Movement Disorders Similar To Parkinsons
Conditions causing excess movement or decreased movement that are sometimes associated with Parkinson’s disease-like symptoms include:
What Movement Disorder Could I Have?
When making a Parkinson’s diagnosis, your doctor will review your medical history and symptoms, perform a careful neurological exam, and, if necessary, carry out further tests to rule out other movement disorders.
Your symptoms may be caused by a movement disorder other than Parkinson’s disease if:
- You display Parkinson’s disease symptoms and features that are characteristic of an additional movement disorder.
- The results of a brain imaging study or laboratory test, such as a blood test, confirm the presence of another movement disorder.
- Your symptoms do not respond to Parkinson’s disease medication.
Because movement disorders are not all treated the same way, it is important to get a proper diagnosis as early as possible so you can formulate the right treatment plan with your doctor.
Skin And Sweat Glands
The autonomic nervous system also controls the sweat glands of the skin. Both excessive sweating and a decrease in sweating are common Parkinsons symptoms. This may be due to a compensatory reaction to a decline of nervous function in extremities. However, Parkinsons patients with anhidrosis are rare, but it can happen.
Can A Stroke Cause Parkinson’s Disease
A stroke can cause some symptoms of Parkinson’s disease, but not Parkinson’s disease itself. This condition is called Parkinsonism. Parkinsonism is associated with many of the same movement problems of Parkinson’s disease, such as tremors and stiffness. However, it usually does not worsen over time as Parkinson’s disease does. If a stroke causes brain damage in the area of the brain that is associated with Parkinson’s disease, then Parkinsonism can occur.
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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 :
Diagnosis Of Parkinsons Disease
A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.
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What Causes Parkinsons Disease
Parkinsons disease causes are still unknown. However, there is a vast amount of research directed at getting answers to its origin, treatment and prevention.
Parkinsons has been linked to declining levels of dopamine, an important brain chemical. Dopamine is a neurotransmitter. It plays a role in controlling movement and coordination. Parkinsons also causes the nerve endings to die on another neurotransmitter called norepinephrine. Norepinephrine controls automatic functions of the body, which contributes to Parkinsons symptoms such as fatigue, constipation and blood pressure changes .
Do All Parkinsons Patients Develop Dementia
Dementia describes a set of symptoms that cause is a significant loss in brain function. It produces a greater impact on patients on patients with Parkinsons than in Alzheimers patients as they have to deal with motor and cognitive impairment.
Alzheimers affect memory and language in general terms. Still, in Parkinsons, it affects problem-solving capacity, speed of thinking, memory, and they run with mild cognitive impairment.
Notably, Parkinsons disease dementia is a common thing among patients with this condition. The vast majority of them may experience some form of cognitive impairment over time.
Though it is a unique process for each person, several risk factors may lead to dementia symptoms and dementia itself.
- Increasing age.
- Exposure to psychological stress
- Low education level and low socioeconomic status
Disease duration has as well a direct correlation with the development of dementia on these patients. The more time the patient has this disease, the risk of developing dementia increases.
Also, Parkinsons dementia has a direct correlation with Lewy bodies. Most people develop dementia as a progression of the disease rather than having Parkinsons and Alzheimers. Nonetheless, a doctor with a neurology specialist should examine the patient to give an assertive diagnosis to the condition.
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A Word From Get Meds Info
Parkinsonism is when someone has the same symptoms as Parkinsons disease, but the symptoms are being caused by another condition. There are many causes of Parkinsonism, ranging from drug-induced, to vascular changes, toxin exposure, infectious disease, neurodegenerative diseases, and more.
Older adults who are taking multiple medications need to be screened for drug-induced Parkinsonism, which is the most common cause of the symptoms.
Research has suggested that Parkinsonism is under-diagnosed and Parkinsons disease is over-diagnosed by general neurologists. If you believe that you could have Parkinsonism but have been diagnosed with Parkinsons disease, you might want to get another doctors input.
Receiving an accurate diagnosis is essential to forming a helpful treatment plan. Parkinsonism is typically seen as harder to treat than Parkinsons disease, which might be because it is initially misdiagnosed as Parkinsons disease and does not respond to levodopa treatment.
Your treatment may include stopping, changing, or adding medications, such as levodopa. You may also receive outpatient or in-home therapy from rehabilitation professionals, such as occupational, physical, and speech therapists, to help you regain your independence and stay safe.
What Are The Symptoms
Symptoms of PD vary from person to person, as does the rate of progression. A person who has Parkinson’s may experience some of these more common “hallmark” symptoms:
- Bradykinesia – slowness of movement, impaired dexterity, decreased blinking, drooling, expressionless face.
- Tremor at rest – involuntary shaking that decreases with purposeful movement. Typically starts on one side of the body, usually the hand.
- Rigidity – stiffness caused by involuntary increase in muscle tone.
- Postural instability – sense of imbalance. Patients often compensate by lowering their center of gravity, which results in a stooped posture.
Other symptoms that may or may not occur:
Freezing or being stuck in place Shuffling gait or dragging of one foot Stooped posture Cognitive impairment
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Environmental Factors In Parkinsons Disease
Here are environmental factors that may play a role in the development of Parkinsons disease:
Although environmental exposure to these and other toxins is of continued research interest, its hard to determine if any one substance is a culprit. Most often, individual cases of Parkinsons disease result from a complex interplay between genetics and environmental and other factors.
Targeting Parkinsons-Linked Protein Could Neutralize 2 of the Diseases Causes
Researchers report they have discovered how two problem proteins known to cause Parkinsons disease are chemically linked, suggesting that someday, both could be neutralized by a single drug designed to target the link.
The Connection Between Pd And Drug
In addition to potentially causing parkinsonism in the general population, these medications should definitely be avoided in people who have parkinsonism from other causes, such as PD. APDA has created a list of Medications to be Avoided or Used With Caution in Parkinsons Disease. It is important to note that there are anti-psychotics and anti-nausea medications which do not cause parkinsonism and can be used safely by people with PD.
Sometimes, a person without a diagnosis of PD is prescribed a medication which leads to a side effect of drug-induced parkinsonism. The prescribing physician may stop the new medication, but the parkinsonism does not resolve. The patient remains off the medication with continuing symptoms, and eventually is given a diagnosis of PD. In this scenario, that person most likely had dopamine depletion in the brain which had not yet manifested as a clinical symptom. The prescription medication that blocked the dopamine receptor, was the proverbial straw that broke the camels back, inducing the full-fledged symptoms of dopamine depletion and revealing that the person did in fact have PD.
The differences of PD vs drug-induced parkinsonism
There are key differences to note between parkinsonism from PD and parkinsonism as a side effect of medication.
What To Do If Your Senior Has Parkinsons
If you notice Parkinsons-like symptoms in your older adult, the first thing to do is talk with their doctor. The doctor should review their complete medication history and you should let them know about any other symptoms or changes.
Important: Dont make any changes to medications without doctor approval that could cause serious problems.
How Are They Alike
These diseases both affect your nerves. MS can break down the coating, called myelin, that surrounds and protects your nerves. In Parkinsonâs, nerve cells in a part of your brain slowly die off.
Both can start out with mild symptoms, but they get worse over time.
Common symptoms of both diseases include:
- Shaky fingers, hands, lips, or limbs
- Slurred speech thatâs hard for others to understand
- Numb or weak limbs that make your walk unsteady
- Loss of muscle control that often affects one side of your body at first, then later both
- Spastic limb movements that are hard to control
- Loss of bladder or bowel control
- Poor balance
Depression is another symptom common to both conditions.
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What Looks Like Parkinsons But Isnt
Dr. Fernandez describes two main Parkinsons mimics:
Essential tremor. Also known as benign essential tremor or familial tremor, this movement disorder causes brief, uncontrollable shaking.
It most often affects your hands, but can also affect your head and neck, larynx and other areas. In rare cases, it affects your lower body as well.
But one clue can help distinguish essential tremor from Parkinsons.
This is not an absolute rule, but if shaking occurs at rest, it often is Parkinsons. And if shaking occurs in action, such as when youre writing or eating, it is essential tremor, Dr. Fernandez says.
About half of those with essential tremor have a family history of the condition.
Unlike Parkinsons, essential tremor is generally not perceived as a progressive disorder, and, if mild, may not require treatment.
Doctors can prescribe medications to reduce shaking, but they are not the same drugs used to treat Parkinsons, he says.
Drug-induced Parkinsons. Along with shaking, this condition may cause many symptoms similar to Parkinsons disease, including stiffness, slow movement, a decrease in facial expression and a change in speech.
As the name suggests, taking certain drugs, most commonly antipsychotics and mood stabilizers, can trigger this condition. How long it takes to develop can vary greatly, depending on which drug youre taking, how long you take it and the dosage.
Your doctor likely will treat drug-induced Parkinsons by adjusting your medication.
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.
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Conditions That Can Cause Tremors Besides Parkinsons:
The tremor of Parkinsons disease occurs even at rest. Hence it is called a rest tremor. Very few other conditions produce rest tremor.
But, many other diseases produce a tremor which is seen only when moving, for example when writing. This is called an Action tremor or posturokinetic tremor. Even these diseases are sometimes misdiagnosed as Parkinsons disease.
|Causes of Rest Tremor|
2. Excessive stress, coffee or smoking
3. Medications such as bronchodilators, valproate and lamotrigine
4. Chromosomal problems such as Fragile-X syndrome
5. Parkinsons disease itself!
And many others
Causes Of Parkinson’s Disease
Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.
Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.
Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.
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What Are Signs And Symptoms Of Parkinsons Disease
Early diagnosis can greatly increase the effectiveness of Parkinsons treatment. However, Parkinsons symptoms are easy to dismiss as normal signs of aging or other conditions such as stroke or head trauma. For these reasons, people may ignore symptoms or doctors may have a harder time with diagnosis.
Treatment Of Vascular Parkinsonism
The most commonly used medications for vascular Parkinsonism are L-dopa and amantadine. However, some people with Parkinsonism do not experience significant improvement with medication. Some stroke survivors who have vascular Parkinsonism can experience better muscle control with physical therapy. Often, safety measures need to be taken to avoid falls.
If you have already had recurrent strokes resulting in vascular Parkinsonism, you may be at risk of experiencing more strokes over the coming years if no action is taken to reduce your risk. Therefore, if you have been diagnosed with vascular Parkinsonism, it is particularly important to follow up with your doctor in order to prevent additional strokes. You should expect to have testing for stroke risk factors and medical treatment to reduce your risk of stroke.
There are also a number of lifestyle factors that can help reduce stroke risk, such as getting regular moderate exercise and quitting smoking if you smoke. Eating a healthy diet is also important.
Tremors Caused By Medications
In addition to drug-induced parkinsonism, which includes rest tremor and is caused by medications that block the dopamine receptor, there are also a wide variety of medications that do not block the dopamine receptor, but can cause other types of tremors, such as postural and action tremors. So if you have these types of tremors, but without the slowness, stiffness and other PD-like symptoms, you could have drug-induced tremor .
A postural tremor occurs when a body part is held against gravity. Postural tremors occur for example, when the arms are extended, such as when holding a tray. An action tremor occurs when a body part is moving. Action tremors occur for example, when the arm is moving toward the mouth to eat.
Drug-induced tremors typically are symmetric or equal on both sides of the body. The medications that can cause tremor include, but are not limited to, lithium, valproic acid, amiodarone, beta-adrenergic agonists, and selective serotonin reuptake inhibitors . Be attentive to whether a tremor starts after any new medication is started. If it does, discuss this with your doctor.
Drugs And Medication Used To Treat Parkinsons Disease
A number of different drugs can be used to treat Parkinsons.
Levodopa is the most common treatment for Parkinsons. It helps to replenish dopamine.
About 75 percent of cases respond to levodopa, but not all symptoms are improved. Levodopa is generally given with carbidopa.
Carbidopa delays the breakdown of levodopa which in turn increases the availability of levodopa at the blood-brain barrier.
Dopamine agonists can imitate the action of dopamine in the brain. Theyre less effective than levodopa, but they can be useful as bridge medications when levodopa is less effective.
Drugs in this class include bromocriptine, pramipexole, and ropinirole.
Anticholinergics are used to block the parasympathetic nervous system. They can help with rigidity.
Benztropine and trihexyphenidyl are anticholinergics used to treat Parkinsons.
Amantadine can be used along with carbidopa-levodopa. Its a glutamate-blocking drug . It offers short-term relief for the involuntary movements that can be a side effect of levodopa.
Catechol O-methyltransferase inhibitors prolong the effect of levodopa. Entacapone and tolcapone are examples of COMT inhibitors.
Tolcapone can cause liver damage. Its usually saved for people who do not respond to other therapies.
Ectacapone does not cause liver damage.
Stalevo is a drug that combines ectacapone and carbidopa-levodopa in one pill.
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