, podcasts, webinars, and other resources.

You can read more about early onset Parkinsons by checking out the answers to some common questions below.

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How Is Parkinsons Disease Diagnosed

Your doctor will ask questions about your symptoms and your past health and will do a neurological exam. This exam includes questions and tests that show how well your nerves are working. For example, your doctor will watch how you move. He or she will check your muscle strength and reflexes and will check your vision.

Your doctor also may check your sense of smell and ask you questions about your mood.

In some cases, your doctor will have you try a medicine for Parkinsons disease. If that medicine helps your symptoms, it may help the doctor find out if you have the disease.

Tests

There are no lab or blood tests that can help your doctor know whether you have Parkinsons. But you may have tests to help your doctor rule out other diseases that could be causing your symptoms. For example:

• An MRI or CT scan is used to look for signs of a stroke or brain tumor.
• Blood tests check for abnormal thyroid hormone levels or liver damage.

Another type of imaging test, called PET, sometimes may detect low levels of dopamine in the brain. These low levels are a key feature of Parkinsons. But PET scanning isnt commonly used to evaluate Parkinsons. Thats because its very expensive, not available in many hospitals, and only used experimentally.

What Tests Might I Have

Your doctor may want to start by testing your blood or doing a brain scan to rule out other conditions.

People who have Parkinsonâs disease donât make enough of a brain chemical called dopamine, which helps you move. If those first tests donât show a reason for your symptoms, your doctor may ask you to try a medication called carbidopa-levodopa, which your brain can turn into dopamine. If your symptoms get much better after you start the drug, your doctor probably will tell you that you have Parkinsonâs disease.

If the medication doesnât work for you and thereâs no other explanation for your issues, your doctor might suggest an imaging test called a DaTscan. This uses a small amount of a radioactive drug and a special scanner, called a single photon emission computed tomography scanner, to see how much dopamine is in your brain. This test can’t tell you for sure that you have Parkinson’s disease, but it can give your doctor more information to work with.

It can take a long time for some people to get a diagnosis. You may need to see your neurologist regularly so they can keep an eye on your symptoms and eventually figure out whatâs behind them.

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What Tests Diagnose Parkinson’s Disease

There currently are no tests that can definitively diagnose Parkinsons Disease. A diagnosis is based on the clinical findings of your physician in combination with your report on the symptoms you are experiencing.

In situations where an older person presents with the typical features of Parkinsons and they are responsive to dopamine replacement therapy, there is unlikely to be any benefit to further investigation or imaging.

How Parkinson’s Disease Is Diagnosed

• How Parkinson’s Disease Is Treated

There’s no “gold standard” test that will diagnose Parkinson’s disease . Instead, a healthcare provider 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 healthcare provider’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 .

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How Is Parkinson’s Disease Managed

Your doctors will tailor your treatment based on your individual circumstances. You will manage your condition best if you have the support of a team, which may include a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.

While there is no cure for Parkinson’s disease, symptoms can be treated with a combination of the following.

What Tests Will Be Done To Diagnose This Condition

When healthcare providers suspect Parkinsons disease or need to rule out other conditions, various imaging and diagnostic tests are possible. These include:

• Positron emission tomography scan.

New lab tests are possible

Researchers have found possible ways to test for possible indicators or Parkinsons disease. Both of these new tests involve the alpha-synuclein protein but test for it in new, unusual ways. While these tests cant tell you what conditions you have because of misfolded alpha-synuclein proteins, that information can still help your provider make a diagnosis.

The two tests use the following methods.

• Spinal tap. One of these tests looks for misfolded alpha-synuclein proteins in cerebrospinal fluid, which is the fluid that surrounds your brain and spinal cord. This test involves a spinal tap , where a healthcare provider inserts a needle into your spinal canal to collect some cerebrospinal fluid for testing.
• Skin biopsy. Another possible test involves a biopsy of surface nerve tissue. A biopsy includes collecting a small sample of your skin, including the nerves in the skin. The samples come from a spot on your back and two spots on your leg. Analyzing the samples can help determine if your alpha-synuclein has a certain kind of malfunction that could increase the risk of developing Parkinsons disease.

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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.

What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

Preventing falls and maintaining balance: Falls are a frequent complication of Parkinsons. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

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Obtaining A Parkinson’s Disease Diagnosis

During the exam, the neurologist will look for cardinal symptoms of the disease. Facial expressions and features will be assessed. The doctor will look for signs of tremor while the patient is at rest. The doctor may watch how easily the patient stands up from sitting in a chair. The doctor may also stand behind the patient and gently pull back on the patients shoulders and look for how easily the patient can regain balance. Good responsiveness to levodopa also helps support the diagnosis of PD. However, taking levodopa may exclude patients from clinical studies that need to recruit recently diagnosed patients who have not yet had treatment . Participation in a clinical trial should be discussed with the doctor.

PD can be challenging to accurately diagnose, particularly in early stages of the disease, which is why a neurologist trained in movement disorders is critical. Approximately 5-10% of patients with PD are misdiagnosed, as many of the symptoms of PD are similar to other diseases. If the patient thinks that he or she has been misdiagnosed, a second opinion may help.1,2

Trouble Moving Or Walking

Do you feel stiff in your body, arms or legs? Have others noticed that your arms dont swing like they used to when you walk? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem stuck to the floor.What is normal?If you have injured your arm or shoulder, you may not be able to use it as well until it is healed, or another illness like arthritis might cause the same symptom.

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How Is It Diagnosed

Diagnosing Parkinsons disease is mostly a clinical process, meaning it relies heavily on a healthcare provider examining your symptoms, asking you questions and reviewing your medical history. Some diagnostic and lab tests are possible, but these are usually needed to rule out other conditions or certain causes. However, most lab tests arent necessary unless you dont respond to treatment for Parkinsons disease, which can indicate you have another condition.

Genes That Cause Parkinson Disease

Several genes have now been implicated in hereditary forms of this disorder. Understanding the function of these genes is helping researchers to identify what things go wrong not only in inherited forms of this disease but also in non-inherited forms. Using genetic mapping studies, a list of genes, not surprisingly originally numbered according to the order in which they were discovered, have been associated with developing PD.

Studies of the proteins produced by these various genes have begun to suggest that alterations in certain cellular functions may be important to the development of Parkinson disease. More importantly, continuing research links some of the different genes to being active in the same pathways within the cell. Thus, evidence mounts as to the importance of these pathways in PD including 1) how cells degrade certain proteins after their useful service life is over, 2) how mitochondria generate enough energy for the cell, and 3) how specific RNA molecules in the cell are managed.

One recent study showed that types of genes called PINK1 and Parkin act together in one pathway affecting mitochondria inside the cell . An earlier study had shown that under energetically stressful conditions inside the cell that DJ1 and Parkin can interact with one another . These types of associations make it more likely that learning how to intervene in these specifically altered pathways may point the way to new treatments for this disorder.

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Physical And Neurological Examination

Your doctor will conduct a physical and neurological examination. This can involve observing your behavior, movements, and mental state and conducting tests or asking you to perform certain exercises.

These are some of the symptoms of Parkinsons your doctor can determine visually:

• Fewer spontaneous movements or hand gestures
• Reduced frequency of blinking
• Tremors in your hands while they are at rest, often only in one hand
• Hunched posture or forward lean while walking
• Stiff movements

These are some of the exercises your doctor may ask you to do to evaluate your movements, balance, and coordination:

• Opening and closing your fist
• Tapping your fingers, toes, and heels
• Holding your arms out in front of you
• Moving your finger from one point to another
• Rotating your wrists or ankles
• Standing from a chair

What Are The Next Steps Following A Diagnosis Of Parkinsons

Once you have a diagnosis of Parkinsons, your doctor can begin developing a treatment plan. Parkinsons treatments aim to minimize symptoms and slow down progression.

Treatment plans will take into account such factors as symptoms, overall health, and response to treatment. Although theres no cure for Parkinsons, treatment can improve your quality of life.

Common treatments for Parkinsons include:

• Physical therapy: Physical therapy can help improve strength and balance.
• Speech therapy: Speech therapy can help reduce communication difficulties.
• Lifestyle changes: People with Parkinsons often benefit from adding exercise to their daily lives.
• Medication: There are several medications approved to treat the symptoms of Parkinsons. You might need to change medications as Parkinsons progresses.
• Deep brain stimulation:Deep brain stimulation is a surgical procedure. Surgeons place electrodes in your brain that are connected to a generator placed in your chest. These electrodes can help reduce the symptoms of Parkinsons.

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Medications For Other Symptoms Of Dementia

People with LBD may often experience a sleep disorder called rapid eye movement sleep behavior disorder. This can sometimes be treated with sedatives like clonazepam or with melatonin . Other more severe symptoms of LBD including fluctuating levels of alertness , hallucinations, agitation, severe confusion, and delirium can be challenging to treat. Doctors must first rule out underlying causes like infection or other medications that can be triggering these symptoms. If unable to find a treatable cause, doctors may use a low dose of the atypical antipsychotic medication quetiapine to treat these symptoms. However, people with LBD must not be given typical antipsychotics or high-potency atypical antipsychotics , as people with LBD are very sensitive to these medications and may develop neuroleptic malignant syndrome if they take them. This is a life-threatening condition that causes fever, muscle stiffness, and racing heart, and can lead to heart and kidney failure. Talk with your doctor about medication options.

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How Is Parkinsons Disease Diagnosed And Treated

There is no definitive test for Parkinsons disease rather, your doctor will diagnose the disease by reviewing your symptoms, medical history, and family history, and by performing a neurological and physical examination. Your doctor may also request a blood test or imaging tests such as an MRI or PET scan to rule out any other possible disorders or conditions causing your symptoms.

While there is no cure for Parkinsons disease, there are medical and non-medical interventions that can help patients manage their symptoms:

• Medication. Medication can dramatically improve ones symptoms. However, as PD progresses, medication dosages may be increased, which can cause dyskinesias, which are uncontrolled, writhing movements.
• Physical therapy. Your doctor may recommend you see a physical therapist to assist you with strengthening and balance exercises.
• Speech-language therapy. Speech-language pathologists can help patients manage speech and voice disorders, common outcomes of Parkinsons disease.
• Deep brain stimulation. PD patients who require high or frequent doses of dopamine and who also experience side effects of their medication are ideal candidates for deep brain stimulation, a minimally invasive surgical treatment often used on those movement disorders.

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