How Do You Know You Have Parkinsons Disease
There is no definitive way to diagnose Parkinsons disease. Your doctor will ask questions about the onset of your symptoms and assess your movement to make referrals to specialists who can make a formal diagnosis.
You can expect to see a neurologist who can complete a neurologic examination. This may include brain imaging, an MRI, or a PET scan to see activity in the area of the brain typically affected by Parkinsons disease.
Your doctor may also refer you to a movement disorder specialist. Seeing subspecialists is very important to avoid being misdiagnosed. Highly trained specialists can provide their expertise in specific areas of medicine where a precise diagnosis isnt possible from blood work or another definitive test.
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 .
What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
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Datscan: A Test To Help In The Diagnosis Of Parkinsons
In 2011, the Food and Drug Administration approved an imaging test to help diagnose PD. In this test, a radioactive tracer, Ioflupane 123I, also known as DaTscan, is injected into the blood, where it circulates around the body and makes its way into the brain. It attaches itself to the dopamine transporter, a molecule found on dopamine neurons. Several hours after the tracer has been injected, special imaging equipment scans the head to detect the presence of DaTscan.
People with PD will typically have a smaller signal in a part of the brain called the striatum, where the ends of the dopamine neurons are meant to be. Here is a normal scan on the left, which would indicate a healthy dopamine system, next to an abnormal scan on the right, which would indicate an unhealthy dopamine system.
It is important to note that conventional MRI imaging will appear normal in PD and is therefore not helpful in confirming the diagnosis. Other atypical parkinsonian conditions, such as vascular parkinsonism however, can have abnormalities on MRI, so the test may be done to rule out other diagnoses.
A Skin Test For Parkinson’s Diagnosis
It may be possible to diagnose Parkinson’s disease with a skin test, a new study suggests.
For the study, researchers used a chemical assay to detect clumping of the protein alpha-synuclein, a hallmark of Parkinson’s disease, in autopsy skin samples taken from patients who had Parkinson’s disease confirmed by brain pathology and from controls without the disease. The test showed a high degree of sensitivity and specificity for the diagnosis of Parkinson’s.
The study was in the scientific journal Movement Disorders.
“This test has a lot of promise,” senior author Anumantha Kanthasamy, PhD, professor of biomedical sciences at Iowa State University in Ames, told Medscape Medical News.
“At present there are no peripheral biomarkers for Parkinson’s disease. The current diagnosis is just based on symptoms and the symptoms can be similar to many other neurological diseases,” he added. “It can take many years to establish a correct diagnosis and the accuracy is low even with experienced neurologists.”
Dr Anumantha Kanthasamy
If the current results can be replicated in samples from live patients and in those with very early stages of Parkinson’s, a skin test could allow early diagnosis and the possibility of starting preventive treatments to slow disease progression before symptoms develop too severely, the researchers suggest.
Dr Charles Adler
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How A Diagnosis Is Made
The bedside examination by a neurologist remains the first and most important diagnostic tool for Parkinsons disease . Researchers are working to develop a standard biological marker such as a blood test or an imaging scan that is sensitive and specific for Parkinsons disease.
A neurologist will make the diagnosis based on:
- A detailed history of symptoms, medical problems, current and past medications. Certain medical conditions, as well as some medications, can cause symptoms similar to Parkinsons.
- A detailed neurological examination during which a neurologist will ask you to perform tasks to assess the agility of arms and legs, muscle tone, gait and balance, to see if:
- Expression and speech are animated.
- Tremor can be observed in your extremities at rest or in action.
- There is stiffness in extremities or neck.
- You can maintain your balance and examine your posture.
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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Testing For Parkinson’s Disease
There are no blood tests or brain scans that can make the diagnosis of Parkinsons disease. Right now, the diagnosis of Parkinsons disease is still made based on the history and the examination.
In some cases, a doctor may order medical imaging such as a or an to make sure nothing else is happening, but these scans will not show any changes relating to Parkinsons disease.
In 2012, the FDA approved a special kind of brain scan called a DaT scan. In this scan, people receive an injection of a dye and then pictures show if there is a brain problem relating to the chemical dopamine. However, this scan was approved only to help figure out if someone with tremor has a disease in the Parkinson family or if their tremor might be related to a different disease called familial essential tremor.
Most of the time, a neurologist especially a movement disorders specialist can know if someone has a disease in the Parkinson family or familial essential tremor without doing this scan. It is also important to know that this scan cannot help a doctor know if a person has Parkinsons disease or one of the other parkinsonisms. Thus, this scan is only used in a few situations. It is not for everyone who might have Parkinsons disease.
In This Section:
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.
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What Happens At The Exam
If your doctor thinks you might have Parkinsonâs disease, theyll recommend that you see a specialist who works with nervous system issues, called a neurologist. One whoâs also trained in movement disorders, like Parkinsonâs, may be able to make the right diagnosis faster.
Your neurologist will probably want to see how well your arms and legs move and check your muscle tone and balance.
They may ask you to get out of a chair without using your arms for support, for example. They also may ask a few questions:
- What other medical conditions do you have now or have you had in the past?
- What medications do you take?
- Has your handwriting gotten smaller?
- Do you have trouble with buttons or getting dressed?
- Do your feet feel âstuckâ to the floor when you try to walk or turn?
- Do people say your voice is softer or your speech is slurred?
Tell your doctor if youâve noticed a change in your sense of smell or you have trouble with sleep, memory, or mood.
Parkinsonâs disease can look different from person to person. Many people have some symptoms and not others.
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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Diagnosing Early Onset Parkinsons Disease
There is no single test to detect Parkinsons. A diagnosis may be difficult and take a while. The condition is usually diagnosed by a neurologist based on a review of your symptoms and a physical exam.
A DaTscan to visualize your brains dopamine system may help confirm diagnosis. Blood tests and other imaging tests, such as an MRI scan, dont diagnose Parkinsons. However, they may be used to rule out other conditions.
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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What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early stage
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Mid stage
Mid-late stage
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Advanced stage
Testing For Parkinsons Disease
There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.
A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.
The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.
The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.
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Tests To Rule Out Other Conditions
Blood tests can help rule out other possible causes of the symptoms, such as abnormal thyroid hormone levels or liver damage.
An MRI or CT scan can check for signs of a stroke or brain tumor, which may cause similar symptoms.
Hydrocephalus due to atrophy can occur with some types of dementia and would be visible with one of these imaging tests. If the person has neurologic symptoms but a normal scan result, Parkinsons disease may be present.
The doctor a lumbar puncture to rule out inflammation or a brain infection.
Is It Parkinson’s Disease Blood Test Might Tell
But new technique needs more study, researchers say
HealthDay Reporter
WEDNESDAY, Feb. 8, 2017 — Measuring a particular blood protein might help doctors easily distinguish Parkinson’s disease from some similar disorders, a new study suggests.
The potential blood test is “not ready for prime time,” Parkinson’s disease experts said. But, it marks progress in the quest for an objective way to diagnose Parkinson’s and similar conditions known as atypical parkinsonian disorders, they noted.
Parkinson’s disease is a movement disorder that affects nearly 1 million people in the United States alone, according to the Parkinson’s Disease Foundation.
The root cause is unclear, but as the disease progresses, the brain loses cells that produce dopamine — a chemical that regulates movement. As a result, people suffer symptoms such as tremors, stiff limbs, and balance and coordination problems that gradually worsen over time.
Right now, there is no blood test, brain scan or other objective measure that can definitively diagnose Parkinson’s, said James Beck, vice president of scientific affairs for the Parkinson’s Disease Foundation.
“In general, Parkinson’s disease is diagnosed with a clinical exam,” Beck explained.
The best person to make that call is a neurologist with expertise in movement disorders, according to Beck.
“But,” he said, “even highly trained doctors initially get it wrong about 10 percent of the time.”
Neurology
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What Are The Pitfalls Of Datscan
DaTscan will appear abnormal in any disease in which there is a loss of dopamine nerve endings in the striatum. Therefore, Parkinson-plus syndromes, discussed in a prior blog, such as Progressive supranuclear palsy , Corticobasal ganglionic degeneration and Multiple system atrophy all typically demonstrate abnormal DaTscans. DaTscan therefore cannot be used to distinguish between these syndromes.
Every medical test has a false positive and a false negative rate. This means, that it is inevitable that in a certain percentage of people who have PD, the DaTscan will be read as normal and in a certain percentage of people without PD, the DaTscan will be read as abnormal. Results of any medical test that is performed, must therefore be considered within the entire clinical context.
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How Is Parkinsons Diagnosed
Doctors use your medical history and physical examination to diagnose Parkinson’s disease . No blood test, brain scan or other test can be used to make a definitive diagnosis of PD.
Researchers believe that in most people, Parkinson’s is caused by a combination of environmental and genetic factors. Certain environmental exposures, such as pesticides and head injury, are associated with an increased risk of PD. Still, most people have no clear exposure that doctors can point to as a straightforward cause. The same goes for genetics. Certain genetic mutations are linked to an increased risk of PD. But in the vast majority of people, Parkinsons is not directly related to a single genetic mutation. Learning more about the genetics of Parkinsons is one of our best chances to understand more about the disease and discover how to slow or stop its progression.
Aging is the greatest risk factor for Parkinsons, and the average age at diagnosis is 60. Still, some people get PD at 40 or younger.
Men are diagnosed with Parkinsons at a higher rate than women and whites more than other races. Researchers are studying these disparities to understand more about the disease and health care access and to improve inclusivity across care and research.
Aging is the greatest risk factor for Parkinsons, and the average age at diagnosis is 60. Still, some people get PD at 40 or younger.
The Michael J. Fox Foundation has made finding a test for Parkinsons disease one of our top priorities.
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