How Parkinson’s Disease Is Diagnosed
Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology.
There’s no “gold standard” test that will diagnose Parkinson’s disease . Instead, a physician relies on their own clinical observations and judgment, along with a patient’s description of possible signs and symptoms, to make the diagnosis. That, of course, makes a physical examination very important in this process. Much of your doctor’s exam will be aimed at assessing whether you have the so-called cardinal signs of Parkinson’s: resting tremor, rigidity , bradykinesia and postural instability .
Blood Tests And Spinal Fluid Tests
A blood test or spinal fluid test cant be used to diagnose Parkinsons. But they can be used to search for certain proteins that indicate you may have another neurodegenerative condition with similar symptoms.
The presence of elevated levels of a nerve protein called neurofilament light chain protein may indicate that you have another movement disorder, such as:
- multiple system atrophy
- corticobasal degeneration
What Are The Symptoms
The four main symptoms of Parkinson’s are:
- Tremor, which means shaking or trembling. Tremor may affect your hands, arms, or legs.
- Stiff muscles.
- Slow movement.
- Problems with balance or walking.
Tremor may be the first symptom you notice. It’s one of the most common signs of the disease, although not everyone has it.
More importantly, not everyone with a tremor has Parkinson’s disease.
Tremor often starts in just one arm or leg or on only one side of the body. It may be worse when you are awake but not moving the affected arm or leg. It may get better when you move the limb or you are asleep.
In time, Parkinson’s affects muscles all through your body, so it can lead to problems like trouble swallowing or constipation.
In the later stages of the disease, a person with Parkinson’s may have a fixed or blank expression, trouble speaking, and other problems. Some people also lose mental skills .
People usually start to have symptoms between the ages of 50 and 60. But sometimes symptoms start earlier.
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People Who Already Have Pd: Should I Get Tested And What Do I Do With The Results
Up until recently, even people with PD with a very extensive family history of PD would not necessarily receive genetic testing because there were no clear uses for the results. There has been research directed at figuring out whether PD caused by or associated with certain mutations have particular clinical characteristics . However, there remains so much variability in clinical characteristics even among people with the same PD mutation, that there are still no clear practical implications in knowing whether a PD patient harbors a particular mutation. There is also, so far, no difference in treatment or management of PD whether or not the patient harbors one of the known mutations. That may change however, with the advent of clinical trials that target particular mutations.
There are two genes that have received particular attention recently because medications are being developed that target those with mutations of these genes.
GBAis a gene that increases the risk of developing PD. The gene encodes for the GBA enzyme, a protein used by the body to break down cellular products. Having two abnormal GBA genes causes Gauchers disease, which is characterized by the buildup of these cellular products resulting in fatigue, bone pain, easy bleeding and an enlarged spleen and liver. When a person inherits only one abnormal gene, he or she does not develop Gauchers disease, but does incur a small increased risk of PD. Most people with one mutated GBA gene do not develop PD.
What Are The Signs And Symptoms Of Parkinsons
Parkinsons disease is a progressive condition, and symptoms tend to get worse over time. The rate of progression varies between people.
At first, symptoms tend to be mild enough that they likely wont interfere with your daily life. But people who regularly spend time with you may notice changes in your gait, posture, or facial expressions.
Parkinsons symptoms usually start on
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Mri In Parkinson’s Testing
One of the more common tests done during a neurologic workup is an MRI scan and one may think that in the investigation of a disease that affects the brain such as Parkinsons, this imaging test would be a necessity. In the context of Parkinsons disease, however, an MRI is not particularly helpful. It looks at the structure of the brain which, for all intents and purposes, appears normal in this disease. An MRI may, however, be indicated when symptoms appear in younger people or if the clinical picture or the progression of symptoms is not typical for Parkinsons. In these situations, MRI can be used to rule out other disorders such as stroke, tumors, hydrocephalus , and Wilsons Disease .
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
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What Are The Symptoms Of Parkinson’s Disease
The main symptoms of Parkinson’s disease are:
- tremor or shaking, often when resting or tired. It usually begins in one arm or hand
- muscle rigidity or stiffness, which can limit movement and may be painful
- slowing of movement, which may lead to periods of freezing and small shuffling steps
- stooped posture and balance problems
The symptoms of Parkinson’s disease vary from person to person as well as over time. Some people also experience:
- loss of unconscious movements, such as blinking and smiling
- difficulties with handwriting
- drop in blood pressure leading to dizziness
- difficulty swallowing
Many of the symptoms of Parkinson’s disease could be caused by other conditions. For example, stooped posture could be caused by osteoporosis. But if you are worried by your symptoms, it is a good idea to see your doctor.
Can Parkinsons Disease Be Diagnosed By How You Smell
Theres evidence that people with Parkinsons disease may emit a specific type of scent, which is related to increased sebum production. However, doctors have not developed a way to use this odor to diagnose the disease. More research is being done to see how the finding can help with diagnosis and treatment.
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What Tests Diagnose Parkinson’s Disease
There currently are no tests that can definitively diagnose Parkinsons Disease. A diagnosis is based on the clinical findings of your physician in combination with your report on the symptoms you are experiencing.
In situations where an older person presents with the typical features of Parkinsons and they are responsive to dopamine replacement therapy, there is unlikely to be any benefit to further investigation or imaging.
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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Gauging Speed Of Movement
Bradykinesia occurs in most people who have Parkinson’s. It may cause a lack of spontaneous facial expression and fewer eye blinks per minute than usual, and your doctor will look for these signs in your physical exam.
Your doctor also may assess your speed of movement by asking you to open and close each hand or tap your index finger against your thumb repeatedly, making large movements as quickly as possible. In people with Parkinson’s disease, the movement may start off fast and precise, but it will deteriorate quickly, becoming slow and limited.
Gait is also another way to test for this. Observing a patient while they walk, noting the length of their stride as well as the speed at which they move, can tell doctors quite a bit. Lack of arm swing is also a feature that appears fairly early in those with Parkinson’s.
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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Assessing Level Of Rigidity
Doctors also look for rigidity by moving the joints in your elbows, wrists, knees, and ankles to see if there’s resistance. The resistance may be smooth or may appear as slight hesitations in movements, known as cogwheeling. This is sometimes made more obvious by the patient actively moving the opposite limb.
Medical History And Physical Exam
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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Natural Treatment For Parkinsons #3 Turmeric And Otherherbs And Spices:
A recent study published in the journal Stem Cell Research & Therapy, foundthat the extracts in turmeric, particularly curcumin and the newly discovered Ar-turmerone,can regenerate a damaged brain and reverse neurological disorders. Researchers said Ar-turmerone is a promising candidate to supportregeneration in neurologic disease. Michigan State University researcherBasir Ahmad also found that a compound in turmeric may help fight Parkinsonsdisease by disrupting the proteins responsible for the disease.
Another study published in the Pharmacognosy Magazine found that tumeric can prevent and evenreverse the toxic effects exerted on the brain from fluoride exposure. Fluorideis a nasty and dangerous heavy metal that destroys brain cells and the intricateworkings of the central nervous system. Fluoride poisoning has also beenimplicated in the development of neurological diseases such as Alzheimers,Parkinsons, ALS and multiple sclerosis. 7
Turmeric is also a very potent anti-inflammatory spice. Because Parkinsons is aninflammation type disease, turmeric will help immensely. A heaped teaspoon ofhigh quality turmeric powder taken 3 times daily in asmoothie will do the trick. Just make sure you combine it with 10-12 blackpeppercorns for enhanced absorption Turmeric is also fat soluble so youll need tocombine it with some coconut oil, red palm oil or fish/krill oil as well.
Your Home And Lifestyle
- Modify your activities and your home. For example, simplify your daily activities, and change the location of furniture so that you can hold on to something as you move around the house.
- Eat healthy foods, including plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, and low-fat dairy products.
- Exercise and do physiotherapy. They have benefits in both early and advanced stages of the disease.
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What Is Parkinsons Disease
Parkinsons disease is a chronic neurological condition. It is progressive and symptoms worsen over time. It is named after Dr James Parkinson who first described the condition in 1817.
People with Parkinsons disease experience a loss of nerve cells in the part of their brains responsible for controlling voluntary movements. This part of the brain is called the substantia nigra . The nerve cells in the substantia nigra usually produce a chemical called dopamine which helps transmit messages from the brain to the rest of the body via the central nervous system . As these cells are lost, people with Parkinsons disease experience a loss of dopamine and the messages controlling movement stop being transmitted efficiently.
Parkinsons disease is more common as people get older but it can affect younger adults. Men tend to be affected in slightly higher numbers than women.
The Diagnostic Criteria Used Today
In 2015, a Movement Disorder Society task force proposed a set of criteria that became known as the Movement Disorder Society United Parkinsons Disease Rating Scale , which includes non-motor symptoms in its criteria.9
The new criteria requires you to have slowness of movement, plus either a rest tremor or rigidity. It also requires that you do not meet any criteria in a list called absolute exclusion criteria. This list of symptoms indicates you most likely do not have PD or that you may have an atypical parkinsonism disorders that resemble Parkinsons disease but are ultimately different. If you meet any of those requirements, PD is ruled out. For example, one absolute exclusion criteria is if you are taking a drug that is known to cause Parkinsons-like side effects.
Next, you must meet at least two of the following four criteria:
- Dramatic improvement of motor symptoms when you take the gold-standard Parkinsons medication called levodopa
- The presence of dyskinesia as a result of taking levodopa dyskinesia is a possible side effect of levodopa among people with PD
- Rest tremor, meaning your tremor occurs when the body part is at rest
- Loss of smell, or if you have a test called MIBG scintigraphy and it indicates that you have autonomic dysfunction, which is when your autonomic nervous system doesnt work correctly, leading to issues with things like heart rate and blood pressure.
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Trying Parkinsons Disease Medications
One of the features of PD is that it will significantly and consistently improve when you begin taking medication that targets your dopamine system.10 Your doctor may ask you to try taking Parkinsons medication, like carbidopa-levodopa, to help confirm a PD diagnosis. Levodopa is a drug that is converted into dopamine in your brain, replacing some of the dopamine you lose due to the disease. Levodopa is frequently paired with carbidopa, which helps prevent levodopa from breaking down before it reaches your brain. Your doctor will observe if carbidopa-levodopa helps your motor symptoms. Carbidopa-levodopa is typically very effective at treating motor symptoms, so a significant response to the medication used to treat it helps confirm the diagnosis. Parkinsons medications are generally very safe and the risk of taking them is low, while the benefit is great because it might help if you do have Parkinsons and improve your mobility.10
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Understanding Parkinsons Disease: Getting A Parkinsons Diagnosis
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.
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Home Remedyfor Parkinsons #8 Green Tea:
Green tea contains theanine, a nutrient that increasesdopamine levels in the brain, and polyphenol antioxidants that help fight free radicals. Three separate studies all found that regularlydrinking tea can either delay or prevent the development of PD. A retrospectivestudy also found that drinking three or more cups of tea a day can delay the onsetof motor symptoms. And a 2007 study found that green tea polyphenols protect braincells and dopamine neurons, and this positive effect increases with the moregreen tea consumed. 10
The minimum amount that should be drank every day is 3cups, with 6-9 cups a day being the ideal.Matcha green tea is the most potent and beneficial so try and purchase this ifyou can. A strong cup of coffee first thing in the morning is thought tobe effective for reducing the symptoms of Parkinsons disease as well, however,we recommend you stick with green tea, or even a strong cup of black tea ifyou can for the theanine and EGCGs.