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Wednesday, February 1, 2023
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What Can Mimic Parkinson’s Disease

Drugs And Medication Used To Treat Parkinsons Disease

What tests are used to differentiate Parkinson’s disease from other similar conditions?

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

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.

COMT inhibitors

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.

MAO-B inhibitors

New Diagnostic Standards For Parkinsons

Until recently, the gold-standard checklist for diagnosis came from the U.K.s Parkinsons Disease Society Brain Bank. It was a checklist that doctors followed to determine if the symptoms they saw fit the disease. But thats now considered outdated. Recently, new criteria from the International Parkinson and Movement Disorder Society have come into use. This list reflects the most current understanding of the condition. It allows doctors to reach a more accurate diagnosis so patients can begin treatment at earlier stages.

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.

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Molecular Imaging And Parkinsons Disease

Because multiple neurological disorders mimic Parkinsons disease and there can be overlaps in multiple conditions, it can be difficult to diagnose. SPECT scanning with the FDA approved radiotracer I-123-ioflupane injection may allow for earlier and more accurate diagnosis of Parkinsons disease. A scan using DaTscan is able to detect dopamine transporters . The distribution of DaTs is abnormal in patients with Parkinsonian syndromes but normal in patients with other conditions, such as essential tremor and Alzheimers disease.

PET scanning with the radiotracer fluorine-18-dihydroxyphenylalanine is a marker of dopamine activity. By revealing a dopamine deficiency, F-18-DOPA PET scanning is used to help diagnose Parkinsons disease and distinguish it from other neurological conditions. PET with F-18-DOPA has also been used to measure the effectiveness of dopamine-producing stem cell transplantation. F-18 DOPA is used in clinical trials but is not FDA-approved.

Research To Find Msa Biomarkers And An Earlier Msa Diagnosis

Treatment of Parkinsons Disease

An important goal of the Coalitions MSA Research Program is to fund and encourage the development of biomarkers to distinguish PD from MSA at a much earlier stage.The stakes are high.An accurate biomarker could lead to quicker development of treatments.In fact, a concern in past clinical trials of MSA treatments that failed is that maybe the patients in the trial are too late stage to show effectiveness.Increasing the number of known early stage MSA patients could improve the likelihood of finding treatments and even a cure.

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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:

  • Ceruloplasmin level & eye examination to look for a ring of copper
  • Ferritin level
  • HIV
  • VDRL
  • 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.

    Parkinsons And Other Movement Disorders

    Parkinsons disease is a brain disorder that leads to shaking and;difficulty with walking, movement, and coordination. PD encompasses a variety of syndromes, all of which are progressive and degenerative.

    Sample Scan

    Progressive metabolic reduction from within reference range at baseline , through stages of mild cognitive impairment , and clinical diagnosis of dementia in PDD converter. 3D-SSP t statistic maps comparing single PDD converter to controls with 18F-FDG PET data normalized to pons. Progressive metabolic reductions in cuneus and precuneus occur before less severe, but more widespread, cortical reductions. Sparing of primary sensorimotor cortical strip is present. LLAT = left lateral; LMED = left medial; RLAT = right lateral; RMED = right medial; Yr = year.

    In individuals with PD, dopamine- and noradrenaline-producing neurons that normally send signals that coordinate muscle movement are destroyed. As a result, the primary symptoms of the disorder are;trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness; slowness of movement; and impaired balance and coordination. The;disease most often develops after age 50 and;symptoms vary from patient to patient.

    PD is the most common among a group of movement disorders called Parkinsonian syndromes, all of which have similar symptoms.

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    Parkinson’s Misdiagnosis: General Aging

    It can be hard to feel like you have been taken seriously when your doctor reviews your symptoms and calls it nothing more than aging. It is true that everyones body declines in strength and mobility as they get older, but Parkinsons impacts someones physical and mental abilities in ways that are more pronounced than standard aging.

    My husbands doctor just said it was aging, and that you have got to expect these things as you get older.

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    Doctors: Misdiagnosed Brain Disorder Mimics Parkinson’s

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    Less Common Misdiagnoses Of Parkinsons Disease

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    Anyone with Parkinsons disease can tell you that the road to diagnosis is anything but direct. Too often, it comes down to a bit of luck as in, finding a doctor experienced enough to connect the symptoms straight away as Parkinsons disease.

    For most members of the community, it took several doctor visits and several physicians to reach the correct diagnosis. Prior to that, the wrong diagnoses were all over the map.

    To learn more, we asked members of our : Were you ever misdiagnosed with another condition before your PD diagnosis?

    Almost 90 community members shared, naming many misdiagnoses. Here are the 7 less common answers.

    Signs It Could Be More Than Parkinsons Disease

    Feb 9, 2020 | MSA-Blog |

    Close to one million people in the US have a diagnosis of Parkinsons disease .Unfortunately, for a small percentage of these people the diagnosis just doesnt seem right. They feel like something more is wrong.Their medicines may not be very effective. They might have severe dizziness and even be prone to fainting.They just sense the disease is progressing faster than expected.

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    Living With Parkinsons Disease

    Coping with Parkinsons disease, the motor system disorder, can be frustrating because of its common symptomstrembling, stiffness , slow movements, and the loss of balance and coordination. A good deal of that frustration comes from the loss of control that you once had over your body. It can also be emotionally overwhelming to know that there is currently no cure for the disease.

    Nonetheless, people have a number of tools at their disposal for better managing the symptoms of Parkinsons disease and living a healthy, enjoyable life.

    Heres what can help:
    • Speaking and communicating with others
    • Being able to solve problems
    • Understanding abstract concepts

    The Right Diagnosis Can Save Time


    Because the symptoms of Parkinsons vary and often overlap other conditions, it is misdiagnosed up to 30% of the time, Dr. Fernandez says. Misdiagnosis is even more common in the early stages.

    Patients;who dont know where to turn may make appointments with a rheumatologist, or an orthopaedic or heart specialist, and undergo MRIs, EMGs and other expensive tests.

    But only a neurologist can distinguish Parkinsons from essential tremor, drug-induced Parkinsons and Parkinsons plus syndromes, he says.

    If patients come to us with typical signs of Parkinsons, we dont need to order expensive tests, he says.

    Instead, neurologists base their diagnosis on a detailed patient exam and medical history, along with other information from the patient, family members or caregivers.

    Thats all stirred into the pot, he says. Sometimes we can diagnose Parkinsons with one visit. Other times, several follow-up visits are necessary.

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    What Is The Prognosis And Life Expectancy For Parkinsons Disease

    The severity of Parkinsons disease symptoms and signs vary greatly from person to peson, and it is not possible to predict how quickly the disease will progress. Parkinsons disease itself is not a fatal disease, and the average life expectancy is similar to that of people without the disease. Secondary complications, such as pneumonia, falling-related injuries, and choking can lead to death. Many treatment options can reduce some of the symptoms and prolong the quality of life.

    Parkinson’s Disease Caused By Stroke: Vascular Parkinsonism

    A stroke involving the substantia nigra or basal ganglia is called vascular Parkinsonism. Similar to other strokes, damage is caused primarily by a lack of blood supply to these regions of the brain. Generally, the strokes associated with Parkinsonism are termedÂ;small vessel strokes as they aren’t normally catastrophic. Diagnosis of small vessel strokes can be confirmed with diagnostic tests such as CT or MRI of the brain.

    It typically takes several small strokes to produce the symptoms of vascular Parkinsonism. In some cases, small vessel strokes can also produce a type of dementia called vascular dementia. As such, it is not unusual for people who have vascular Parkinsonism to also have vascular dementia.

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    What Can Mimic Parkinsons Disease

    A number of other neurological conditions can mimic PD.Because the pathology underlying PD results in a loss of dopamine-releasing nerve cells in the brain, anything that has the same effect can result in symptoms that resemble those of PD. Any medication that blocks dopamine receptors can do this and anti-sickness drugs and some of the medicines used to treat depression and psychosis will do this.Other neurodegenerative diseases can resemble PD but may cause earlier problems with balance or more marked problems with control of blood pressure and bladder and bowel function as well as cognitive function. These conditions can initially be difficult to distinguish from typical PD and additional investigations including imaging studies may be recommended.;

    Who Should Consider A Genetic Test For Parkinsons

    This Device Lets You Feel The Effects Of Parkinson’s Disease | CNBC

    There are two groups of people who might consider getting genetic testing and we will discuss each group separately.

  • People with PD, possibly with a strong family history, who may want to know if they carry a genetic mutation that contributed to their developing PD, and if they may pass on that mutation to their children.
  • Children and siblings of people with PD who do not have PD, but are concerned about their genetic risk of developing the disease.
  • Genetic testing for PD is a common request and a number of commercial labs perform panels of genetic testing for PD. You may ask: How can I test myself for Parksinons? Whether youre considering getting a genetic test through your doctor, or performing one at home, its important to note that at-home test dont map the entire gene for mutations. Genetic testing through your doctor will test for GBA, PARK7, SNCA, LRRK2, parkin and PINK1.

    Both groups are faced with two questions: Should I get genetic testing? And if so, what should I do with the results? Before we address these two questions, we need to learn more about the complexity of genetic testing in PD.

    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:

    Once the patient is at the doctors office, the physician:

    Is It Parkinsons Disease Blood Test Might Tell

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    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.

    Global Problem: Lack Of Diagnosis Negates Treatment Impact


    Methodological Limitations Of The Diagnostic Studies

    What Are The Symptoms Of Atypical Parkinsonian Disorders

    Like classic Parkinsons disease, atypical Parkinsonian disorders cause muscle stiffness, tremor, and problems with walking/balance and fine motor coordination.

    Patients with atypical Parkinsonism often have some degree of difficulty speaking or swallowing, and drooling can be a problem. Psychiatric disturbances such as agitation, anxiety or depression may also be part of the clinical picture.

    Dementia with Lewy bodies can cause changes in attention or alertness over hours or days, often with long periods of sleep during the day. Visual hallucinations typically of small animals or children, or moving shadows in the periphery of the visual field are common in DLB. DLB is second only to Alzheimers disease as a cause of dementia in the elderly, and it most commonly affects patients in their 60s.

    Patients with progressive supranuclear palsy may have difficulties with eye movements, particularly when looking downward, and with balance when descending stairs, for instance. Backward falls are common and may occur during the early course of the disease. PSP is not usually associated with tremor, unlike Parkinsons disease.

    Parkinsons Disease and Movement Disorders Center

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    What Makes Pd Hard To Predict

    Parkinsonâs comes with two main buckets of possible symptoms. One affects your ability to move and leads to motor issues like tremors and rigid muscles. The other bucket has non-motor symptoms, like pain, loss of smell, and dementia.

    You may not get all the symptoms. And you canât predict how bad theyâll be, or how fast theyâll get worse. One person may have slight tremors but severe dementia. Another might have major tremors but no issues with thinking or memory. And someone else may have severe symptoms all around.

    On top of that, the drugs that treat Parkinsonâs work better for some people than others. All that adds up to a disease thatâs very hard to predict.

    Simple Blood Tests For Parkinsons Disease Derived From Genome

    Progressive Supranuclear Palsy: The Parkinson

    The diagnosis of Parkinsons disease relies on expert opinion. Autopsy studies, however, have demonstrated that even experienced neurologists misdiagnose Parkinsons disease in about a quarter out of a hundred cases. Diagnostic accuracy at disease onset, when neuroprotective treatment is anticipated to be most effective, is even lower. Thus, there is a crucial need for biomarkers that are disease-specific and which precisely identify early disease stages.

    Traditional studies of blood from Parkinsons disease patients have analyzed expression levels of one gene or gene product at a time. We plan to take advantage of gene chip technology allowing expression analysis of up to 22,000 genes on a single glass slide, known as microarray. We hypothesize that a comparison of the gene chip analyses of blood samples from Parkinsons disease patients and normal controls or patients with other neurological diseases will identify a set of signature genes with characteristic expression in patients with Parkinsons disease. These key genes will provide a molecular fingerprint of Parkinsons disease in blood.

    Brain Imaging And Other Tools To Aid Diagnosis Of Parkinsons

    Helping diagnose Parkinsons with DaTscan and other tests

    Why Genetic Testing For Parkinsons Disease Is Complex:

    In addition to the above, it is important to realize that not all genes associated with PD contribute to disease in the same way:

    Blood Test Aims To Detect Parkinsons In Early Stages

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