What Doctor To See For Parkinson Disease

Medical Treatment For Parkinson’s Disease

Parkinson’s disease cannot be cured, though taking the medicines timely as prescribed by the doctor can control your symptoms, often dramatically. The doctor may suggest lifestyle changes, and exercises and physical therapy that focuses on balance and stretching.

Based on the severity of the patients condition the doctor may also suggest surgery.

Parkinson’s Symptoms That Lead To Diagnosis

The biggest clues your doctor will look for involve observing you as you sit and speak during an exam for PD, as well as how you perform movement tasks that your doctor may ask you to do. This will help your doctor determine if you have the hallmark symptoms of PD:

• Balance and posture problems

• Stiffness, or rigidity

• Tremor, or uncontrolled shaking

For example, your doctor will likely look for any signs of tremor as you sit with your hands relaxed in your lap. Such hand tremors normally occur in only one hand, as PD tends to impact one side of your body more than the other. In addition, your doctor will take note of your facial expressions. PD symptoms can affect your facial muscles, and people with PD often smile and blink less often than people who do not have the disease. Other signs that can be picked up during an exam include:

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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Speech And Language Pathologist

A speech and language pathologist helps people to communicate both verbally and nonverbally . In earlier stages of Parkinsons, you may see a speech and language pathologist to help with voice control.

Some are also trained to help with swallowing problems which can happen as Parkinsons progresses and can recommend exercises and different eating techniques.

General Strategies For Getting The Most Out Of Your Care Team

It’s important to be an active partner in your care. Try to resist adopting the role of a passive patient who just follows the orders of the doctors. Ask questions. But ask them in a cordial way in order to learn. Ask questions so that you can maximize the benefits of any treatment you undergo. Try also to avoid the opposite danger of asking too many questions and of taking over the role of doctor yourself. You will have to learn to accept the care of others. Let them do their job. Learn from them. Partner with them. If you can establish this kind of partnership with your care team you and your family will find it easier to cope with all the challenges that PD will throw at you over the years.

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What Are The Symptoms Of Parkinson’s Disease How Is Parkinson’s Disease Diagnosed

People with Parkinsons disease suffer from motor symptoms as well as non-motor symptoms.

Motor symptoms include intermittent tremors, slow and rigid movements. Non-motor symptoms include loss of smell, pain and even dementia.

In the initial stages of Parkinsons disease a person may experience symptoms such as:

• Slight rigidity in the arms and legs
• unable to change facial expressions according to emotions spontaneously
• Slight back pain due to which the posture of the person may be slightly stooped
• Sudden stiffness in the body at times
• Tremor on one arm on one side of the body
• The symptoms may be experienced only on one side of the body
• Handwriting may get messier and smaller

In the intermediate stage of Parkinsons disease a person may experience symptoms such as:

• Slower movements and therefore takes longer to do the daily work such as combing, dressing etc
• Loss of balance
• Sudden falls due to frequent loss of balance
• Slurring of speech
• Inability to speak loudly and clearly
• Erratic footwork, as the person is unable to start walking immediately after getting up as if the feet are stuck to the ground, or change direction quickly while walking
• Taking smaller steps than normal while walking
• Trouble swallowing food
• May require aids while walking such as a walker

In the advanced stage of Parkinsons disease the symptoms include:

Passive Manipulation Of Limbs

To test for the presence of rigidity, we need to passively manipulate the limbs of the patient. However, If the disease is in its early stage or the symptoms are well controlled with medications, we may not be able to see rigidity. We will need to use some activation maneuvers, that basically consist in performing repetitive movements with the limb contralateral to the one that is being tested.

Also, there are two types of rigidity:

– Lead-pipe rigidity: where the tone is uniformly and smoothly increased throughout the entire range of movement

– Cogwheel rigidity: where a tremor is superimposed on the hypertonia, making the movement irregular due to intermittent increase and reduction of tone

Upper Extremity Testing

For the upper extremity the most sensitive joint where to check for rigidity is the wrist. To uncover rigidity, passively rotate the wrist and feel for a resistance to the movement. It is very important that the arm of the patient is fully relaxed when rotating the wrist. To do this, place your proximal hand under the patients forearm, while your distal hand grabs and rotates the wrist of the patient. When rigidity is present, the range of motion will be preserved but you will feel a resistance in performing the movement.

Wrist rotation with activation maneuver.

It is also possible to test for rigidity in the elbow by passively flexing and extending the forearm.

Elbow flexion-extension with activation maneuver.

Lower Extremity Testing

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What Are The Causes Of Parkinson’s Disease

The causes of Parkinsons disease include:

• Genetics and family history
• Frequent exposure to pesticides such as insecticides, herbicides, and fungicides
• Lewy bodies that are abnormal clumps of proteins found in the brain stem of people with Parkinsons disease which affect brain functions
• Loss of dopamine production in the brain when cells that produce dopamine are damaged
• Advanced age

How Is Parkinson’s Disease Diagnosed

Diagnosis is difficult at every stage of the disease, but particularly in the early stages. No single test can provide a diagnosis. A diagnosis will likely involve physical and neurological examinations, conducted over time to assess changes in reflexes, coordination, muscle strength, and mental function. Your doctor might also see how you respond to medicine.

You may need to have brain imaging tests to rule out other conditions that might be causing your symptoms. Such tests could include MRI and CT scans and possibly some other types of scans. Blood tests may also be done to exclude other illnesses.

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Members Of The Healthcare Team

Who should make up your care team? At a minimum you will need:

• A primary care physician who looks after your day-to-day medical needs. This may be someone who you have seen for many years and knows you well, or you may need to find a primary care physician.
• A neurologist who specializes in movement disorders. This is most important as a neurologist in movement disorders will likely be able to help you find others who are experienced in Parkinson’s disease to fill out your healthcare team.
• A counselor or psychiatrist or psychologist who can help you manage potential emotional and mental health problems is they arise
• Allied health professionals like physical therapists, occupational therapists, sleep medicine specialists and so forth. Your neurologist should be able to help you find the allied health professionals right for you.
• Yourself – Part of being an empowered patient is playing an active role in your care.
• Your partner – Parkinson’s disease can have a tremendous impact on relationships, and including your partner or other family members can be very helpful in managing the disease.

All of these people will, of course, need to communicate with one another, but the key figure for management of your Parkinson’s symptoms will be your neurologist. So how do you find a neurologist who is right for you?

Don’t overlook your own role as a very important member of your healthcare team, as well as that of your family.

Finding Other Parkinson’s Caregivers

Your neurologist will be your main caregiver for Parkinson’s. But other doctors and therapists will also be important. For instance, you might also see a specialist in internal medicine or geriatrics , a doctor who specializes in treating elderly patients.

Other caregivers you may see include:

• Speech pathologist: This person can help you use your voice better and improve your speech. Speech pathologists also treat swallowing problems that are common with Parkinson’s.
• Physical therapist: This caregiver can help you maintain muscle strength and stay flexible. Physical therapy also can help relieve pain, improve balance, and prevent falls. You may work with this therapist at a physical therapy center and continue therapy on your own at home.
• Occupational therapist: This therapist can help you remain independent at work and at home. You may learn safer and easier ways to dress, bathe, use devices, and move around your environment.

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Preparing For The Initial Visit

• Laboratory or other test results from previous treatment for Parkinsons symptoms.
• Films or CDs of brain imaging.
• Names and contact information for all doctors you see .
• Lists of your movement and non-motor symptoms .
• List of all medications you take and the actual pills, including over-the-counter drugs and supplements .
• Your insurance or Medicare card.
• Perhaps most importantly, bring a family member or friend who can take notes and help ask and answer questions. You will receive a lot of information during this visit. Later, it may help you to talk it over with the person who went with you.

Review Your Treatment Plan

Besides these basic questions, the most important way to choose the neurologist you will work with is by listening to the treatment plan she puts together for you. Does it make sense? Does your doctor discuss it with you after considering your personal needs, goals, and symptoms? Does she mention that the treatment plan needs to be flexible and be re-evaluated over time? Does she try to integrate the plan into your everyday life and needs?

You need to use your common sense when choosing a Parkinson’s disease neurologist/specialist. You cannot doctor yourself. You need to trust at some point that this highly trained specialist knows what he or she is doing.

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How Is Parkinsonism Diagnosed

Parkinson’s UK explained: “You should be referred to a Parkinsons specialist for the diagnosis of any parkinsonism.

“They may wish to explore different things before giving you a diagnosis.”

According to the health body, your specialist will look at your medical history, ask you about your symptoms and do a medical examination.

Symptoms Of Parkinsons Disease

The 4 primary motor symptoms of Parkinsons disease are:

• Tremor of the hands, arms, legs, jaw, or face. Tremors caused by Parkinsons may be barely noticeable at first. They get worse over time. Tremors tend to get worse when the person is at rest and better when the person moves. The tremor may affect one side of the body more than the other.
• Slowed movements . Over time, a person who has Parkinsons may begin to move slowly and take a long time to perform simple tasks. This includes getting out of a chair, buttoning a shirt, or cutting food.
• Stiff muscles . Over time, muscles in the body may contract and become stiff, which makes it hard to move them. This can make it difficult for a person to do simple tasks, including feeding themselves, standing up, or walking.
• Posture and balance problems. Parkinsons disease can make it hard for a person to stand up or sit up straight. It can also cause balance problems when sitting, standing, or walking. This can lead to falls.

Other motor symptoms include:

• Feet feel like they are glued to the floor, and that it is impossible to step forward.
• Handwriting shrinkage. The slowed movements cause problems with repetitive actions. This can make handwriting get smaller over time.
• Mask-like expression. A persons face may look less expressive than normal.
• Quick movements. Some people with Parkinsons experience movements that are too quick instead of too slow.

• loss of smell
• vision or dental problems
• fatigue or loss of energy

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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.

Information Regarding Parkinson’s Disease And Its Management

MPF staff, with the advice of the Professional Advisory Board, maintains literature, articles, bibliographies, video tapes and information on web sites relating to Parkinson’s disease. Should you have any questions, please feel free and contact us. The majority of information is free of charge. There may be a fee for duplication and mailing costs for tapes and books.

If you would like the information by mail, please .

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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.

Living With Parkinsons Disease

Living with a chronic illness can be frustrating and discouraging. Parkinsons will gradually get worse. You will eventually have trouble with simple tasks. These include walking, talking, and eating, among many others. It is common for people with Parkinsons to develop depression. Antidepressant medicines are available and can help with your depression symptoms. If youve been feeling persistently sad or hopeless, call your doctor. There is help available.

Joining a support group can be particularly helpful for Parkinsons patients. It is helpful to have people around you who know exactly what youre going through. It is also a good idea to eat a healthy diet, exercise, and stay as active as you can.

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What Are The Symptoms Of Parkinson’s Disease

The main symptoms of Parkinson’s disease are:

• tremor or shaking, often when resting or tired. It usually begins in one arm or hand
• muscle rigidity or stiffness, which can limit movement and may be painful
• slowing of movement, which may lead to periods of freezing and small shuffling steps
• stooped posture and balance problems

The symptoms of Parkinson’s disease vary from person to person as well as over time. Some people also experience:

• loss of unconscious movements, such as blinking and smiling
• difficulties with handwriting
• drop in blood pressure leading to dizziness
• difficulty swallowing
• sweating

Many of the symptoms of Parkinson’s disease could be caused by other conditions. For example, stooped posture could be caused by osteoporosis. But if you are worried by your symptoms, it is a good idea to see your doctor.

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.

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