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How Do They Check For Parkinson’s Disease

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How does a physician arrive at a Parkinson’s disease diagnosis?

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What Is Parkinsons Disease

Parkinsons disease is a progressive neurological disorder. The first signs are problems with movement.

Smooth and coordinated bodily muscle movements are made possible by dopamine, a substance in the brain. Dopamine is produced in a part of the brain called the substantia nigra.

In Parkinsons, the cells of the substantia nigra start to die. When this happens, dopamine levels are reduced. When they have dropped 60 to 80 percent, symptoms of Parkinsons start to appear.

Some of the early symptoms of Parkinsons can begin several years before motor problems develop. These earliest signs include:

  • problems with attention and memory
  • difficulty with visual-spatial relationships

Early signs of Parkinsons disease may go unrecognized. Your body may try to alert you to the movement disorder many years before movement difficulties begin with these warning signs.

The exact cause of Parkinsons is unknown. It may have both genetic and environmental components. Some scientists believe that viruses can trigger Parkinsons as well.

Low levels of dopamine and norepinephrine, a substance that regulates dopamine, have been linked with Parkinsons.

Abnormal proteins called Lewy bodies have also been found in the brains of people with Parkinsons. Scientists do not know what role, if any, Lewy bodies play in the development of Parkinsons.

While theres no known cause, research has identified groups of people who are more likely to develop the condition, which include:

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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Symptoms Of Parkinson’s Disease

The symptoms and rate of progression of Parkinsons are different among individuals. Effects of normal aging are sometimes confused for Parkinsons. It is difficult to accurately diagnose this disease because there is not a test that can accurately do it.

There are physical and non-physical symptoms that could indicate someone has Parkinsons disease:

Physical symptoms

Early stage symptoms

Parkinson’s disease occurs gradually. At first, the symptoms might not even be noticeable. Early symptoms can include feeling mild tremors or having difficulty getting out of bed or a chair. The person might start to notice that they are speaking softer than usual, or that their handwriting looks different.

Usually, it is friends or family members who are the first to notice changes in someone with early Parkinson’s. For example, they may notice that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.

Further Testing In Parkinson’s

How does Parkinsons Disease affect function? Or, why can ...

In other situations, where perhaps the diagnosis is not as clear, younger individuals are affected, or there are atypical symptoms such as tremor affecting both hands or perhaps no tremor at all, further testing may help. For example, imaging can play a role in differentiating between essential tremor and Parkinsons. It can also be important to confirm what is initially a clinical diagnosis of Parkinsons prior to an invasive treatment procedure such as surgical DBS

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How To Test For Parkinson’s Disease

This article was medically reviewed by Erik Kramer, DO, MPH. Dr. Erik Kramer is a Primary Care Physician at the University of Colorado, specializing in internal medicine, diabetes, and weight management. He received his Doctorate in Osteopathic Medicine from the Touro University Nevada College of Osteopathic Medicine in 2012. Dr. Kramer is a Diplomate of the American Board of Obesity Medicine and is board certified.There are 10 references cited in this article, which can be found at the bottom of the page. This article has been viewed 35,437 times.

Parkinsons Disease is a progressive neurodegenerative disorder affecting both motor and non-motor abilities. It afflicts 1% of those over 60 years of age.XResearch sourceJOHN D. GAZEWOOD, MD, MSPH,D. ROXANNE RICHARDS, MD,KARL CLEBAK, MD, Parkinsons An Update, The American Family Physician, 2013 Feb 15 87:267-273 It is a progressive disorder of the central nervous system. PD is caused by a lack of dopamine, a chemical that helps the parts of your brain responsible for motor function communicate with each other. This condition often causes tremors, muscle stiffness, slowness, and poor balance. If you suspect that you, or someone you love, has Parkinsons, it is important to know how you can diagnose this condition. Begin by trying to identify symptoms of the disease at home, and then see your doctor for an appropriate medical diagnosis.

How Should I Diagnose The Disease Clinically

The problem with Parkinsons is that it cannot be diagnosed with a single test. Essentially, you need to go through many diagnostic steps that include a detailed health history, general physical examination, genetic testing, brain imaging tests, and drug responsive test.

In detailed health history, your neurologist may ask you the following typical questions:

  • What kind of symptoms did you experience and when did you notice?
  • How often they appear?
  • Does anyone in your family has Parkinsons?
  • Did you encounter any medical illness in the past?
  • Are you on any medication these days?

In general physical examination, you will be checked for typical motor symptoms that appear in Parkinsons disease. These symptoms include tremor, slowness of movement, body stiffness, abnormal walking pattern, reduced facial expression, and micrographia .

Genetic testing is performed to find out if a patient carries mutations in the genes linked to Parkinsons disease. These genes include SNCA, LRRK2, PRKN, PINK1, DJ-1, and ATP13A2. People carrying a mutation in these genes can develop the disease symptoms either before the 40s or after the age of 50s.

In some cases, you may also subject to brain imaging tests, which help in the correct diagnosis of Parkinsons disease.The most commonly used brain tests are PET and MRI . These tests are used to determine the disease severity by accessing abnormal changes in different regions of the brain.

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If Its Not Curable Then How Can I Be Treated

Parkinsons disease can be treated either by medication or through surgical approach.

Medication is the most common way of dealing with Parkinsons disease symptoms. There have been developed drugs that not only help to treat the symptoms but also improve the overall quality of life. Commonly known classes of drugs used for Parkinsons disease are L-Dopa, MAO-B inhibitors, Dopamine Agonists, and COMT Inhibitors. These drugs are designed to restore dopamine levels in the brain.

Surgical approach or the deep brain stimulation is a newly introduced treatment approach for treating Parkinsons symptoms. You can be a candidate for deep brain stimulation if youre at the advanced stage of your disease and your symptoms are not well controlled with medication. In this approach, parts of your brain responsible for movement functions are reawakened by using low electric current. This requires a surgery during which a small chip containing electrodes is installed into the brain.

What Causes Parkinson’s Disease

Approach to the Exam for Parkinson’s Disease

In the very deep parts of the brain, there is a collection of nerve cells that help control movement, known as the basal ganglia . In a person with Parkinson’s disease, these nerve cells are damaged and do not work as well as they should.

These nerve cells make and use a brain chemical called dopamine to send messages to other parts of the brain to coordinate body movements. When someone has Parkinson’s disease, dopamine levels are low. So, the body doesn’t get the right messages it needs to move normally.

Experts agree that low dopamine levels in the brain cause the symptoms of Parkinson’s disease, but no one really knows why the nerve cells that produce dopamine get damaged and die.

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There Are No Laboratory Tests To Diagnose Parkinson’s Disease

Currently there are no laboratory tests that can diagnose Parkinson’s disease. This can make it difficult to accurately diagnose because PD resembles other movement disorders. In order to diagnose PD, a physician will take a complete medical history and perform a neurological exam. Additional testing may be done simply to rule out other neurological conditions that may resemble Parkinson’s.

How It All Fits Together

Diagnosing Parkinsons disease can be tricky. The process relies heavily on your doctors judgment. In addition, the causes and risk factors of Parkinsons are not entirely clear yet, which contributes to the difficulty in diagnosing this condition.

However, there have been efforts to try and detect this disease earlier. For instance, clinicians have started focusing more on prodromal symptoms, which are early symptoms that appear before movement-related difficulties begin.

These symptoms include:

  • Loss of smell, which can sometimes occur years before other symptoms
  • Chronic constipation, without any other explanation
  • Rapid eye movement behavior disorder, which causes sleep disturbances

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How Does Alcohol Affect Parkinsons Symptoms

In general, alcohol can be harmful to people with chronic conditions. According to the Centers for Disease Control and Prevention , overconsuming alcohol can be a long-term risk factor for a weakened immune system, learning and memory problems, high blood pressure, digestive issues, and various types of cancer. When looking specifically at Parkinsons symptoms, however, reports differ on how alcohol and PD may be linked.

The type of alcoholic beverage consumed may affect whether drinking has an impact on PD. A 2013 study found that the risk for developing Parkinson’s disease appeared to increase depending on the amount of liquor consumed, although no link was conclusively found between drinking wine and the development of PD.

In terms of how long-term alcohol use affects the risk of PD, one study published in 2013 followed people who had been admitted to the hospital with alcohol use disorders for up to 37 years. The study authors found that a history of alcohol abuse increased the risk of admission into the hospital for Parkinsons for both men and women. The study authors suggested that chronically drinking too much alcohol can have neurotoxic effects on dopamine, the neurotransmitter in the brain that is relevant to Parkinson’s disease.

There may also be factors other than observable symptoms such as how alcohol interacts with your medication that are important to consider when making decisions about your lifestyle and drinking habits.

Medical History And Physical Exam

How to Diagnose the Cause of Essential Tremor

The process of diagnosing Parkinsons usually begins with the neurologist evaluating your medical history and performing a physical exam. For a formal diagnosis to be made, you need to have a general slowness of movement with either a resting tremor or rigidity.

During the physical exam, your doctor will have you perform a series of tests to monitor your movement. An example of a test they might use is a finger tap, where they measure how many times you can tap your finger in 10 to 15 seconds.

They will also look for signs that you may have another condition. A group of movement disorders collectively called parkinsonisms can produce symptoms that are indistinguishable from those of Parkinsons but are not the same. Usually, additional tests are needed to rule out these conditions as well.

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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.

How Is Parkinson’s Disease Diagnosed

Your doctor will ask questions about your symptoms and your past health and will do a neurological exam. This exam includes questions and tests that show how well your nerves are working. For example, your doctor will watch how you move. He or she will check your muscle strength and reflexes and will check your vision.

Your doctor also may check your sense of smell and ask you questions about your mood.

In some cases, your doctor will have you try a medicine for Parkinson’s disease. If that medicine helps your symptoms, it may help the doctor find out if you have the disease.

Tests

There are no lab or blood tests that can help your doctor know whether you have Parkinson’s. But you may have tests to help your doctor rule out other diseases that could be causing your symptoms. For example:

  • An MRI or CT scan is used to look for signs of a stroke or brain tumor.
  • Blood tests check for abnormal thyroid hormone levels or liver damage.

Another type of imaging test, called PET, sometimes may detect low levels of dopamine in the brain. These low levels are a key feature of Parkinson’s. But PET scanning isn’t commonly used to evaluate Parkinson’s. That’s because it’s very expensive, not available in many hospitals, and only used experimentally.

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How Will Parkinson’s Disease Affect Your Life

Finding out that you have a long-term, progressive disease can lead to a wide range of feelings. You may feel angry, afraid, sad, or worried about what lies ahead. It may help to keep a few things in mind:

  • Usually this disease progresses slowly. Some people live for many years with only minor symptoms.
  • Many people are able to keep working for years. As the disease gets worse, you may need to change how you work.
  • It is important to take an active role in your health care. Find a doctor you trust and can work with.
  • Depression is common in people who have Parkinson’s. If you feel very sad or hopeless, talk to your doctor or see a counsellor.
  • It can make a big difference to know that you’re not alone. Ask your doctor about Parkinson’s support groups, or look for online groups or message boards.
  • Parkinson’s affects more than just the person who has it. It also affects your loved ones. Be sure to include them in your decisions.

Stiffness And Slow Movement

Diagnosing Parkinson’s Disease by Dr. Steve McGee (Stanford Skills Symposium)

Parkinsons disease mainly affects adults older than 60. You may feel stiff and a little slow to get going in the morning at this stage of your life. This is a completely normal development in many healthy people. The difference with PD is that the stiffness and slowness it causes dont go away as you get up and start your day.

Stiffness of the limbs and slow movement appear early on with PD. These symptoms are caused by the impairment of the neurons that control movement. A person with PD will notice jerkier motions and move in a more uncoordinated pattern than before. Eventually, a person may develop the characteristic shuffling gait.

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Is There A Cure For Parkinsons

Theres currently no cure for Parkinsons, a disease that is chronic and worsens over time. More than 50,000 new cases are reported in the United States each year. But there may be even more, since Parkinsons is often misdiagnosed.

Its reported that Parkinsons complications was the

Complications from Parkinsons can greatly reduce quality of life and prognosis. For example, individuals with Parkinsons can experience dangerous falls, as well as blood clots in the lungs and legs. These complications can be fatal.

Proper treatment improves your prognosis, and it increases life expectancy.

It may not be possible to slow the progression of Parkinsons, but you can work to overcome the obstacles and complications to have a better quality of life for as long as possible.

Parkinsons disease is not fatal. However, Parkinsons-related complications can shorten the lifespan of people diagnosed with the disease.

Having Parkinsons increases a persons risk for potentially life threatening complications, like experiencing:

  • falls

Parkinsons often causes problems with daily activities. But very simple exercises and stretches may help you move around and walk more safely.

Blood Test Would Detect Parkinsons In Early Stages

A group of researchers developed a blood test that would allow neurologists detect Parkinsons disease and track the illness as it progresses.

If successful, we expect our findings will translate into a valuable diagnostic tool for Parkinsons disease, said study co-author Judith Potashkin, professor of cellular and molecular pharmacology at Chicago Medical School, Rosalind Franklin University of Medicine and Science.

According to the Parkinsons Disease Foundation, it is estimated that 60,000 people in the United States are diagnosed with Parkinsons disease each year. Data from 2013, by the University Center for Health Sciences at the University of Guadalajara, reported more than 500,000 cases of this neurodegenerative condition in Mexico. The same year, an economic model of Parkinsons disease forecasted that cases in the worlds population will double by 2040.

Now days, this disease is still incurable. It can cause tremors and severely hamper movement. Although medications allow controlling the condition, it gets worse over the years and medications do not stop its progression.

The traditional method to diagnose Parkinsons is by analyzing symptoms. Currently, brain scans are available, allowing the analysis of imaging studies to detect the disease however, the information obtained from these devices may still be somewhat imprecise, Potashkin said.

The study was published in the Feb. 3 online issue of the Proceedings of the National Academy of Sciences.

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