Evaluation Of Parkinson’s Disease
- Medicine, Psychology
- Advances in biochemical psychopharmacology
- Journal of neurology, neurosurgery, and psychiatry
- Journal of the Neurological Sciences
- View 1 excerpt, cites background
- Movement disorders : official journal of the Movement Disorder Society
- Medicine, Psychology
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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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Evaluation Of Balance Disorders In Parkinson’s Disease Using Simple Diagnostic Testsnot So Simple To Choose
- Department of Neurology of the Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
Background: Balance disorders are one of the main symptoms in parkinson’s Disease patients have a tendency to fall, related traumas and also a significant restriction of mobility. Numerous tools may be used to evaluate the balance, but it is difficult to choose the proper one. The aim of this review was to compare simple diagnostic tools for PD and emphasize those characterized by a high reliability and sensitivity.
Methods: The global literature search was conducted in PubMED, Scopus, Science Direct, Web of Science, Cochrane, and Google Scholar for publications in English and Polish.
Results: According to the literature some scales and functional tests in which clinimetric properties had been assessed in PD population were selected and described.
Basing on current knowledge, psychometric properties, and clinical experience, the authors suggest the BESTest with its shortened versions and the Fullerton Advanced Balance Scale to be used for comprehensive balance assessment of parkinson’s disease patients. These tests are easy in administration, not time-consuming and provide a professional diagnosis allowing to plan individual therapy for the patient being examined.
What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
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Fullerton Advanced Balance Scale
Both static and dynamic balance under varying sensory conditions are tested with the FAB Scale. The scale was designed to measure balance in higher-functioning active elderly adults. The FAB consists of 10 items that require static and dynamic postural control. The range of total score is 0 to 40 points . Administration instructions may be found in the original paper .
The majority of clinimetric properties were assessed in PD patients only once, in mild to moderate disease. The FAB has an excellent test-retest reliability in PD , the ceiling effect was not reported . There are few studies where the FAB was used to assess postural control in PD, although it was mostly implemented in the same laboratory .
The advantages are as follows: the FAB scale is simple to administer, not time-consuming and allows to assess patients under daily activity conditions to identify the efficiency of all postural control aspects. However, there is contradicting information about the sensitivity and specificity to discriminate between fallers and non-fallers in PD which may be considered a limitation of the scale. The FAB is not recommended by The Movement Disorders Society Rating Scales Committee , due to the lack in the clinimetric evidence in PD.
Quantitative Motor Assessment Using The Webcam
The single features extracted by the classifiers showed differences between the most affected side and less affected side in the patients with PD and between the dominant side and non-dominant side according to handedness in HSs . There were statistically significant differences for the unilateral finger tapping speed, hand movement speed, and pronation-supination movement amplitude . For the bilateral task, there were statistically significant differences for the finger tapping amplitude, finger tapping speed, and hand movement speed .
Table 2. Video-extracted motor features in the unilateral and bilateral tasks of the MDS-UPDRS-III bradykinesia upper limb motor tasks.
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Blood Test May Help Differentiate Parkinsons From Similar Diseases
The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
Clinical Parameters And Tools For Home
Article type: Research Article
Authors: Ferreira, Joaquim J.a b * | Santos, Ana T.a | Domingos, Josefaa | Matthews, Helenc | Isaacs, Tomc | Duffen, Joyc | Al-Jawad, Ahmedd | Larsen, Franke | Serrano, J. Arture f | Weber, Peterg | Thoms, Andreag | Sollinger, Stefanh | Graessner, Holmi | Maetzler, Walterj
Affiliations: Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal | Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Portugal | The Cure Parkinsons Trust, London, UK | HSG-IMIT, Villingen-Schwenningen, Germany | NST-Norwegian Centre for Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway | Department of Clinical Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway | Hasomed GmbH, Magdeburg, Germany | AbilityNet, London, UK | Institute for Medical Genetics and Applied Genomics, University of Tübingen, Germany | Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany
Correspondence: Correspondence to: Joaquim Ferreira, Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz 1649-028 Lisboa,Portugal. Tel.: +351 217802120 Fax: +351 217802129 E-mail:
Keywords: Outcomes assessment, delphi technique, patient-centered outcomes research, Parkinsons disease
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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.
Testing For Parkinsons Disease
There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.
A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.
The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.
The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.
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What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
- Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
- Pain, lack of interest , fatigue, change in weight, vision changes.
- Low blood pressure.
What Is Parkinsons Disease
Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.
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Objective And Quantitative Assessment Of Motor Function In Parkinsons Diseasefrom The Perspective Of Practical Applications
Ke Yang, Wei-Xi Xiong, Feng-Tao Liu, Yi-Min Sun, Susan Luo, Zheng-Tong Ding, Jian-Jun Wu, Jian Wang
Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
Contributions: Conception and design: J Wang Administrative support: None Provision of study materials or patients: None Collection and assembly of data: None Data analysis and interpretation: None Manuscript writing: All authors Revision and Final approval of manuscript: All authors.
Abstract: Parkinsons disease is a common neurodegenerative disorder with high morbidity because of the coming aged society. Currently, disease management and the development of new treatment strategies mainly depend on the clinical information derived from rating scales and patients diaries, which have various limitations with regard to validity, inter-rater variability and continuous monitoring. Recently the prevalence of mobile medical equipment has made it possible to develop an objective, accurate, remote monitoring system for motor function assessment, playing an important role in disease diagnosis, home-monitoring, and severity evaluation. This review discusses the recent development in sensor technology, which may be a promising replacement of the current rating scales in the assessment of motor function of PD.
Keywords: Parkinsons disease motor function objective measurement wearable sensors
Submitted Feb 11, 2016. Accepted for publication Feb 26, 2016.
Continuous Monitoring In Daily Activities
Monitoring motor function of PD patients during real life activities could provide physicians with an assessment of specific motor symptoms, predict fall risk, evaluate medication compliance and provide information for early diagnosis.
Unlike guided and standardized motor tasks, motor assessment in unsupervised environment allows subjects to moving in daily activities, which means that two subjects can walk with different motion parameters not because of disease itself but due to individual differences . A fully charged measuring device such as portable gait rhythmogram could achieve 40 consecutive hours of recording . With this PGR attached to the limbs, different motor fluctuations were observed according to the alterations in gait rhythm: if a subject was noted with a shift to a faster gait cycle, he/she may suffer from short-step walking, festination or freezing of gait on the other hand, if a subject was found to exhibited a shift to a slower gait cycle, there was high possibility that he/she had bradykinesia or instability . On the other hand, some researchers thought that parameters regarding the gait performance were not representative enough and the utilization of alternative measures like entropy or the measure of the arm swing might be a better choice . In presenting variation in ON and OFF states, arm swing and entropy showed better performance compared to step frequency, stride length and speed .
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Conflict Of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer Dr Ines Moreno-Gonzalez and handling Editor declared their shared affiliation, and the handling Editor states that the process nevertheless met the standards of a fair and objective review.
Is Parkinsons Disease Inherited
Scientists have discovered gene mutations that are associated with Parkinsons disease.
There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.
Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.
Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.
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Balance Evaluation Systems Test
The BESTest is a 36-item clinical balance assessment tool, designed to assess balance disorders. The evaluation process consists of six subscales/sections, each assessing a different aspect of postural control: mechanical constraints, limits of stability, anticipatory postural adjustments, postural response to induced loss of balance, sensory orientation, and gait . Each item is scored by the examiner from 0 to 3 . The sum of all scores is the total result. However, each category gives its own result, which makes it very helpful in balance assessment to find out which mechanisms of postural control are impaired. The authors provide paper and video instruction, which greatly facilitates correct administration of the BESTest. According to the authors of the test a complete assessment should last about 30 min. However, in clinical practice the evaluation of patients with PD using the BESTest may even exceed 40 min.
There are two shorter versions of the BESTestthe Mini-BESTest and the Brief-BESTestless time-consuming assessment tools, which may have a higher clinical utility. The Brief version has 1 item from each category of the BESTest .
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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What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .