What Are The Five Stages Of Parkinsons Disease
Neurologists use a number of scales and criteria to describe stages of PD. In my experience whilst these have clear utility in the context of observational research studies as well as prospective trials of treatment, on an individual basis they are not especially useful in day to day clinical practice. The key is to understand what the main symptoms affecting a persons quality of life are and to adjust treatment to try to improve those symptoms.If you are worried that either you or your loved one is showing early signs of Parkinsons disease, do not hesitate to book an appointment with Dr Paviour now for an assessment.
Characteristics Of Atypical Msa: Parkinsons Disease Mimics
A 67-year-old female : presented with a 1-year history of worsening dexterity of her left hand. Examination revealed an asymmetrical tremor of the hand at rest with cogwheel rigidity and bradykinesia. Her symptoms and signs improved with levodopa therapy . Over the next 3 years, she developed motor fluctuations, generalized peak-dose dyskinesia, worsening dysarthria, urinary frequency and constipation. She also reported intermittent mild non-threatening visual hallucinations. Orofacial dystonia and urinary incontinence then became more intrusive. She died aged 75. The final clinical diagnosis was Parkinsons disease. Autopsy confirmed the pathological diagnosis of MSA . There were frequent depositions of neuritic plaques but no neurofibrillary tangles were found in the brain. Key clinical features of all Parkinsons disease mimics are provided in Supplementary Table 2.
Atypical MSA versus typical MSA or Parkinsons disease
Red flag features in atypical MSA versus typical MSA or Parkinsons disease
|Pathological diagnosis .|
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 But thats now considered outdated.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.
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Parkinson Disease & Mimics
Parkinson disease is a complex progressive neurological disease involving the loss of neurons in a part of the brain called the substantia nigra. This results in a reduction in the amount of dopamine, a chemical messenger or neurotransmitter. When this important chemical in the brain is depleted, the symptoms of Parkinsons disease develop.
There are two types of symptoms: motor and non-motor . Common motor symptoms include: essential tremor, slowness of movement, stiffness and impairment of balance later.
Non-motor symptoms vary from person-to-person and more so than the motor symptoms. They can include, low-blood pressure, constipation, speech difficulties , depression, Fatigue, Sleep problems, osteoporosis etc
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.
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.
What Are The Early Warning Signs Of Parkinsons Disease
Parkinsons disease typically causes a one-sided tremor, most obvious when at rest rather than engaged in an active task. The slowness of movement and muscle stiffness are also typical. The symptoms are often initially quite subtle and emerge slowly over a period of months. It is not unusual in my experience for someone with early-stage PD to have seen a rheumatology specialist for something like a frozen shoulder that is actually related to the muscle stiffness caused by PD.The typical clinical signs of PD that a neurologist will look for are slowness of repetitive movements , difficulty in initiation of movement , and a progressive reduction in the speed and amplitude of sequential movements , with muscular rigidity and a slow pill-rolling resting tremor.An early sign can be a reduced arm swing on walking, reduced facial expressiveness, a quietening of the voice and smaller handwriting. So-called non-motor signs can precede the problems with movement by months or even years and include depression, anxiety, constipation and a particular sleep disorder called REM sleep behaviour disorder, whereby an individual may act out dreams or start talking in their sleep.
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B History Part : Prevalence:
Mean age of diagnosis for idiopathic Parkinsons disease is late 50s. There is no racial or ethnic predisposition, but men are affected more frequently than women. Multiple meta-analyses have shown that age and a family history of Parkinsons disease are associated with an increased risk for development of Parkinsons. Interestingly, cigarette smoking has been associated with decreased risk.
Quarter Of Parkinson’s Sufferers Were Wrongly Diagnosed Says Charity
Poll of more than 2,000 people found 26% of respondents were told they had something else
More than a quarter of people with Parkinsons disease were initially misdiagnosed, new research has found.
The poll of more than 2,000 people found 26% were first told they had something else, while 21% saw their GP three or more times before being referred to a specialist.
Of those who were misdiagnosed, 48% were given treatment for their nonexistent condition, with 36% receiving medication, 6% undergoing operations or procedures and a further 6% given both medication and operations or procedures.
Of those who received unnecessary treatment, 34% said their health had got worse as a result.
The poll, for the charity Parkinsons UK, also found that women were more likely to be misdiagnosed than men, and errors were most common in people aged 51 to 60.
Katie Goates of Parkinsons UK said: Parkinsons is an incredibly complex condition with more than 40 symptoms, and it affects everyone differently.
One of the biggest challenges for Parkinsons research is that there is no definitive test for Parkinsons, and as a result weve heard of people being misdiagnosed with anything from a frozen shoulder or anxiety to a stroke.
Our survey has shown that because of this, people are being left in limbo and seeing their health deteriorate, which is unacceptable.
About 145,000 people in the UK are diagnosed with Parkinsons every year.
Signs of Parkinsons can include:
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Conditions That Mimic Shuffling Gait Seen In Parkinsons:
Please read the article on shuffling gait. It describes 5 causes of shuffling of gait.
The most crucial mimic to remember is Normal Pressure Hydrocephalus .
The person with NPH feels like he is stuck to the ground. This is a magnetic gait. It is easy to mistake this for Parkinsons disease.
For example, see this video posted by the Hydrocephalus Association of America on youtube:
NPH can be treated by implanting a small shunt pipe. This shunt drains excess water around the brain into the abdomen.
Parkinsonism Accompanying Other Conditions
Parkinsonian symptoms may also appear in patients with other, clearly distinct neurological disorders such as Wilson’s disease, Huntington’s disease, Alzheimer’s disease, spinocerebellar ataxias, and Creutzfeldt-Jakob disease. Each of these disorders has specific features that help to distinguish them from PD.
MSA, corticobasal degeneration, and progressive supranuclear palsy are sometimes referred to as “Parkinson’s-plus” diseases because they have the symptoms of PD plus additional features.
Source: The National Institute of Neurological Disorders and Stroke ,
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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.
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.
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What Health Conditions Mimic The Symptoms Of Parkinson’s Disease
Parkinsonism is a medical term that refers to the symptoms experienced by people with the disease, which include slowness of movements, stiffness of the joints, as well as tremor and imbalance. However, there are a series of conditions whose symptoms are very similar to those of Parkinson’s disease, which is why so many people are misdiagnosed.
Being aware of these health conditions is essential if you have a history of exposure to paraquat, as it may facilitate the assignment of a correct diagnosis. The following are some of the conditions that mimic the symptoms of Parkinson’s disease:
If you have a history of exposure to paraquat and were diagnosed with one of the above conditions, we strongly advise you to seek a second opinion from a specialist, as you may be in fact struggling with Parkinson’s disease, which qualifies you for compensation.
It is essential to receive a correct and precise diagnosis, as it will not only help you obtain the money you deserve from the liable companies but will also improve your quality of life.
For over 35 years, the team of experts at Atraxia Law has been helping people recover the compensation they were eligible for by evaluating their personal injury or product liability claims and are ready to provide you with quality assistance as well if your health was affected by exposure to paraquat.
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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I What Every Physician Needs To Know
Idiopathic Parkinsons disease is a progressive neurologic disorder characterized by motor dysfunction including rest tremor, bradykinesia, postural instability and rigidity of movement. Symptoms can progress to include speech and swallowing problems, and in some cases, dementia or psychosis.
While the exact mechanism remains unknown, there is clear nerve cell loss in the dopamine-producing substantia nigra, leading to diminished dopamine in the basal ganglia. Pathology shows intracytoplasmic inclusions in the neurons, known as Lewy bodies, which are a hallmark finding of Parkinsons disease. Idiopathic Parkinsons disease is a clinical diagnosis of exclusion.
Parkinsonism is the cluster of traits seen in Parkinsons disease, but with an alternate etiology . Identifying the drug induced variant is important, as symptoms can improve once the offending agent is discontinued. Other forms of parkinsonism often have a more rapid, aggressive course, and are less responsive to dopamine replacement medications.
Parkinson’s Disease Is Often Misdiagnosed In People With Paraquat Exposure
by Legal Staff
Because the symptoms of Parkinson’s disease are very similar to those of other health problems, it is often misdiagnosed in people with a history of exposure to paraquat, which prevents victims of toxic exposure from recovering the financial compensation they deserve. According to medical studies, Parkinson’s disease is misdiagnosed in up to 30% of cases and the rate of misdiagnosis is even higher in people whose disease is in the early stages. 1 in 4 people with Parkinson’s disease will receive a wrong diagnosis
Therefore, seeking a second and even a third opinion is essential in being assigned a correct and accurate diagnosis. It is a known fact that frequent exposure to paraquat in agricultural workers increases the risk of developing Parkinson’s disease by 250%.
Thereby, if you have a history of paraquat exposure, it is crucial to keep a close eye on your health for the symptoms of Parkinson’s disease.
A poll from the American Journal of Managed Care found that over 26% of people with Parkinson’s disease were initially misdiagnosed and 21% had to see their general healthcare provider 3 times before being referred to a specialist to have their health problem correctly diagnosed.
What is more alarming is that 48% of the participants received treatment for the wrong health condition, with 36% being prescribed medication and 6% undergoing surgical procedures. Consequently, a significant decline in the quality of life was noted in the misdiagnosed patients.
Is A Dat Scan Or F
No! Not at all!
First, the diagnosis of Parkinsons disease is obvious in most patients.
The proof of the pudding is in the eating. If you improve significantly with levodopa you have parkinsonism.
If this improvement is consistent for many years you probably have Parkinsons disease.
Second, while these scans are useful in differentiating some diseases like Essential tremor from Parkinsons disease, they are not very useful in identifying mimics .
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 .
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What Are Atypical Parkinsonian Disorders
Atypical Parkinsonian disorders are progressive diseases that present with some of the signs and symptoms of Parkinsons disease, but that generally do not respond well to drug treatment with levodopa. They are associated with abnormal protein buildup within brain cells.
The term refers to several conditions, each affecting particular parts of the brain and showing a characteristic course:
- Dementia with Lewy bodies, characterized by an abnormal accumulation of alpha-synuclein protein in brain cells
- Progressive supranuclear palsy, involving tau protein buildup affecting the frontal lobes, brainstem, cerebellum and substantia nigra
- Multiple system atrophy, another synucleinopathy that affects the autonomic nervous system , substantia nigra and at times the cerebellum
- Corticobasal syndrome, a rare tauopathy that typically affects one side of the body more than the other and makes it difficult for patients to see and navigate through space