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.
Pd Diagnosis Disease Severity And Disease Progression
The diagnosis of PD is essentially clinical , and we believe that the clinical evaluation of patients will not be replaced by modern imaging techniques. Nevertheless, as pointed out earlier, misdiagnosis can approach 20% of cases . Recently, in line with the European Union, the U.S. FDA approved DAT scan as a diagnostic tool to help differentiate between PD and Essential Tremor. This is the only current FDA-approved subsidiary examination to aid in PD diagnosis.
The role of magnetic resonance imaging in the diagnosis of PD is still not fully established. Traditionally, it has been seen as a means to potentially exclude alternate diagnoses such as vascular parkinsonism, or more importantly , atypical forms of degenerative parkinsonism such as MSA or progressive supranuclear palsy . Traditional structural MRI findings of these latter diagnoses such as increased pallidal iron, rim of putaminal hyperintensity, hot cross bun sign and/or cerebellar atrophy in MSA or the hummingbird or penguin sign in PSP may not be reliable, particularly in early disease.
Figure 5. Multimodal MRI in PD. Differences are noted between patients with PD and controls through voxel-based analysis of R2, mean diffusivity, and fractional anisotropy maps.
Low dopamine transporter uptake in basal ganglia demonstrated by SPECT or PET imaging.*
Brent A. Vogt, in, 2019
Understanding Parkinsons Disease: Getting A Parkinsons Diagnosis
Once you start noticing some changes in your body that impact your daily life or are just simply bothersome, you should begin the process of figuring out if you have Parkinsons disease. It may seem like a daunting undertaking, but dont let fear stop you. Once you are diagnosed, you can start treating your symptoms and learning strategies that will help you feel better.
There are many manifestations of but the classical diagnostic symptoms are:
- slowness and poverty of movement
The physical signs of include:
- slowness of movement
At diagnosis, these signs are usually unilateral, but they become bilateral as the disease progresses. Later in the disease additional signs may be present including postural instability , cognitive impairment and orthostatic hypotension .
There is no single way to define Parkinsons disease or what is often called idiopathic Parkinsons disease in order to differentiate it from other causes of parkinsonism, such as multiple system atrophy and progressive supranuclear palsy .
is traditionally defined, pathologically, by the finding of Lewy bodies and degeneration of catecholaminergic neurones at post-mortem. Using a pathological definition of PD is problematic for a number of reasons:
In recent years, attempts to define genetically have become possible with the discovery of monogenic forms of the disease. However, such families account for a very small proportion of cases.
Common causes of tremor.
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Blood Tests And Spinal Fluid Tests
A blood test or spinal fluid test cant be used to diagnose Parkinsons. But they can be used to search for certain proteins that indicate you may have another neurodegenerative condition with similar symptoms.
The presence of elevated levels of a nerve protein called neurofilament light chain protein may indicate that you have another movement disorder, such as:
- multiple system atrophy
- corticobasal degeneration
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.
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Blood Test May Help Differentiate Parkinsons From Similar Diseases
The American Academy of Neurology is the worlds largest association of neurologists and neuroscience professionals, with 36,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimers disease, stroke, migraine, multiple sclerosis, concussion, Parkinsons disease and epilepsy.
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How Can I Try To Get An Early Diagnosis
By the time Parkinsons causes noticeable motor symptoms, usually about 50 percent of the cells that produce dopamine in your substantia nigra have already died off. Non-motor symptoms, such as constipation, loss of smell, or restless sleep, often appear before motor symptoms.
Theres still debate among medical professionals on how long non-motor symptoms may appear before an individual has noticeable changes in their movement. Its thought that they could appear years to decades beforehand.
But a formal Parkinsons diagnosis requires the symptom slowness of movement. In the time before this symptom appears, your doctor cant make a Parkinsons diagnosis, but they may alert you that youre at a high risk of developing Parkinsons in the future if these or other symptoms appear at any point.
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Who Does It Affect
The risk of developing Parkinsons disease naturally increases with age, and the average age at which it starts is 60 years old. Its slightly more common in men or people designated male at birth than in women or people designated female at birth .
While Parkinsons disease is usually age-related, it can happen in adults as young as 20 .
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If Its Not Parkinsons Disease What Could It Be
Here are some possibilities:
Side effects of medication: Certain drugs used for mental illnesses like psychosis or major depression can bring on symptoms like the ones caused by Parkinsonâs disease. Anti-nausea drugs can, too, but they typically happen on both sides of your body at the same time. They usually go away a few weeks after you stop taking the medication.
Essential tremor: This is a common movement disorder that causes shaking, most often in your hands or arms. Itâs more noticeable when youâre using them, like when you eat or write. Tremors caused by Parkinsonâs disease usually happen when youâre not moving.
Progressive supranuclear palsy: People with this rare disease can have problems with balance, which may cause them to fall a lot. They donât tend to have tremors, but they do have blurry vision and issues with eye movement. These symptoms usually get worse faster than with Parkinsons disease.
Normal pressure hydrocephalus : This happens when a certain kind of fluid builds up in your brain and causes pressure. People with NPH usually have trouble walking, a loss of bladder control, and dementia.
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Single Photon Emission Computed Tomography
In single photon emission computed tomography , a gamma ray-emitting radioactive isotope is tagged to a molecule of interest , which is given to the person with by intravenous injection. The labelled cocaine derivatives 123ICIT and 123I-FP-CIT tropane) have most commonly been used, although only the latter is licensed in the UK. These label the presynaptic dopamine re- site and thus the presynaptic neurone, which can be visualised in two-dimensional images. These demonstrate normal uptake in the caudate and putamen in controls and in people with essential tremor, neuroleptic-induced parkinsonism or psychogenic parkinsonism, but reduced uptake in those with PD, PD with dementia, or .
How useful is SPECT in discriminating from alternative conditions?
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Why Is Early Diagnosis Important In Parkinson’s Disease
There is no apparent cure for Parkinsons, as the degenerated nerve cells cannot be repaired. But according to doctors, mild symptoms of Parkinsons disease start very early before it becomes noticeably worse. Diagnosing the disease in its initial phases may change the patient’s life and future completely for the better. At this stage, one might be able to do the needful to reverse the disease or halt the disease’s progression without further advancement. This is why understanding the symptoms helps one read the possible signs and reach out for medical assistance at the earliest.
Imaging Tests For Parkinsons Disease
While no lab or imaging test can definitively diagnose Parkinsons disease, several helpful imaging tools can be used to support Parkinsons disease diagnosis.
For example, while not approved by the FDA for Parkinsons disease diagnosis, positron emission tomography scans are often used during the diagnostic process to rule out other conditions.
Individuals with Parkinsons disease experience dopamine deficits in the striatum resulting from the destruction of dopaminergic neurons located in the substantia nigra. A dopamine transporter scan , a specific single-photon emission computerized tomography scan, can be used to visualize the dopaminergic neurons.
For this test, a radioactive tracer is injected into the bloodstream, where it then circulates around the body, making its way to the brain. The drug binds to dopamine transmitters in the brain, producing detailed pictures of the dopamine system in the brain. Not everyone with suspected Parkinsons disease will require this test, but it can help distinguish between other functional movement disorders, such as essential tremor.
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:
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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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.
If Its Not Parkinsons Disease What Else Could It Be
There are several other conditions that might produce symptoms that can be mistaken for Parkinsons disease. Here are some possibilities:
- Medication side effects: Certain drugs can produce or exacerbate symptoms.
- Essential, or familial, tremor: This is a relatively common and benign cause of recurrent tremor and is often confused with the tremor of idiopathic Parkinsons. A general neurologist or movement disorder specialist is the best physician to help differentiate between these two conditions.
- A Parkinsonian syndrome: The symptoms of several neurologic conditions are similar to those of idiopathic Parkinsons, but they are often managed differently and often do not respond to the typical medications.
Remember: Only a general neurologist or movement disorder specialist can tell you with reasonable certainty if you have idiopathic Parkinsons. If for some reason you are not comfortable with the results of your first physician visit, getting a second opinion from another general neurologist or movement disorder specialist is always an option. It is important that you feel comfortable with your physician to ensure the best possible outcome for you.
Once you or your loved one has a diagnosis of Parkinsons disease, it is time to discuss treatment options with your physician.
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New Laboratory Tests For Parkinsons Disease
Currently, Parkinsons disease diagnosis is based on a visual clinical exam, done by a doctor in their office. This means that motorsymptoms such as tremor, stiffness and slowness must be apparent before a diagnosis is made by the neurologist yet those visible symptoms dont often appear until long after the initial brain changes of PD are present. However, this is changing! There are two newly available laboratory tests that bring us closer to a new era in Parkinsons diagnosis.
For more background, continue reading. If youd like to skip down to learn about the two new lab tests for Parkinsons, .
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Understanding The Basics Of A Parkinsons And How It Affects The Body
A physician looks for the presence or absence of the possible symptoms of Parkinsons disease by interviewing the patient and performing a detailed neurologic examination. While there is presently no definitive test for Parkinsons, it can often be identified by a general neurologist, who is trained to diagnose and treat neurologic disorders. The first signs of parkinsons are often not motor-related, and a physician can help you come to a diagnosis.
To avoid misdiagnosis, consultation with a movement disorder specialist is recommended. After training in general neurology, a movement disorder specialist is a physician who has undergone subspecialty training in the diagnosis and treatment of movement disorders such as Parkinsons.
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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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:
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
Bradykinesia: Slowness of movement in the limbs, face, walking or overall body
Rigidity: Stiffness in the arms, legs or trunk
Posture instability: Trouble with balance and possible falls
Once the patient is at the doctors office, the physician:
Takes a medical history and does a physical examination.
Asks about current and past medications. Some medications may cause symptoms that mimic Parkinsons disease.
Performs a neurological examination, testing agility, muscle tone, gait and balance.
The Path Towards Early Accurate Diagnosis Of Parkinsons Disease
Like Alzheimers disease and many other neurological diseases, Parkinsons disease begins long before symptoms arise. The benefits of early diagnosis of such diseases are immense and not only affect patients and their families but also the wider society and research community.
Research efforts surrounding Parkinsons disease risk factors, early symptoms, traditional biomarkers, and digital biomarkers will pave the way for an earlier, more accurate diagnosis. Our growing understanding of the factors involved in Parkinsons disease risk, development, and progression opens the door to more robust and sensitive testing and diagnostic approaches.
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What Are The Stages Of Disease Progression In Parkinson’s Disease
Brain cells communicate with each other using electrical signals and certain chemicals known as neurotransmitters. In Parkinsons disease, the cells that produce the neurotransmitter- dopamine get damaged over time. This affects the individual’s ability to move, maintain body balance, and more.
At the time of diagnosis, doctors always refer to the patients condition regarding the stages of Parkinsons disease. One may go through five stages:
Prodromal Stage – This stage starts many years before the individual starts to experience the obvious symptoms of Parkinsons. Identifying them early is crucial for better treatment outcomes.
Stage 1 – Where the individual can perform almost all the day-to-day activities independently. Only there may be small changes in walking , posture, and facial expression. Symptoms may be appreciated only on one side of the body.
Stage 2 – Starts to find it hard to perform activities of daily living. One may have noticeable tremors in the body. Both sides may get affected.
Stage 3 – Most activities require assistance from somebody. Starts to suffer problems with muscular coordination and balancing the body. Becomes more prone to falls.
Stage 4 – Cannot walk without assistance. Swallowing and balancing become major issues. One may need full-time nursing assistance.
Stage 5 – The ability to move around becomes practically nil. Have to depend on a wheelchair.