Parkinson’s How To Diagnose

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

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.

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.

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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.

How Is Parkinson’s 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 Parkinson’s disease, symptoms can be treated with a combination of the following.

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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.

Medications For Other Symptoms Of Dementia

People with LBD may often experience a sleep disorder called rapid eye movement sleep behavior disorder. This can sometimes be treated with sedatives like clonazepam or with melatonin . Other more severe symptoms of LBD including fluctuating levels of alertness , hallucinations, agitation, severe confusion, and delirium can be challenging to treat. Doctors must first rule out underlying causes like infection or other medications that can be triggering these symptoms. If unable to find a treatable cause, doctors may use a low dose of the atypical antipsychotic medication quetiapine to treat these symptoms. However, people with LBD must not be given typical antipsychotics or high-potency atypical antipsychotics , as people with LBD are very sensitive to these medications and may develop neuroleptic malignant syndrome if they take them. This is a life-threatening condition that causes fever, muscle stiffness, and racing heart, and can lead to heart and kidney failure. Talk with your doctor about medication options.

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Incidence Of Parkinsons Disease

Its estimated that approximately four people per 1,000 in Australia have Parkinsons disease, with the incidence increasing to one in 100 over the age of 60. In Australia, there are approximately 80,000 people living with Parkinsons disease, with one in five of these people being diagnosed before the age of 50. In Victoria, more than 2,225 people are newly diagnosed with Parkinsons every year.

Understanding The Basics Of A Parkinsons And How It Affects The Body

A physician looks for the presence or absence of the possible symptoms of Parkinsons disease by interviewing the patient and performing a detailed neurologic examination. While there is presently no definitive test for Parkinsons, it can often be identified by a general neurologist, who is trained to diagnose and treat neurologic disorders. The first signs of parkinsons are often not motor-related, and a physician can help you come to a diagnosis.

To avoid misdiagnosis, consultation with a movement disorder specialist is recommended. After training in general neurology, a movement disorder specialist is a physician who has undergone subspecialty training in the diagnosis and treatment of movement disorders such as Parkinsons.

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Medicines For Parkinsons Disease

Medicines can help treat the symptoms of Parkinsons by:

• Increasing the level of dopamine in the brain
• Having an effect on other brain chemicals, such as neurotransmitters, which transfer information between brain cells
• Helping control non-movement symptoms

The main therapy for Parkinsons is levodopa. Nerve cells use levodopa to make dopamine to replenish the brains dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy such as nausea, vomiting, low blood pressure, and restlessness and reduces the amount of levodopa needed to improve symptoms.

People living with Parkinsons disease should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, like being unable to move or having difficulty breathing.

The doctor may prescribe other medicines to treat Parkinsons symptoms, including:

• Dopamine agonists to stimulate the production of dopamine in the brain
• Enzyme inhibitors to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain
• Amantadine to help reduce involuntary movements
• Anticholinergic drugs to reduce tremors and muscle rigidity

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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What Tests Will Be Done To Diagnose This Condition

When healthcare providers suspect Parkinsons disease or need to rule out other conditions, various imaging and diagnostic tests are possible. These include:

• Positron emission tomography scan.

New lab tests are possible

Researchers have found possible ways to test for possible indicators or Parkinsons disease. Both of these new tests involve the alpha-synuclein protein but test for it in new, unusual ways. While these tests cant tell you what conditions you have because of misfolded alpha-synuclein proteins, that information can still help your provider make a diagnosis.

The two tests use the following methods.

• Spinal tap. One of these tests looks for misfolded alpha-synuclein proteins in cerebrospinal fluid, which is the fluid that surrounds your brain and spinal cord. This test involves a spinal tap , where a healthcare provider inserts a needle into your spinal canal to collect some cerebrospinal fluid for testing.
• Skin biopsy. Another possible test involves a biopsy of surface nerve tissue. A biopsy includes collecting a small sample of your skin, including the nerves in the skin. The samples come from a spot on your back and two spots on your leg. Analyzing the samples can help determine if your alpha-synuclein has a certain kind of malfunction that could increase the risk of developing Parkinsons disease.

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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Causes Of Parkinsons Disease

At present, we do not know the cause of Parkinsons disease. In most people there is no family history of Parkinsons Researchers worldwide are investigating possible causes, including:

• environmental triggers, pesticides, toxins, chemicals
• genetic factors
• combinations of environment and genetic factors

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.

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Is Parkinsons Disease Inherited

Scientists have discovered gene mutations that are associated with Parkinsons disease.

There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.

Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.

Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.

How Is Parkinson’s Diagnosed

Current evidence suggests that Parkinsons tends to develop gradually. It may be many months, even years, before the symptoms become obvious enough for someone to go to the doctor.

This information looks at what parkinsonism is, how Parkinsons and other similar conditions may be diagnosed, and explains some of the tests that may be involved in the process.

Parkinsonism is a term used to describe symptoms or signs that are found in Parkinsons, but which can also be found in other conditions that cause slowness of movement, stiffness and tremor.

Most people with a form of parkinsonism have idiopathic Parkinsons disease, also known as Parkinsons. Idiopathic means the cause is unknown.

Other less common forms of parkinsonism include multiple system atrophy , progressive supranuclear palsy , drug-induced parkinsonism and vascular Parkinsons.

If youre concerned about symptoms youve been experiencing, you should visit your GP. If your GP suspects you have Parkinsons, clinical guidelines recommend they should refer you quickly to a specialist with experience in diagnosing the condition .

Its not always easy to diagnose the condition. So its important that you see a Parkinsons specialist to get an accurate diagnosis and to consider the best treatment options.

Diagnosing Parkinsons can take some time as there are other conditions, such as essential tremor , with similar symptoms. There is also currently no definitive test for diagnosing Parkinsons.

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Obtaining A Parkinson’s Disease Diagnosis

During the exam, the neurologist will look for cardinal symptoms of the disease. Facial expressions and features will be assessed. The doctor will look for signs of tremor while the patient is at rest. The doctor may watch how easily the patient stands up from sitting in a chair. The doctor may also stand behind the patient and gently pull back on the patients shoulders and look for how easily the patient can regain balance. Good responsiveness to levodopa also helps support the diagnosis of PD. However, taking levodopa may exclude patients from clinical studies that need to recruit recently diagnosed patients who have not yet had treatment . Participation in a clinical trial should be discussed with the doctor.

PD can be challenging to accurately diagnose, particularly in early stages of the disease, which is why a neurologist trained in movement disorders is critical. Approximately 5-10% of patients with PD are misdiagnosed, as many of the symptoms of PD are similar to other diseases. If the patient thinks that he or she has been misdiagnosed, a second opinion may help.1,2

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.

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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