What Other Diseases Mimic Parkinson’s

Poll Finds 1 In 4 People With Parkinson Disease Misdiagnosed

In a poll of people with Parkinson disease, more than 1 in 4 participants reported having been misdiagnosed, with a further 21% having to see their general provider 3 times before being referred to a specialist.

In a poll of people with Parkinson disease , more than 1 in 4 participants reported having been misdiagnosed, with a further 21% having to see their general provider 3 times before being referred to a specialist, according to a report published by The Guardian.

The poll, for the charity Parkinsons UK, included more than 2000 patients with PD . Results showed that among participants who were misdiagnosed, 48% were given treatment for their nonexistent condition, with 36% receiving medication, 6% undergoing operations or procedures, and 6% given both medication and operations/procedures. A decline in health was reported in 34% of those misdiagnosed, and women were shown to be more likely to be misdiagnosed than men.

Katie Goates, MSc, BSc, professional communications and engagement program manager at Parkinson’s UK, highlighted the difficulty in diagnosing PD, which is a complex condition of more than 40 symptoms, as one of the chief reasons behind the polls findings. 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, said Goates.

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.

Parkinson’s Disease and Movement Disorders Center

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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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.

Other Illnesses Mimic Parkinson’s

DEAR DR. DONOHUE: My brother-in-law and a close neighbor are both in their mid-70s. Both shuffle their feet when they walk and have a slight shaking of their arms and other symptoms regarded as Parkinson’s disease.

A short time ago, there was a segment on TV about these same symptoms, with an elderly man crossing the stage, stooped over, shaking and shuffling his feet. The announcer said he did not have Parkinson’s disease. The sickness was three initials. Everyone remembers the program, but no one remembers what those three initials are. Can you help me?

S.D.

ANSWER: The three major Parkinson’s signs are bradykinesia a Greek word whose literal translation is “slow movement” resting tremor and muscle rigidity. People with bradykinesia take a long time to start any movement and a long time to execute the movement. For instance, they take forever to get out of a chair, and they chew slowly. When they walk, they take short steps and barely swing their arms. The Parkinson’s disease tremor is a resting tremor. That means it comes on when the hands are idle, resting in the lap. Muscle rigidity is resistance to bending an arm when another person tries to bend it.

As the illness progresses, Parkinson’s patients often walk stooped over, with both knees bent, and take baby steps on their toes. Their gait may speed up uncontrollably as they walk. They’re prone to falling.

K.H.

K.H.

ANSWER: It’s not brazen to ask two questions, but I split them up as separate entries.

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What Can Mimic Als

There are a number of diseases which can initially be mistaken for ALS, with multiple sclerosis and Parkinsons among the most well-known. Symptoms exhibited by Patients will vary, especially in the early stages of a disease that affects the nerves and this often leads to misdiagnosis for conditions that have similar presentations.

Here we take a look at the diseases which are commonly mistaken for ALS and how they compare, particularly in the initial stages.

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.

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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.

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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What Is Parkinson’s Disease

Parkinson’s disease is the second most common neurodegenerative disorder and the most common movement disorder. Characteristics of Parkinsons disease are progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance. As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks.

The progression of Parkinson’s disease and the degree of impairment vary from person to person. Many people with Parkinson’s disease live long productive lives, whereas others become disabled much more quickly. Complications of Parkinsons such as falling-related injuries or pneumonia. However, studies of patent populations with and without Parkinsons Disease suggest the life expectancy for people with the disease is about the same as the general population.

Most people who develop Parkinson’s disease are 60 years of age or older. Since overall life expectancy is rising, the number of individuals with Parkinson’s disease will increase in the future. Adult-onset Parkinson’s disease is most common, but early-onset Parkinson’s disease , and juvenile-onset Parkinson’s disease can occur.

How Do Treatments Differ

MS treatments can ease your symptoms during an attack or slow down the diseaseâs effects on your body.

Steroids like prednisone calm the inflammation that damages your nerves.

Plasma exchange is another therapy if steroids donât work. Your doctor will use a machine to remove the plasma portion of your blood. The plasma gets mixed with a protein solution and put back into your body.

Some people with both diseases who take anti-inflammatory medicines like steroids see their Parkinsonâs symptoms get better.

Disease-modifying treatments slow down MS nerve damage and disability. They include:

National Institute for Neurological Disorders and Stroke: âTremor Fact Sheet.â

Neurology: âParkinsonâs Disease in Multiple Sclerosis – A Population-Based, Nationwide Study in Denmark .â

Mayo Clinic: âMultiple Sclerosis: Overview,â âMultiple Sclerosis: Symptoms and Causes,â âMultiple Sclerosis: Treatment,â âParkinsonâs Disease: Causes,â âParkinsonâs Disease: Definition,â âParkinsonâs Disease: Risk Factors,â âParkinsonâs Disease: Symptoms.â

Christopher Reeve Foundation: âHow the spinal cord works.â

National Association for Continence: âParkinsonâs Disease.â

National Multiple Sclerosis Society: âMS Symptoms,â âWho Gets MS? .â

National Parkinson Foundation: âNon-Motor Symptoms.â

Multiple Sclerosis Trust: âLhermitteâs sign.â

Johns Hopkins Medicine: âPlasmapheresis.â

FDA.

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How Are They Alike

MS and Parkinsonâs both affect your central nervous system, which includes your brain and spinal cord. Thatâs why they both can affect how you move, sleep, feel, and talk.

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.

Whats The Difference Between Dementia With Lewy Bodies And Parkinsons

In dementia with Lewy bodies, dementia always appears first. There can also be changes in alertness as well as visual hallucinations. However, because of the presence of Lewy bodies throughout the entire brain, characteristics of this disease not only include cognitive characteristics, but also physical, sleep, and behavioral changes. As the disease progresses, the motor symptoms common to Parkinsons such as tremor, slowness, stiffness, and walking and balance problems will appear.

For more information on dementia with Lewy bodies, visit www.lbda.org.

Read Also: Katharine Hepburn Parkinsons

What Are The Current Treatment Options

While there is no specific cure for Parkinsons plus syndrome, there are treatments that can control your symptoms. A doctor can develop a plan for your overall health and to treat your specific symptoms. Medications that treat the symptoms of Parkinsons disease often do not work as well for Parkinsons plus syndrome.

Treatment options might include:

• Walking and balance assistance. You might receive physical and occupational therapy to help keep you moving. Therapists can help you build strength and prevent falls. They can also help you learn to use canes, walkers, and other mobility aids, if needed.
• Swallowing and speech assistance. A speech therapist can help you adjust to changes that might make it hard to swallow and speak. They can help you communicate and can recommend foods and beverages that are easier to swallow.
• Medications for cognitive issues. Your doctor might prescribe a variety of medications that can help with your focus and memory. Many of these medications are also used for conditions such as Alzheimers or dementia.
• Medications for trouble with movement. You might be prescribed medications that can help you control your muscles and movement. These medications might also address stiffness and balance problems.
• Medications to help with mood symptoms. If youre experiencing depression, anxiety, or other mood-related concerns, your doctor might prescribe medications that can help with these symptoms.

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.

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What Makes Them Different

MS and Parkinsonâs have different causes. They usually start to affect you at different ages, too.

MS often affects people between ages 20 and 50, but children get it, too. Parkinsonâs usually starts at age 60 or older, but some younger adults get it.

MS is an autoimmune disease. That means your bodyâs immune system goes haywire for some reason. It attacks and destroys myelin. As myelin breaks down, your nerves and nerve fibers get frayed.

In Parkinsonâs, certain brain cells start to die off. Your brain makes less and less of a chemical called dopamine that helps control your movement. As your levels dip, you lose more of this control.

Some genes may put you at risk for Parkinsonâs, especially as you age. Thereâs a small chance that people who are exposed to toxic chemicals like pesticides or weed killers can get it, too.

These symptoms are more common if you have MS. They not usually found in Parkinsonâs:

• Dizziness or vertigo, where you feel like the room spins around and you lose your balance

Whats The Outlook For People With Parkinsons Plus

Although there currently isnt a treatment to halt the progression of Parkinsons plus syndrome, there are treatments that can help you manage your symptoms and improve your quality of life.

The exact outlook for Parkinsons plus syndrome depends on the person and the specific condition they have. Someone who is otherwise healthy when theyre diagnosed will typically have a longer life expectancy than someone who is already facing other health conditions when theyre diagnosed. Your doctor will monitor your condition over time and can let you know how its progressing.

Recommended Reading: What Is The Life Expectancy Of Someone With Parkinson’s Disease

What Are The Primary Motor Symptoms Of Parkinsons Disease

There are four primary motor symptoms of Parkinsons disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinsons.

It is important to know that not all of these symptoms must be present for a diagnosis of Parkinsons disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinsons disease has a tremor, nor is a tremor proof of Parkinsons. If you suspect Parkinsons, see a neurologist or movement disorders specialist.

Tremors

Rigidity

Bradykinesia

Postural Instability

Walking or Gait Difficulties

Dystonia

Vocal Symptoms