How To Diagnose Parkinsons Disease

Diagnosis And Management Of Parkinsons Disease

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

There are no diagnostic tests for Parkinsons. X-rays, scans and blood tests may be used to rule out other conditions. For this reason, getting a diagnosis of Parkinsons may take some time.

No two people with Parkinsons disease will have exactly the same symptoms or treatment. Your doctor or neurologist can help you decide which treatments to use.

People can manage their Parkinsons disease symptoms through:

seeing a Doctor who specialises in Parkinsons
multidisciplinary therapy provided for example, by nurses, allied health professionals and counsellors
deep brain stimulation surgery .

Looking For Signs Of Parkinsons

Your specialist will examine you to look for common signs of Parkinsons. You may be asked to:

write or draw to see if your writing is small or gradually fades
walk to see whether theres a reduction in the natural swing of your arm or in your stride length and speed
speak to see if your voice is soft or lacks volume

The specialist will also look at and ask you about your:

face to see if there is a masked look or if you have difficulty with facial expressions
limbs to see if you have a tremor, any stiffness or slowness of movement

As well as examining you for any of the typical signs of Parkinsons, the specialist will also look for signs that may suggest a different diagnosis.

It may be helpful to take someone with you for support when seeing a specialist. Taking a list of questions you want to ask can also be useful so you dont forget to mention something you want to know about. If a healthcare professional says something you dont understand, dont be afraid to ask them to explain what they mean.

Living With Parkinson’s Disease

Coming to terms with a diagnosis of Parkinson’s and living with the disease is challenging and will take a lot of adjustment. There are still things you can do that can help you to feel more in control of your situation and to stay positive. Some things that might help could include:

choosing to lead a healthy lifestyle
making informed decisions related to your treatment
keeping a diary of your symptoms in preparation for meetings with health and social care professionals
attending a self-management course

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Gait & Balance Abnormalities

Parkinsons Disease Exam

Patients with Parkinsons disease can develop an alteration of the postural reflexes that causes instability in gait and balance control. Such alterations usually develop later in the course of the illness and are a major cause of disability, especially because of the high risk for falls that derives.

Using the exam to pick up postural instability is of the utmost importance for the management of patients with PD, since it will trigger either a medication adjustment or a physical therapy intervention both aimed at falls prevention.

We have three tests for this part of the PD exam:

1) Standing up from a chair

2) Free walking

3) Provoked pull test maneuver for balance

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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Clinical Diagnostic Criteria For Parkinsons Disease

As we continue to see advancements in neuroscience, and researchers continue to deepen our understanding of Parkinsons disease, clinical diagnostic criteria will continue to evolve to better support more accurate diagnosis.

Currently, Parkinsons disease is considered likely in patients who exhibit two or more of the four main symptoms of Parkinsons disease:

Bradykinesia : Slow initiation of voluntary movement with a progressive reduction in speed and amplitude of repetitive actions
Shaking or resting tremor: A tremor, or slight shaking, of the hand, fingers, or chin while at rest
Rigidity: Stiffness in the arms, legs, or trunk
Postural instability: Difficulty with balance

Currently, for diagnosis, many doctors use the gold standard checklist created by the UK Parkinsons Disease Society Brain Bank. However, recently, a new set of diagnostic criteria created by the International Parkinson and Movement Disorder Society has come into use. This also included the first-ever criteria for prodromal Parkinsons disease.

Complementary And Alternative Therapies

Some people with Parkinson’s disease find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinson’s disease.

However, there’s no clinical evidence they’re effective in controlling the symptoms of Parkinson’s disease.

Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldn’t be used instead of the medicines prescribed by your doctor.

Some types of herbal remedies, such as St John’s wort, can interact unpredictably if taken with some types of medication used to treat Parkinson’s disease.

If you’re considering using an alternative treatment along with your prescribed medicines, check with your care team first.

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Idiopathic Basal Ganglia Calcification

This is a heterogenous disease associated with mineral deposition in the basal ganglia, as well as in other brain structures. There is a strong familial component, with causative mutations identified in SCL20A2 and PDGFRB. Patients commonly have a movement disorder, with parkinsonian features of akinesia and rigidity which show a variable response to levodopa. Other features include cognitive impairment, gait disorder, pyramidal signs, and a psychiatric presentation. Imaging is crucial in diagnosis to identify the areas of calcification, with CT imaging being more useful than MRI .

Understanding Parkinsons Disease: Getting A Parkinsons Diagnosis

How is Parkinson’s disease diagnosed?

Once you start noticing some changes in your body that impact your daily life or are just simply bothersome, you should begin the process of figuring out if you have Parkinsons disease. It may seem like a daunting undertaking, but dont let fear stop you. Once you are diagnosed, you can start treating your symptoms and learning strategies that will help you feel better.

What Is The Prognosis For Parkinsons Disease

The rate at which Parkinsons progresses varies from patient to patient. Some patients experience its changes over 20 years or more. While others find the disease advances quicker.

Parkinsons is not a fatal disease. However, secondary complications from symptoms may increase falls, blood clots or pneumonia, which can be life-threatening. These are more common in later stages of Parkinsons.

In general, the average life expectancy of Parkinson’s patients is similar to people without the disease.

Symptoms Of Parkinson’s Disease

The symptoms of Parkinson’s disease usually develop gradually and are mild at first.

There are many different symptoms associated with Parkinson’s disease. Some of the more common symptoms are described below.

However, the order in which these develop and their severity is different for each individual. It’s unlikely that a person with Parkinson’s disease would experience all or most of these.

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.

Dural Lymphatic Vasculature: A New Player In The Pathophysiology Of Parkinsons Disease

Many researchers are drawn to studying the brain because theyre still making basic discoveries about how this mysterious organ works. One of those recent discoveries may be key to deciphering the causes of Parkinsons disease.

Most organs in the body have a lymphatic system to drain toxins, waste and other unwanted materials. After long believing it did not exist, researchers have realized the brain, too, has a lymphatic system to do this cleansing work.

At Toronto Western Hospital, Scientific Associate Naomi Visanji, a neuroscientist, immediately saw the implications of this discovery. Shes investigating the lymph vessels in the brain to see if they door coulddrain alpha-synuclein, a protein that accumulates in the brain cells critical to Parkinsons disease. That accumulation kills the brain cells producing dopamine, the chemical that signals other cells to initiate movement.

Because lymph vessels are involved in drainage of fluid, waste and other unwanted material, its a natural idea that the vessels might be involved in the drainage of excess toxic proteins in the brain, says Visanji.

Using imaging equipment, Visanji will compare the brains of two mouse models. One has been genetically engineered to remove its lymphatic vessels in the brain the other is a normal mouse.

The next questionrequiring a further studyis whether these vessels are damaged in people with Parkinsons disease.

Search

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Response To Parkinsons Drugs

After examining you, and depending on the severity of your symptoms, your specialist may suggest you take medication for Parkinsons. If your symptoms improve after taking Parkinsons medication for a few weeks or months, your specialist may confirm a Parkinsons diagnosis. However, some people with other forms of parkinsonism will also respond well to these drugs.

Your specialist may suggest you have a scan to help make a diagnosis. However, scans alone cant make a definite diagnosis of Parkinsons, so they are not commonly used.

Physical And Neurological Examination

Your doctor will conduct a physical and neurological examination. This can involve observing your behavior, movements, and mental state and conducting tests or asking you to perform certain exercises.

These are some of the symptoms of Parkinsons your doctor can determine visually:

Fewer spontaneous movements or hand gestures
Reduced frequency of blinking
Tremors in your hands while they are at rest, often only in one hand
Hunched posture or forward lean while walking
Stiff movements

These are some of the exercises your doctor may ask you to do to evaluate your movements, balance, and coordination:

Opening and closing your fist
Tapping your fingers, toes, and heels
Holding your arms out in front of you
Moving your finger from one point to another
Rotating your wrists or ankles
Standing from a chair

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Is Early Diagnosis Possible

Experts are becoming more aware of symptoms of Parkinsons that precede physical manifestations. Clues to the disease that sometimes show up before motor symptoms and before a formal diagnosis are called prodromal symptoms. These include the loss of sense of smell, a sleep disturbance called REM behavior disorder, ongoing constipation thats not otherwise explained and mood disorders, such as anxiety and depression.

Research into these and other early symptoms holds promise for even more sensitive testing and diagnosis.

For example, biomarker research is trying to answer the question of who gets Parkinsons disease. Researchers hope that once doctors can predict that a person with very early symptoms will eventually get Parkinsons disease, those patients can be appropriately treated. At the very least, these advances could greatly delay progression.

Pioneering Precision Neurology To Drive Early Accurate Diagnosis

Breakthrough Test to Diagnose Parkinsonian Syndromes

At Altoida, we are dedicated to providing a reliable, affordable, and highly accurate way to measure and monitor brain health. We are building the worlds-first Precision Neurology platform and app-based medical devicebacked by 11 years of clinical validationto accelerate and improve drug development, neurological disease research, and patient care.

By completing a 10-minute series of and motor activities designed to simulate complex Activities of Daily Living on a smartphone or tablet, Altoidas device extracts and provides robust measurements of neurocognitive function across 13 neurocognitive domains. Our device measures and analyzes nearly 800 multimodal cognitive and functional digital biomarkers. Through the collection of highly granular data from integrated smartphone or tablet sensors, Altoidas device produces comprehensive neurocognitive domain scores. This data can be tracked longitudinally to reveal trends and patterns while flagging concerning ones.

This method, along with our innovative artificial intelligence, will pioneer fully digital predictive neurological disease diagnosis. Recently receiving Breakthrough Device designation by the FDA, Altoida’s platform has demonstrated ability to predict conversion from Mild Cognitive Impairment to Alzheimer’s disease with a high degree of accuracy.

To learn more about if there is a test for Parkinsons disease or about utilizing Altoidas Precision Neurology platform, contact us today.

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Common Symptoms Of Lewy Body Dementia

The disease of Lewy Body Dementia affects cognitive response, changes physical and sleep pattern along with changing behavioral features. Some people may start developing the disorder in movement in the initial stage that further leads to dementia. This is often termed as Parkinsons disease dementia.

Another group of people may start developing cognitive disorder with two or more distinctive features of dementia. There are very few people that come up with neuropsychiatric symptoms. These include hallucinations, behavioral problems, and complex mental activities.

Generic symptoms of Lewy Body Dementia include:

Impaired thinking like loss of execution, planning, processing and/or ability to understand visual information
Fluctuation in alertness, attention, and cognition
Sudden tremors, stiffness, and difficulty in walking
Changes in bodily functions like blood pressure, temperature regulation bowel and bladder function.

Eat Fresh Raw Vegetables

If you needed more reasons to eat your vegetables, this should be the clincher. Studies show that increased amounts of the B vitamin folic acid, found primarily in vegetables, can significantly reduce the risk of Parkinsons.

The best sources of folic acid are simultaneously some of the healthiest foods on the planet, namely dark green vegetables like broccoli, spinach, collard greens, brussels sprouts, asparagus and okra all of which can be grown in your backyard! This B vitamin can also be found in avocado, legumes and lentils.

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Impact On Families And Carers

Informal carers spendmany hours dailyproviding care for people living with PD.This can be overwhelming. Physical, emotional and financial pressures can cause great stress to families and carers, and support is required from the health, social, financial and legal systems. Useful support resources from other conditions can be drawn upon, such as WHOs iSupport programme for dementia.

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Brain Imaging Can Help With Diagnosis

Doctors use two tests that take detailed pictures of your brain. Each one may help your doctor make a diagnosis. These tests are:

PET scan: This shows how your brain functions. It shows how the brain uses sugar. This scan can help tell the difference between Parkinson’s and dementia.
DaTscan: This shows problems with brain cells that make dopamine. Healthy brain cells light up during the test. Cells without enough dopamine appear dark. This scan can help your doctor tell the difference between Parkinson’s and a brain disease called essential tremor.

Imaging studies are a newer way to diagnose Parkinson’s. However, not every healthcare facility can do them. It takes an experienced doctor to interpret the scans accurately. These scans also can be very expensive. Be sure to check with your insurance company ahead of time to see whether you are covered and what your out-of-pocket costs will be.

What Parkinsons Diagnosis Criteria Do Doctors Use

Until the 1980s, there was no formal diagnostic criteria for Parkinsons disease. Beginning with James Parkinsons 1817 article, An Essay on the Shaking Palsy, and Margaret Hoehn and Melvin Yahrs description of the five stages of motor progression in 1967, scientists focused on the unique ways Parkinsons disease affects movement. A few scientists also noted non-motor symptoms like issues with automatic body functions, such as heart rate and blood pressure.

With the discovery in the 1950s of levodopa, a drug that gets turned into dopamine in your brain and thus replaces some of the dopamine that is lost due to PD, and the discovery of how dramatically levodopa improves motor symptoms, the medical community continued to focus more of their efforts on defining and treating Parkinsons as a motor condition.7

What Causes 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.