How To Diagnose Parkinson’s Disease Symptoms

Deep Brain Stimulation Surgery

As Parkinsons disease progresses, deep brain stimulation surgery may become an option. Our team is one of the most experienced in the United States. Under the direction of Dr. Delaram Safarpour, Dr. Kim Burchiel, an OHSU neurosurgeon, pioneered asleep DBS so you dont have to be awake during surgery.

For this procedure, our team places tiny electrodes in your brain. The electrodes are connected to a small pacemaker-like device placed under the skin of your chest. The device sends mild electrical pulses to regulate movement and control Parkinsons symptoms such as:

In some parts of the state, you can have follow-up care at a doctors office in your community.

Colin Halstead had deep brain stimulation surgery at OHSU to treat his Parkinsons. It gave me my life back, he says.

Referral To A Specialist

If your GP suspects Parkinson’s disease, you’ll be referred to a specialist.

This will usually be:

• a neurologist, a specialist in conditions affecting the brain and nervous system
• a geriatrician, a specialist in problems affecting elderly people

The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement.

A diagnosis of Parkinson’s disease is likely if you have at least 2 of the 3 following symptoms:

• shaking or tremor in a part of your body that usually only occurs at rest
• slowness of movement
• muscle stiffness

If your symptoms improve after taking a medication called levodopa, it’s more likely you have Parkinson’s disease.

Special brain scans, such as a single photon emission computed tomography scan, may also be carried out in some cases to try to rule out other causes of your symptoms.

Support For People With Parkinsons Disease

Early access to a multidisciplinary support team is important. These teams may include doctors, physiotherapists, occupational therapists, speech therapists, dietitians, social workers and specialist nurses. Members of the team assess the person with Parkinsons disease and identify potential difficulties and possible solutions.There are a limited number of multidisciplinary teams in Victoria that specialise in Parkinsons disease management. But generalist teams are becoming more aware of how to help people with Parkinsons disease.

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Genes That Cause Parkinson Disease

Several genes have now been implicated in hereditary forms of this disorder. Understanding the function of these genes is helping researchers to identify what things go wrong not only in inherited forms of this disease but also in non-inherited forms. Using genetic mapping studies, a list of genes, not surprisingly originally numbered according to the order in which they were discovered, have been associated with developing PD.

Studies of the proteins produced by these various genes have begun to suggest that alterations in certain cellular functions may be important to the development of Parkinson disease. More importantly, continuing research links some of the different genes to being active in the same pathways within the cell. Thus, evidence mounts as to the importance of these pathways in PD including 1) how cells degrade certain proteins after their useful service life is over, 2) how mitochondria generate enough energy for the cell, and 3) how specific RNA molecules in the cell are managed.

One recent study showed that types of genes called PINK1 and Parkin act together in one pathway affecting mitochondria inside the cell . An earlier study had shown that under energetically stressful conditions inside the cell that DJ1 and Parkin can interact with one another . These types of associations make it more likely that learning how to intervene in these specifically altered pathways may point the way to new treatments for this disorder.

How Is Parkinsons Disease Managed

Your doctors will tailor your treatment based on your individual circumstances. You will manage your condition best if you have the support of a team, which may include a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.

While there is no cure for Parkinsons disease, symptoms can be treated with a combination of the following.

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Where Can You Find Support For Parkinsons

A chronic condition such as Parkinsons can be overwhelming to manage. Its important to have support. Here are some useful resources where you can find educational materials, support groups, and more.

• The Michael J. Fox Foundation: The Michael J. Fox Foundation offers advocacy, educational materials, and community for people with Parkinsons.
• The American Parkinson Disease Association: You can connect with The American Parkinson Disease Association to find wellness programs and other support in your community.
• The Parkinsons Foundation:The Parkinsons Foundation provides online support, a resource library, and connections to local community-based support.
• The Davis Phinney Foundation fro Parkisons: You can learn more about managing Parkinsons through The Davis Phinney Foundation for Parkinsons events, blog, podcasts, webinars, and other resources.

You can read more about early onset Parkinsons by checking out the answers to some common questions below.

How Can Mris Be Used To Detect Early Onset Parkinsons

MRIs use magnets to create detailed images of the inside of the body. Brain MRIs can help doctors spot tumors, brain bleeding, and other brain health conditions. Recently, medical researchers have discovered that MRIs can also spot small changes in the brain that can indicate Parkinsons disease.

A 2019 study on MRIs and Parkinsons found that people with Parkinsons often have visibly damaged brain neurons. The damage to neurons is present before any brain atrophy begins, and before symptoms are present.

Using this information, doctors can prescribe appropriate treatments, such as Deep Brain Stimulation therapy, that can slow down decline and improve the quality of life for people with Parkinsons.

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What To Expect At The Appointment

To make a Parkinsons diagnosis, your doctor will look for the three main motor symptoms: bradykinesia , tremor and rigidity. Remember, not everyone with Parkinsons disease has a tremor. They will also ask questions and examine you to see if there are possible other explanations for your symptoms besides Parkinsons.

The doctor will ask you questions and look for Parkinsons signs like:

• If you have a resting tremor, meaning your tremor appears when your limb like an arm or leg is still
• If your tremor and/or other movement issues occur on one side of your body only
• If your handwriting has become very small
• If you have issues with balance
• If the way you walk has changed for example, you are taking small steps or having trouble turning
• If you have stiffness, aka rigidity, in your arms or legs for example, you dont swing your arm when you walk
• If you have difficulty with fine motor movements like combing your hair or brushing your teeth
• If your voice has become softer or more difficult for others to hear

To assess your non-motor symptoms, your doctor may ask you questions about:

• If youve lost your sense of smell
• If you experience constipation
• If you talk or act out dreams while you sleep

Determining Diagnosis Through Response To Parkinsons Medication

If a persons symptoms and neurologic examination are only suggestive of Parkinsons disease, the physician may 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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Benefits Of Exercise For Parkinsons Patients

One way to manage Parkinsons disease is exercise. Exercise and therapy can have direct effects on the mobility of a person with a neurological condition such as Parkinsons disease. Studies have shown aerobic exercise augments blood flow in the body, which helps with the removal of waste products. This is especially important because one of the non-motor symptoms of Parkinsons disease is constipation.

The balance training can increase the number of synapses in the brain. Additionally, exercise can help boost survival factors in brain cells, and thus limit cell death in certain cases. Other research has shown moderate exercise can complement medication and help it work more effectively. Exercise programs should be prescribed specifically for each Parkinsons patient since every case is different.

If Its Not Parkinsons Disease What Else Could It Be

There are several other conditions that might produce symptoms that can be mistaken for Parkinsons disease. Here are some possibilities:

• Medication side effects: Certain drugs can produce or exacerbate symptoms.
• Essential, or familial, tremor: This is a relatively common and benign cause of recurrent tremor and is often confused with the tremor of idiopathic Parkinsons. A general neurologist or movement disorder specialist is the best physician to help differentiate between these two conditions.
• A Parkinsonian syndrome: The symptoms of several neurologic conditions are similar to those of idiopathic Parkinsons, but they are often managed differently and often do not respond to the typical medications.

Remember: Only a general neurologist or movement disorder specialist can tell you with reasonable certainty if you have idiopathic Parkinsons. If for some reason you are not comfortable with the results of your first physician visit, getting a second opinion from another general neurologist or movement disorder specialist is always an option. It is important that you feel comfortable with your physician to ensure the best possible outcome for you.

Once you or your loved one has a diagnosis of Parkinsons disease, it is time to discuss treatment options with your physician.

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Early Signs Of Parkinson’s

Early physical signs include the common motor symptoms: tremor, muscle rigidity and slowness. They may also include the following:

• Symptoms starting on one side of the body
• Change in facial expression
• Failure to swing one arm when walking
• Stooped posture
• Loss of sense of smell
• Depression or anxiety

Some of these symptoms are quite common and by no means exclusive to Parkinsons, so if you have some of them, it does not mean you have Parkinsons.

Primary Symptoms Of Parkinsons

The symptoms someone has and how quickly the condition develops will differ from one person to the next. Always consult your doctor to determine if the symptoms youre experiencing may be a sign of Parkinsons disease or a sign of other health issues.

Slowness of Movement

Individuals with Parkinsons disease experience a change in spontaneous movement that causes them to move or respond slowly. The face may lack changing facial expressions .

Tremor

Tremors occur in about 70% of those living with Parkinsons. Typically, the tremor appears on one side of the body in the hand or foot while relaxed or at rest.

Rigidity

Muscles may fail to relax like normal muscles causing the individual to appear rigid and have a decreased range of motion. Rigidity can cause posture changes. Tightness of the muscles of the body may be painful.

Postural Instability

Loss of some reflexes needed to maintain an upright posture may cause individuals to be unstable when standing. The presence of postural instability increases the likelihood of falling.

Secondary motor symptoms include:

Non-motor symptoms of PD include:

• Oily skin, flaky red patches near hairline, nose
• Variable blood pressure
• Mood changes anxiety and depression
• Cognitive changes
• Excessive or low sex drive
• Excessive sweating especially of hands and feet
• Frequent urination and incontinence

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How Is Parkinsons 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 Parkinsons 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 Parkinsons. 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 Parkinsons. But PET scanning isnt commonly used to evaluate Parkinsons. Thats because its very expensive, not available in many hospitals, and only used experimentally.

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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What Are The Next Steps Following A Diagnosis Of Parkinsons

Once you have a diagnosis of Parkinsons, your doctor can begin developing a treatment plan. Parkinsons treatments aim to minimize symptoms and slow down progression.

Treatment plans will take into account such factors as symptoms, overall health, and response to treatment. Although theres no cure for Parkinsons, treatment can improve your quality of life.

Common treatments for Parkinsons include:

• Physical therapy: Physical therapy can help improve strength and balance.
• Speech therapy: Speech therapy can help reduce communication difficulties.
• Lifestyle changes: People with Parkinsons often benefit from adding exercise to their daily lives.
• Medication: There are several medications approved to treat the symptoms of Parkinsons. You might need to change medications as Parkinsons progresses.
• Deep brain stimulation:Deep brain stimulation is a surgical procedure. Surgeons place electrodes in your brain that are connected to a generator placed in your chest. These electrodes can help reduce the symptoms of Parkinsons.

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Surgical Treatments & Deep Brain Simulation

Surgical interventions of varying types for limiting the symptoms of PD have emerged over the last three decades. While treatment with medications is always the first choice, these surgical treatments have proven useful for many people. The earliest surgical treatments involved intentionally damaging specific structures in the brain that are involved in modulating movement control. The idea behind this is that some of the symptoms of PD, largely the tremors, could be dampened. These included procedures known as pallidotomy and thalamotomy .

One option for treating Parkinsons disease is deep brain stimulation . This treatment helps particularly with the walking problems, tremors, slowed movements, rigidity, and stiffness. DBS is a surgical procedure in which the surgeon implants an electrode, or lead, into the patients brain at specific motor locations. The lead connects to an extension wire, which attaches to the neurostimulator. The National Institute of Neurological Disorders and Stroke explains that the neurostimulator sends the electrical impulses through the extension to the lead, where the electrical impulses block the abnormal nerve signals that cause tremor and Parkinsons disease symptoms.

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How Common Is Parkinson’s Disease Psychosis

Between 20-40% of people with Parkinsons report the experience of hallucinations or delusions.

When followed as the disease progresses over the years, this number increases. The increase does not mean that the hallucinations are persistent across the majority of people with PD. However, it is important to note that these statistics sometimes include delirium, in which the symptoms are temporary due to medication that needs to be adjusted or infection that needs to be treated, and isolated minor symptoms or minor hallucinations, including illusions, where instead of seeing things that are not there , people misinterpret things that are really there.

These are the most common types of psychosis in people with PD, with different studies placing the occurrence between 25-70% of people with Parkinsons. Typically, if the person with PD only has these minor hallucinations, their doctor will not prescribe an antipsychotic medication, though more significant psychosis that requires medication may develop over time. In one study, 10% of those with minor hallucinations had their symptoms resolved within a few years, while 52% saw their symptoms remain the same and 38% saw their psychosis symptoms get worse.

We recommend that people with Parkinsons not use a single percentage to represent the prevalence of hallucinations and PDP. Parkinsons is a complex disease and as it progresses the percentages and risk of symptoms will change.

I Have Pd And Several Symptoms Should I Get A Datscan

Likely no. There is no need for DaTscan when your history and exam suggest Parkinsons disease and you meet the diagnostic criteria. Occasionally, if signs and symptoms are mild or you dont meet the diagnostic criteria, your doctor will refer you for a DaT scan. Keep in mind that ultimately the diagnosis is based on your history and physical exam. The DaT scan is most commonly used to complete the picture and is not a test for a diagnosis.

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