How Is Parkinsons Disease Diagnosed
There are currently no specific tests that diagnose PD. The diagnosis is based on:
- medical history and a neurological examination
- blood and laboratory tests, to rule out other disorders that may be causing the symptoms
- brain scans to rule out other disorders. However, computed tomography and magnetic resonance imaging brain scans of people with PD usually appear normal.
In rare cases, where people have a clearly inherited form of PD, researchers can test for known gene mutations as a way of determining an individuals risk of developing the disease. However, this genetic testing can have far-reaching implications and people should carefully consider whether they want to know the results of such tests.
Medicines For Parkinson’s Disease
Medicines prescribed for Parkinson’s include:
- Drugs that increase the level of dopamine in the brain
- Drugs that affect other brain chemicals in the body
- Drugs that help control nonmotor symptoms
The main therapy for Parkinson’s is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.
People with Parkinson’s should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.
Other medicines used to treat Parkinsons symptoms include:
- Dopamine agonists to mimic the role of dopamine in the brain
- MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
- COMT inhibitors to help break down dopamine
- Amantadine, an old antiviral drug, to reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
So What Is It Is It Parkinsons Disease Or Is It Something Else
The answer is not easy, but many who feel they have more than Parkinsons may in fact have multiple system atrophy .MSA is a very rare disorder that has similarities and features of Parkinsonism.However, it is so rare that many physicians are unfamiliar with it and so the diagnosis is not considered. As a result, a likely diagnosis of MSA might be delayed by years and even missed all together. Whats more, due to many symptoms that could possibly be attributed to other conditions diagnosing MSA can be challenging, even to the most experienced doctors. This can be very frustrating to those who know it is more than PD.
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Foster A Good Relationship
Lastly, maintaining your relationship and communication with the person with Parkinsonâs can be the most challenging and rewarding aspect of caregiving. As Parkinsonâs disease progresses, the roles change and the person with Parkinsonâs may go from being an independent head of the household to a very dependent person requiring a significant level of care. However, research shows that despite high levels of strain, caregivers with good quality relationships have reduced depression and better physical health. Remember, as a caregiver your service to your loved one is beyond measure in terms of love, depth of care, and concern.
Parkinson’s Disease Is Often Misdiagnosed In People With Paraquat Exposure
by Legal Staff
Because the symptoms of Parkinson’s disease are very similar to those of other health problems, it is often misdiagnosed in people with a history of exposure to paraquat, which prevents victims of toxic exposure from recovering the financial compensation they deserve. According to medical studies, Parkinson’s disease is misdiagnosed in up to 30% of cases and the rate of misdiagnosis is even higher in people whose disease is in the early stages. 1 in 4 people with Parkinson’s disease will receive a wrong diagnosis
Therefore, seeking a second and even a third opinion is essential in being assigned a correct and accurate diagnosis. It is a known fact that frequent exposure to paraquat in agricultural workers increases the risk of developing Parkinson’s disease by 250%.
Thereby, if you have a history of paraquat exposure, it is crucial to keep a close eye on your health for the symptoms of Parkinson’s disease.
A poll from the American Journal of Managed Care found that over 26% of people with Parkinson’s disease were initially misdiagnosed and 21% had to see their general healthcare provider 3 times before being referred to a specialist to have their health problem correctly diagnosed.
What is more alarming is that 48% of the participants received treatment for the wrong health condition, with 36% being prescribed medication and 6% undergoing surgical procedures. Consequently, a significant decline in the quality of life was noted in the misdiagnosed patients.
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What Is The Prognosis And Life Expectancy For Parkinson’s Disease
The severity of Parkinson’s disease symptoms and signs vary greatly from person to person, and it is not possible to predict how quickly the disease will progress.
- Parkinson’s disease itself is not a fatal disease, and the average life expectancy is similar to that of people without the disease.
- Secondary complications, such as pneumonia, falling-related injuries, and choking can lead to death.
- Many treatment options can reduce some of the symptoms and prolong the quality of life.
What Tests Might I Have
Your doctor may want to start by testing your blood or doing a brain scan to rule out other conditions.
People who have Parkinsonâs disease donât make enough of a brain chemical called dopamine, which helps you move. If those first tests donât show a reason for your symptoms, your doctor may ask you to try a medication called carbidopa-levodopa, which your brain can turn into dopamine. If your symptoms get much better after you start the drug, your doctor probably will tell you that you have Parkinsonâs disease.
If the medication doesnât work for you and thereâs no other explanation for your issues, your doctor might suggest an imaging test called a DaTscan. This uses a small amount of a radioactive drug and a special scanner, called a single photon emission computed tomography scanner, to see how much dopamine is in your brain. This test can’t tell you for sure that you have Parkinson’s disease, but it can give your doctor more information to work with.
It can take a long time for some people to get a diagnosis. You may need to see your neurologist regularly so they can keep an eye on your symptoms and eventually figure out whatâs behind them.
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Knowing That It Is Msa And Not Parkinsons Is Important
Over the years MSA Coalition Board Members have heard the frustration about a slow diagnosis after the initial diagnosis of Parkinsons.While MSA is fatal, knowing the correct diagnosis, is still important.
Multiple system atrophy affects multiple systems in the body.As a result, while there are not MSA specific treatments, treating the various symptoms from sleep disorders, urinary and bowel issues, blood pressure control, etc. can vastly improve quality of life. The earlier an MSA patient is diagnosed, the earlier doctors can establish a plan of action to improve symptoms that can be very disabling. Another factor is that Parkinsons medications typically stop working in MSA patients.
An early diagnosis also allows patients and their families to spend quality time together while they are still able.It also provides time to prepare for end-of-life issues, such as preparing wills and living wills.
A Decade Of Unnecessary Parkinsons Drugs Is Likely To Have Remodelled My Brain
A key issue is that I no longer have a convenient label for my symptoms. I had pre-existing joint and gastro issues that have worsened immeasurably during the past decade. My ability to concentrate, to function, to move, to be all worsened beyond comprehension. I have been told that nearly a decade of unnecessary Parkinsons drugs is likely to have remodelled my brain, through its innate neuroplasticity, so that it now considers the symptomatic side effects of those drugs normal for me. Just as hitting a tennis ball every day for 10 years will build up your ball-hitting skills, so the brain can be driven by drugs and their side effects into behaviours that it then reconfigures and learns as normal.
Writhing and contorting
Actually weaning myself off Stalevo a Parkinsons medication used to increase dopamine levels in the brain which I was taking eight times a day, was pretty terrifying. I was initially advised to drop one daily dose per week. By the second week I was writhing and contorting involuntarily not something I had ever done before. I was then asked to drop one daily dose per month. I took my last Stalevo dose on 25 October 2015.
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Caregiving For People Living With Parkinsons
Caring for a loved one with PD can be a challenging job, especially as the disease progresses. Former caregivers of a loved one with PD suggest doing the following : Get prepared, Take care of yourself, Get help , Work to maintain a good relationship with your loved one, and Encourage the person with PD for whom you care, to stay active.
Preparing for caregiving starts with education. Reading this fact sheet is a good start. More resources are available to you in theResources section of this fact sheet. Early Parkinsonâs disease usually requires more emotional support and less hands-on care. It is a good time for family members/caregivers to educate themselves about the disease.
What Genes Are Linked To Parkinsons Disease
Several genes have been definitively linked to PD:
- SNCA. This gene, which makes the protein alpha-synuclein, was the first gene identified to be associated with Parkinsons. Research findings by the National Institutes of Health and other institutions prompted studies of the role of alpha-synuclein in PD, which led to the discovery that Lewy bodies seen in all cases of PD contain clumps of alpha-synuclein. This discovery revealed the link between hereditary and sporadic forms of the disease.
- LRRK2. Mutations in LRRK2 were originally identified in several English and Basque families as a cause of a late-onset PD. Subsequent studies have identified mutations of this gene in other families with PD as well as in a small percentage of people with apparently sporadic PD. LRRK2 mutations are a major cause of PD in North Africa and the Middle East.
- DJ-1. This gene normally helps regulate gene activity and protect cells from oxidative stress and can cause rare, early forms of PD.
- PRKN . The parkin gene is translated into a protein that normally helps cells break down and recycle proteins.
- PINK1. PINK1 codes for a protein active in mitochondria. Mutations in this gene appear to increase susceptibility to cellular stress. PINK1 has been linked to early forms of PD.
- GBA . Mutations in GBA cause Gaucher disease , but different changes in this gene are associated with an increased risk for Parkinsons disease as well.
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Drug Therapy And Research
If the disease progresses beyond minor symptoms, drug treatment may be indicated. Drug therapy for Parkinsonâs typically provides relief for 10â15 years or more. The most commonly prescribed medication is L-dopa , and this helps replenish some of the depleted dopamine in the brain. Sinemet, a combination of levodopa and carbidopa, is the drug most doctors use to treat Parkinsonâs disease. Recent clinical studies have suggested, in the younger person, the class of drugs called âdopamine agonistsâ should be used prior to levodopa-carpidopa except in patients with cognitive problems or hallucinations. In those older than 75, dopamine agonists should be used cautiously because of an added risk of hallucinations.
Other drugs are also used, and new drugs are continually being tested. It is common for multiple drugs to be prescribed because many of them work well together to control symptoms and reduce side effects. Contrary to past beliefs, starting Sinemet in newly diagnosed people does not lead to early symptoms of dyskinesia . Current knowledge is that the disease progression causes dyskinesias, not a âresistanceâ to the drug.
Quality of life studies show that early treatment with dopaminergic medications improves daily functioning, prevents falls, and improves a personâs sense of well-being.
If Its Not Parkinsons Disease What Could It Be
Here are some possibilities:
Side effects of medication: Certain drugs used for mental illnesses like psychosis or major depression can bring on symptoms like the ones caused by Parkinsonâs disease. Anti-nausea drugs can, too, but they typically happen on both sides of your body at the same time. They usually go away a few weeks after you stop taking the medication.
Essential tremor: This is a common movement disorder that causes shaking, most often in your hands or arms. Itâs more noticeable when youâre using them, like when you eat or write. Tremors caused by Parkinsonâs disease usually happen when youâre not moving.
Progressive supranuclear palsy: People with this rare disease can have problems with balance, which may cause them to fall a lot. They donât tend to have tremors, but they do have blurry vision and issues with eye movement. These symptoms usually get worse faster than with Parkinson’s disease.
Normal pressure hydrocephalus : This happens when a certain kind of fluid builds up in your brain and causes pressure. People with NPH usually have trouble walking, a loss of bladder control, and dementia.
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Common Forms Of Dementia
Alzheimers disease symptoms include a progressive loss of recent memory problems with language, calculation, abstract thinking, and judgment depression or anxiety personality and behavioral changes and disorientation to time and place. LBD is frequently misdiagnosed as Alzheimers disease, especially in the early stage. Over time, changes in movement, hallucinations or RBD can help distinguish LBD from Alzheimers disease.Lewy body dementia is an umbrella term for a form of dementia that has three common presentations.
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Is It Lbd Or Something Else
Sometimes early dementia symptoms can be vague, making the type of dementia hard to identify. It may take several years for enough symptoms to develop to point to a specific type of dementia. By learning about common forms of dementia, you can help your physician most quickly identify what type of dementia has developed.
- Some types of dementia are reversible. They may be caused by an interaction of certain medications, a vitamin deficiency or a curable illness. If you are experiencing changes in your memory or cognitive abilities, please consult with a doctor to identify the cause and begin treatment immediately.
- For many types of dementia, there are no known cures. These types of dementia mainly affect older adults, though some people are diagnosed with early-onset dementia as young as their forties. Getting an early and accurate diagnosis along with appropriate treatment is very important since people with LBD often respond very differently to certain medications.
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Symptoms Of Parkinsons Disease
Parkinson’s disease has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include depression and other emotional changes difficulty swallowing, chewing, and speaking urinary problems or constipation skin problems and sleep disruptions.
Symptoms of Parkinsons and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson’s as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.
Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
Diagnosis Of Parkinsons Disease
A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.
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Symptoms Advancing Or Something Else
My dr. is out until mid Dec. I was dx in July of this year. On my last visit in Oct. she upped my carbidopa-levodopa to 1 1/2 pills 4x/day. I ve been very faithful in taking them 30 minutes before eating. I have very weak leg muscles even though I’m doing strengthening exercises and walking about 1/4 mile or as much as I can. I’ve had severe low back pain and hip pain with difficulty standing in place and with walking since 2002. I’ve gone from a cane, to a walker, to a manual wheelchair and now to a power chair. since my last visit with my PD dr. in Oct. my legs keep giving out on me and I fall, if I bend to pick up anything, my body doesn’t stop but rolls right down to the floor. I have no warning sign before my legs give out…..it just happens. My back and hip pain have increased and I just asked my PCP to increase my Vicodin. I am flat out exhausted as well. The increase in the carbidopa-levodopa has given me auditory hallucinations. My tremors have increased and are now on my right side as well. Sometimes my whole body – head to legs shake. I’m just looking for input or something if anyone can. Are my PD symptoms advancing or is this something else. I didn’t know who else to ask while my PD dr. is away. Any input is appreciated. Therese
Since the Carbidopa/Levodopa works best on an empty stomach, try taking it one hour before you eat. That may lessen the tremors.
Thank you. I’ll try taking it an hour before I eat, rather than just 1/2 hr.