What Is Parkinson’s Disease
Parkinsons disease occurs when brain cells that make dopamine, a chemical that coordinates movement, stop working or die. Because PD can cause tremor, slowness, stiffness, and walking and balance problems, it is called a movement disorder. But constipation, depression, memory problems and other non-movement symptoms also can be part of Parkinsons. PD is a lifelong and progressive disease, which means that symptoms slowly worsen over time.
The experience of living with Parkinson’s over the course of a lifetime is unique to each person. As symptoms and progression vary from person to person, neither you nor your doctor can predict which symptoms you will get, when you will get them or how severe they will be. Even though broad paths of similarity are observed among individuals with PD as the disease progresses, there is no guarantee you will experience what you see in others.
Parkinsons affects nearly 1 million people in the United States and more than 6 million people worldwide.
For an in-depth guide to navigating Parkinsons disease and living well as the disease progresses, check out our Parkinsons 360 toolkit.
What Is Parkinson’s Disease?
Dr. Rachel Dolhun, a movement disorder specialist and vice president of medical communications at The Michael J. Fox Foundation, breaks down the basics of Parkinson’s.
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 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
A Parkinsons Diagnosis: Next Steps
Because there is no conclusive screening or test, patients with veryearly Parkinsons disease may not meet the clinical diagnosis criteria.On the flip side, this lack of specificity means that you could bediagnosed with Parkinsons disease, only to find out later that youhave a different condition that mimics Parkinsons.
Further Testing In Parkinson’s
In other situations, where perhaps the diagnosis is not as clear, younger individuals are affected, or there are atypical symptoms such as tremor affecting both hands or perhaps no tremor at all, further testing may help. For example, imaging can play a role in differentiating between essential tremor and Parkinsons. It can also be important to confirm what is initially a clinical diagnosis of Parkinsons prior to an invasive treatment procedure such as surgical DBS
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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:
Diagnosing Parkinsons Disease Accurately
Ensuring accurate diagnoses can be especially challenging when patients are in early stages of their conditions. Early accurate diagnosis is key for the development of preventative treatment options to slow progression of PD, DLB, and MSA. In addition, symptomatic treatment options will differ based on the diagnosis, and patients deserve an answer as soon as possible when facing these potential diagnoses. Patients who have an obvious or well established diagnosis do not need further testing, but for those whose diagnosis is unclear, the use of the Syn-One test can be extremely useful.
Advances such as the use of the Syn-One test as well as the DaTSCAN are just two of the ways that our work at PNI is helping improve the quality of life of our patients and our community.
Pacific Movement Disorders Center |
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How Is Parkinson’s Diagnosed
This information looks at what parkinsonism is, how Parkinsons and other similar conditions may be diagnosed, and explains some of the tests that may be involved in the process.
Most people with a form of parkinsonism have idiopathic Parkinsons disease, also known as Parkinsons. Idiopathic means the cause is unknown.
Other less common forms of parkinsonism include multiple system atrophy , progressive supranuclear palsy , drug-induced parkinsonism and vascular Parkinsons.
If youre concerned about symptoms youve been experiencing, you should visit your GP. If your GP suspects you have Parkinsons, clinical guidelines recommend they should refer you quickly to a specialist with experience in diagnosing the condition .
Its not always easy to diagnose the condition. So its important that you see a Parkinsons specialist to get an accurate diagnosis and to consider the best treatment options.
Diagnosing Parkinsons can take some time as there are other conditions, such as essential tremor , with similar symptoms. There is also currently no definitive test for diagnosing Parkinsons.
Early Signs Of Parkinson’s
Early physical signs include the common motor symptoms: tremor, muscle rigidity and slowness. They may also include the following:
- Symptoms starting on one side of the body
- Change in facial expression
- Failure to swing one arm when walking
- Stooped posture
- Loss of sense of smell
- Depression or anxiety
Some of these symptoms are quite common and by no means exclusive to Parkinsons, so if you have some of them, it does not mean you have Parkinsons.
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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.
Common Symptoms For These People *:
* Approximation only. Some reports may have incomplete information.
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Simple Blood Test Could Help Predict Progression Of Parkinson’s Disease
- IOS Press
- In order to provide the best medical care for newly diagnosed Parkinson’s disease patients, a method of predicting their cognitive and motor progression, beyond using purely clinical parameters, would have major implications for their management.
In order to provide the best medical care for newly diagnosed Parkinson’s disease patients, a method of predicting their cognitive and motor progression, beyond using purely clinical parameters, would have major implications for their management. A novel study published in the Journal of Parkinson’s Disease suggests that a blood test for inflammatory and cell senescence biomarkers may be a reliable predictor of cognitive decline, including identifying those who will develop an early dementia and motor progression in PD patients.
Investigators examined the association of blood-derived markers with motor and cognitive function over time to discover if this could help to better predict disease progression of newly diagnosed PD patients. More than 150 newly diagnosed PD patients who participated in the Cognitive Impairments in Cohorts with Longitudinal Evaluation-Parkinson’s Disease study and 99 controls underwent physical and cognitive assessments over 36 months of follow-up.
Blood Test May Help Distinguish Parkinsons From Similar Diseases
Researchers have found that people with Parkinsons disease have lower levels of a certain protein in their blood than people with similar diseases. The results suggest that testing for the protein might help doctors to accurately differentiate between PD and similar diseases early on. The study appears in the February 8 online edition of Neurology.
Because there are no definitive diagnostic tests for Parkinson’s, the diagnosis can be unclear especially early on in the disease. When diagnosis is uncertain, some people may be diagnosed with parkinsonism,” which refers to a category of diseases, including Parkinson’s, that cause slowness of movement, stiffness and rest tremor. Other diseases in the category include multiple system atrophy , progressive supranuclear palsy and corticobasal degeneration .
Earlier studies found that a spinal fluid test may help distinguish PD from these other diseases, but this test is difficult to do during a routine visit to the doctor.
- Blood levels of NfL protein were generally lower in people with PD and in healthy individuals than in people with other Parkinsonian disorders.
- This result held both for those recently diagnosed and those who had been living with their disease for four to six years.
- The test for NfL could not distinguish between MSA, PSP and CBD.
What Does It Mean?
Hansson O, Janelidze S, Hall S, et al. . Blood-Based NfL: A Biomarker for Differential Diagnosis of Parkinsonian Disorder. Neurology 88: 1-8
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Brain Imaging Can Help With Diagnosis
Doctors use two tests that take detailed pictures of your brain. Each one may help your doctor make a diagnosis. These tests are:
- PET scan: This shows how your brain functions. It shows how the brain uses sugar. This scan can help tell the difference between Parkinson’s and .
- DaTscan: This shows problems with brain cells that make dopamine. Healthy brain cells light up during the test. Cells without enough dopamine appear dark. This scan can help your doctor tell the difference between Parkinson’s and a brain disease called .
Imaging studies are a newer way to diagnose Parkinson’s. However, not every healthcare facility can do them. It takes an experienced doctor to interpret the scans accurately. These scans also can be very expensive. Be sure to check with your insurance company ahead of time to see whether you are covered and what your out-of-pocket costs will be.
Mri In Parkinson’s Testing
One of the more common tests done during a neurologic workup is an MRI scan and one may think that in the investigation of a disease that affects the brain such as Parkinsons, this imaging test would be a necessity. In the context of Parkinsons disease, however, an MRI is not particularly helpful. It looks at the structure of the brain which, for all intents and purposes, appears normal in this disease. An MRI may, however, be indicated when symptoms appear in younger people or if the clinical picture or the progression of symptoms is not typical for Parkinsons. In these situations, MRI can be used to rule out other disorders such as stroke, tumors, hydrocephalus , and Wilsons Disease .
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Physical Examination And Tests
A trip to the neurologists office often includes what seems like dozens of questions, along with multiple tests.
There currently are no diagnostic blood tests for Parkinson’s disease, but your doctor may do some routine blood and urine tests to assess your overall health. Your blood pressure will be taken sitting and standing to look for orthostatic hypotension.
A movement disorder specialist will do a variety of physical tests to assess you as well.
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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Blood Test May Help Differentiate Parkinsons From Similar Diseases
The American Academy of Neurology is the world’s 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 Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
How It All Fits Together
Diagnosing Parkinsons disease can be tricky. The process relies heavily on your doctors judgment. In addition, the causes and risk factors of Parkinsons are not entirely clear yet, which contributes to the difficulty in diagnosing this condition.
However, there have been efforts to try and detect this disease earlier. For instance, clinicians have started focusing more on prodromal symptoms, which are early symptoms that appear before movement-related difficulties begin.
These symptoms include:
- Loss of smell, which can sometimes occur years before other symptoms
- Chronic constipation, without any other explanation
- Rapid eye movement behavior disorder, which causes sleep disturbances
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.
Response To Medication Can Matter
Other movement disorders can act like Parkinson’s. That makes it hard to know for sure whether you have the disease, even after a complete exam. However, the loss of dopamine causes Parkinson’s. It’s a chemical made by brain cells. It is important for movement.
For this reason, your doctor may want you to take a dopamine replacement drug called levodopa. Then your doctor will watch to see whether your symptoms improve. If you get better on levodopa, it’s more likely that you have Parkinson’s.
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