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.
Effective Care And Advancing Research
Parkinsons disease is a progressive, degenerative disorder of the nervous system that causes people to gradually lose control over movement and other functions. The cause of PD is unknown, and currently there is no cure.
The physicians in UT Southwesterns Movement Disorders Clinic have advanced training and significant experience in managing PD. Our team collaborates with specialists across the medical center to help patients continue living their fullest possible lives, through a combination of treatment and rehabilitation.
UT Southwestern offers coordinated care for patients with Parkinsons, providing the full range of services and support needed to diagnose this illness and manage its symptoms and complications.
Living With Parkinsons Disease
Without being proactive in seeking medical attention and treatment, later stages of Parkinsons disease can be a living nightmare full of uncertainty, confusion, and hallucinations.
In this article, you discovered the definition of Parkinsons disease, the symptoms that accompany it, how a diagnosis is made, its 5 stages, and its treatment options.
Dont allow minor symptoms to develop into major health issues. Ignoring little aches and pains and self-diagnosing could lead to life-long regrets. When there are signs of trouble, seek help from your primary care physician.
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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.
What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
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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.
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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What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Is It Normal To Feel Depressed
Yes! Researchers have found that 40 to 50 percent of people with Parkinsons are depressed. Other brain and mood symptoms include anxiety, sleep disturbances, and behavior changes. Getting a difficult diagnosis can make people feel sad or worried, but this kind of depression is more prolonged and more serious.
Researchers believe that the underlying changes in the brain that cause PD might also cause depression. In fact, some people think that depression might be an early sign of Parkinsons. Medication, mental health counseling, and support groups can all effectively treat this kind of depression, so be sure to tell your doctor how you feel.
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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
Physical And Neurological Examination
Your doctor will conduct a physical and neurological examination. This can involve observing your behavior, movements, and mental state and conducting tests or asking you to perform certain exercises.
These are some of the symptoms of Parkinsons your doctor can determine visually:
- Fewer spontaneous movements or hand gestures
- Reduced frequency of blinking
- Tremors in your hands while they are at rest, often only in one hand
- Hunched posture or forward lean while walking
- Stiff movements
These are some of the exercises your doctor may ask you to do to evaluate your movements, balance, and coordination:
- Opening and closing your fist
- Tapping your fingers, toes, and heels
- Holding your arms out in front of you
- Moving your finger from one point to another
- Rotating your wrists or ankles
- Standing from a chair
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What Is Parkinsons Disease
Parkinsons disease is a chronic neurological condition. It is progressive and symptoms worsen over time. It is named after Dr James Parkinson who first described the condition in 1817.
People with Parkinsons disease experience a loss of nerve cells in the part of their brains responsible for controlling voluntary movements. This part of the brain is called the substantia nigra . The nerve cells in the substantia nigra usually produce a chemical called dopamine which helps transmit messages from the brain to the rest of the body via the central nervous system . As these cells are lost, people with Parkinsons disease experience a loss of dopamine and the messages controlling movement stop being transmitted efficiently.
Parkinsons disease is more common as people get older but it can affect younger adults. Men tend to be affected in slightly higher numbers than women.
What Treatments Are Available To Me
There is no cure for Parkinsons disease, but there are many treatments that can help improve your symptoms and delay the progress of the disease. The combination of medication and other treatments that work best for you depend on your specific symptoms as well as your total health history.
Available treatments include:
- Prescription medications: Prescription medications often include levodopa, MAO inhibitors, and/or anticholinergics. Levodopa is often the first-line treatment for people with PD. It increases the neurotransmitter dopamine in the brain. MAO inhibitors affect how fast dopamine is cleared from the brain. Anticholinergics affect a different neurotransmitter in the brain and can sometimes help reduce PD tremors.
- Surgical treatment, including deep brain stimulation: Surgery is generally reserved for people who are in the later stages of the disease or who dont improve with medication, therapy, and other lifestyle changes.
- Over-the-counter medications and supplements: There is a lot of ongoing research about how effective alternative medicines and supplements can be in reducing PD symptoms. Some supplements might be able to help, but some can actually cause harm, including vitamin E supplements, although dietary vitamin E is good for your body. Be sure to inform your doctors about any supplements you are taking, since they can often interfere with prescription medications.
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Tests To Rule Out Other Conditions
Blood tests can help rule out other possible causes of the symptoms, such as abnormal thyroid hormone levels or liver damage.
Hydrocephalus due to atrophy can occur with some types of dementia and would be visible with one of these imaging tests. If the person has neurologic symptoms but a normal scan result, Parkinsons disease may be present.
The doctor a lumbar puncture to rule out inflammation or a brain infection.
What Are Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease are typically slow to manifest themselves and may go unnoticed or disregarded until multiple symptoms appear or frequent mishaps begin to occur.
Some of the more common symptoms are:
Involuntary Tremors these tremors may occur while at rest, in the hands, arms, legs, or even through the back affecting posture.
Muscular Affliction The onset of Parkinsons may cause minor to severe:
Dribbling or Leaking Urine Unintentional Weight Loss
While many of the symptoms above may appear from other afflictions or illnesses, any one or a combination of them should be checked out by your primary care physician.
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
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.
Diagnosis Of Parkinsons Disease
The movement disorder specialists at Mount Sinai are expert in diagnosing and treating Parkinsons disease. There is no one test that diagnoses Parkinsons disease. Instead, we conduct a comprehensive history of symptoms and a detailed neurologic examination. After we confirm the diagnosis, we develop a comprehensive treatment plan, personalized to your needs.
Our neurosychologists and neuropsychiatrists evaluate patients who are being considered for certain medications or treatments , provide support and counseling, and oversee treatments and strategies for dealing with mood, memory, or other challenges.
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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
Besides Medication How Else Can I Manage The Disease
There are multiple lifestyle choices and home remedies that you can incorporate to help improve your PD symptoms.4,5
- Exercise: Exercise can benefit people at every stage of PD to enhance or maintain balance, endurance, flexibility, and strength. Studies show exercise can improve your symptoms no matter what you exercise you do.
- Alternative medicine: Tai Chi, massage, meditation, yoga, Alexander technique, and pet therapy can all help with balance, flexibility, and emotional stability that can sometimes be challenging for people with PD.
- Nutrition: Maintaining a healthy diet is important, and adding plenty of liquid, fiber, fresh fruits, and vegetables, and healthy fats to your diet can help constipation that can affect people with PD and improve your overall health.
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Stages Of Parkinsons Disease
There are 5 different stages of Parkinsons disease, beginning with the mildest and running up to the most severe. While there are similarities in each stage, it is the severity of the symptoms that differentiate one stage from another.
Stage 1 This stage may include mild tremors along one side of the body, and slight changes in facial expressions, posture, and walking. At this stage, symptoms typically wont interfere with daily activities and are usually only noticeable by people around them.
Stage 2 In this stage, tremors may affect both sides of the body, commonly accompanied by rigidity. Everyday activities can still be accomplished but are harder to accomplish. Also in this stage, difficulty with posture and walking are now obvious.
Stage 3 This stage sees a significant loss of motor control, as sense of balance is disrupted and falls become more frequent. While many can still live independently, basic activities like eating, dressing, and bathing become increasingly difficult as body movements can become very slow.
Stage 4 In this later stage of the disease, standing is still possible without assistance, but bodily movement is now significantly impaired as the symptoms have become limiting. Patients in stage 4 Parkinsons disease require assistance with everyday activities and are no longer able to live independently.
The symptoms of Parkinsons disease can also be referred to as mild , medium , and severe .
Living With Parkinson’s Disease
Coming to terms with a diagnosis of Parkinson’s and living with the disease is challenging and will take a lot of adjustment. There are still things you can do that can help you to feel more in control of your situation and to stay positive. Some things that might help could include:
- choosing to lead a healthy lifestyle
- making informed decisions related to your treatment
- keeping a diary of your symptoms in preparation for meetings with health and social care professionals
- attending a self-management course
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Symptoms Of Parkinsons Disease
The type, number, severity and progression of Parkinsons disease symptoms vary greatly. Every person is affected differently they may not get every symptom.
Some of the more common symptoms are:
- resting tremor
- blood pressure fluctuation
People living with Parkinsons for some time may experience hallucinations , paranoia and delusions . These symptoms are able to be treated so have a talk with your doctor.