What Is Parkinson’s Disease
Parkinson’s disease is the second most common neurodegenerative disorder and the most common movement disorder. Characteristics of Parkinsons disease are progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance. As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks.
The progression of Parkinson’s disease and the degree of impairment vary from person to person. Many people with Parkinson’s disease live long productive lives, whereas others become disabled much more quickly. Complications of Parkinsons such as falling-related injuries or pneumonia. However, studies of patent populations with and without Parkinsons Disease suggest the life expectancy for people with the disease is about the same as the general population.
Most people who develop Parkinson’s disease are 60 years of age or older. Since overall life expectancy is rising, the number of individuals with Parkinson’s disease will increase in the future. Adult-onset Parkinson’s disease is most common, but early-onset Parkinson’s disease , and juvenile-onset Parkinson’s disease can occur.
Same Day Tests Assessments
There is no single test to diagnosis Parkinsons and reaching a conclusive diagnosis can take time. At Dementech Neurosciences London clinic we offer different levels of care to treat patients with Parkinsons. Because it is far more effective to prevent a disease, our approach involves risk assessments, prevention strategies and tools to manage symptoms and treat the condition and lessen its impact.
However, in cases where a diagnosis of a disease has been established, our multidisciplinary team will do everything possible to treat symptoms and prevent them from progressing further, improving the patients quality of life, emotional health and well-being.
How Do Treatments Differ
MS treatments can ease your symptoms during an attack or slow down the diseaseâs effects on your body.
Steroids like prednisone calm the inflammation that damages your nerves.
Plasma exchange is another therapy if steroids donât work. Your doctor will use a machine to remove the plasma portion of your blood. The plasma gets mixed with a protein solution and put back into your body.
Some people with both diseases who take anti-inflammatory medicines like steroids see their Parkinsonâs symptoms get better.
Disease-modifying treatments slow down MS nerve damage and disability. They include:
National Institute for Neurological Disorders and Stroke: âTremor Fact Sheet.â
Neurology: âParkinsonâs Disease in Multiple Sclerosis – A Population-Based, Nationwide Study in Denmark .â
Mayo Clinic: âMultiple Sclerosis: Overview,â âMultiple Sclerosis: Symptoms and Causes,â âMultiple Sclerosis: Treatment,â âParkinsonâs Disease: Causes,â âParkinsonâs Disease: Definition,â âParkinsonâs Disease: Risk Factors,â âParkinsonâs Disease: Symptoms.â
Christopher Reeve Foundation: âHow the spinal cord works.â
National Association for Continence: âParkinsonâs Disease.â
National Multiple Sclerosis Society: âMS Symptoms,â âWho Gets MS? .â
National Parkinson Foundation: âNon-Motor Symptoms.â
Multiple Sclerosis Trust: âLhermitteâs sign.â
Johns Hopkins Medicine: âPlasmapheresis.â
FDA.
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Which Test Can Be Done When The Diagnosis Is In Doubt
I request a small set of tests on almost all patients I diagnose with Parkinsons. These detect some mimics of Parkinsons disease.
Some doctors dont request all these tests. And for a good reason.
The diagnosis of Parkinsons mimics is primarily based on a careful history and examination. Even in my practice, these tests change the diagnosis only in a minority of patients.
I like the additional confirmation provided by these tests. They also have other benefits. For example, they help me determine the proper dosages of medications like Amantadine.
| Simple tests to detect Parkinsons Mimics |
|---|
| 1. MRI-Brain with size measurements of brain parts called the midbrain and pons. I usually also request a unique picture called SWI, which shows iron inside the brain.
2. Blood tests: |
But when the diagnosis s really in doubt, there is another brain scan that can be done.
A Trodat scan. Or even better an F-DOPA scan. Both these scans measure dopamine activity inside the brain.
You can read more about Trodat & F-DOPA scans by clicking here.
These scans are not perfect. Let me tell you why very quickly:
In Parkinsons disease, dopamine activity inside the brain is deficient. This deficiency produces an abnormal scan. If the Trodat/F-DOPA scan is normal, it is unlikely that you have Parkinsons disease.
What Are The Early Warning Signs Of Parkinsons Disease
Parkinsons disease typically causes a one-sided tremor, most obvious when at rest rather than engaged in an active task. The slowness of movement and muscle stiffness are also typical. The symptoms are often initially quite subtle and emerge slowly over a period of months. It is not unusual in my experience for someone with early-stage PD to have seen a rheumatology specialist for something like a frozen shoulder that is actually related to the muscle stiffness caused by PD.The typical clinical signs of PD that a neurologist will look for are slowness of repetitive movements , difficulty in initiation of movement , and a progressive reduction in the speed and amplitude of sequential movements , with muscular rigidity and a slow pill-rolling resting tremor.An early sign can be a reduced arm swing on walking, reduced facial expressiveness, a quietening of the voice and smaller handwriting. So-called non-motor signs can precede the problems with movement by months or even years and include depression, anxiety, constipation and a particular sleep disorder called REM sleep behaviour disorder, whereby an individual may act out dreams or start talking in their sleep.
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Whats The Difference Between Dementia With Lewy Bodies And Parkinsons
In dementia with Lewy bodies, dementia always appears first. There can also be changes in alertness as well as visual hallucinations. However, because of the presence of Lewy bodies throughout the entire brain, characteristics of this disease not only include cognitive characteristics, but also physical, sleep, and behavioral changes. As the disease progresses, the motor symptoms common to Parkinsons such as tremor, slowness, stiffness, and walking and balance problems will appear.
For more information on dementia with Lewy bodies, visit www.lbda.org.
The Connection Between Pd And Drug
In addition to potentially causing parkinsonism in the general population, these medications should definitely be avoided in people who have parkinsonism from other causes, such as PD. APDA has created a list of Medications to be Avoided or Used With Caution in Parkinsons Disease. It is important to note that there are anti-psychotics and anti-nausea medications which do not cause parkinsonism and can be used safely by people with PD.
Sometimes, a person without a diagnosis of PD is prescribed a medication which leads to a side effect of drug-induced parkinsonism. The prescribing physician may stop the new medication, but the parkinsonism does not resolve. The patient remains off the medication with continuing symptoms, and eventually is given a diagnosis of PD. In this scenario, that person most likely had dopamine depletion in the brain which had not yet manifested as a clinical symptom. The prescription medication that blocked the dopamine receptor, was the proverbial straw that broke the camels back, inducing the full-fledged symptoms of dopamine depletion and revealing that the person did in fact have PD.
The differences of PD vs drug-induced parkinsonism
There are key differences to note between parkinsonism from PD and parkinsonism as a side effect of medication.
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What Are The Symptoms Of Atypical Parkinsonian Disorders
Like classic Parkinsons disease, atypical Parkinsonian disorders cause muscle stiffness, tremor, and problems with walking/balance and fine motor coordination.
Patients with atypical Parkinsonism often have some degree of difficulty speaking or swallowing, and drooling can be a problem. Psychiatric disturbances such as agitation, anxiety or depression may also be part of the clinical picture.
Dementia with Lewy bodies can cause changes in attention or alertness over hours or days, often with long periods of sleep during the day. Visual hallucinations typically of small animals or children, or moving shadows in the periphery of the visual field are common in DLB. DLB is second only to Alzheimers disease as a cause of dementia in the elderly, and it most commonly affects patients in their 60s.
Patients with progressive supranuclear palsy may have difficulties with eye movements, particularly when looking downward, and with balance when descending stairs, for instance. Backward falls are common and may occur during the early course of the disease. PSP is not usually associated with tremor, unlike Parkinsons disease.
Parkinson’s Disease and Movement Disorders Center
What Looks Like Parkinsons But Isnt
Dr. Fernandez describes two main Parkinsons mimics:
Essential tremor. Also known as benign essential tremor or familial tremor, this movement disorder causes brief, uncontrollable shaking.
It most often affects your hands, but can also affect your head and neck, larynx and other areas. In rare cases, it affects your lower body as well.
But one clue can help distinguish essential tremor from Parkinsons.
This is not an absolute rule, but if shaking occurs at rest, it often is Parkinsons. And if shaking occurs in action, such as when youre writing or eating, it is essential tremor, Dr. Fernandez says.
About half of those with essential tremor have a family history of the condition.
Unlike Parkinsons, essential tremor is generally not perceived as a progressive disorder, and, if mild, may not require treatment.
Doctors can prescribe medications to reduce shaking, but they are not the same drugs used to treat Parkinsons, he says.
Drug-induced Parkinsons. Along with shaking, this condition may cause many symptoms similar to Parkinsons disease, including stiffness, slow movement, a decrease in facial expression and a change in speech.
As the name suggests, taking certain drugs, most commonly antipsychotics and mood stabilizers, can trigger this condition. How long it takes to develop can vary greatly, depending on which drug youre taking, how long you take it and the dosage.
Your doctor likely will treat drug-induced Parkinsons by adjusting your medication.
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Other Illnesses Mimic Parkinson’s
DEAR DR. DONOHUE: My brother-in-law and a close neighbor are both in their mid-70s. Both shuffle their feet when they walk and have a slight shaking of their arms and other symptoms regarded as Parkinson’s disease.
A short time ago, there was a segment on TV about these same symptoms, with an elderly man crossing the stage, stooped over, shaking and shuffling his feet. The announcer said he did not have Parkinson’s disease. The sickness was three initials. Everyone remembers the program, but no one remembers what those three initials are. Can you help me?
S.D.
ANSWER: The three major Parkinson’s signs are bradykinesia a Greek word whose literal translation is “slow movement” resting tremor and muscle rigidity. People with bradykinesia take a long time to start any movement and a long time to execute the movement. For instance, they take forever to get out of a chair, and they chew slowly. When they walk, they take short steps and barely swing their arms. The Parkinson’s disease tremor is a resting tremor. That means it comes on when the hands are idle, resting in the lap. Muscle rigidity is resistance to bending an arm when another person tries to bend it.
As the illness progresses, Parkinson’s patients often walk stooped over, with both knees bent, and take baby steps on their toes. Their gait may speed up uncontrollably as they walk. They’re prone to falling.
K.H.
K.H.
ANSWER: It’s not brazen to ask two questions, but I split them up as separate entries.
Whats The Difference Between Corticobasal Degeneration And Parkinsons
The main difference between CBD and Parkinsons is that it usually starts on one side with the gradual loss of use of one hand or leg , and there may be little flicks of involuntary muscle jerks. Walking and balance difficulties usually occur later in CBD than in Parkinsons. Also, in CBD, a person may have trouble with purposeful movements, such as buttoning a shirt or cutting food.
For more information on corticobasal degeneration, read this information page.
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Whats The Outlook For People With Parkinsons Plus
Although there currently isnt a treatment to halt the progression of Parkinsons plus syndrome, there are treatments that can help you manage your symptoms and improve your quality of life.
The exact outlook for Parkinsons plus syndrome depends on the person and the specific condition they have. Someone who is otherwise healthy when theyre diagnosed will typically have a longer life expectancy than someone who is already facing other health conditions when theyre diagnosed. Your doctor will monitor your condition over time and can let you know how its progressing.
What Are Atypical Parkinsonian Disorders
Atypical Parkinsonian disorders are progressive diseases that present with some of the signs and symptoms of Parkinsons disease, but that generally do not respond well to drug treatment with levodopa. They are associated with abnormal protein buildup within brain cells.
The term refers to several conditions, each affecting particular parts of the brain and showing a characteristic course:
- Dementia with Lewy bodies, characterized by an abnormal accumulation of alpha-synuclein protein in brain cells
- Progressive supranuclear palsy, involving tau protein buildup affecting the frontal lobes, brainstem, cerebellum and substantia nigra
- Multiple system atrophy, another synucleinopathy that affects the autonomic nervous system , substantia nigra and at times the cerebellum
- Corticobasal syndrome, a rare tauopathy that typically affects one side of the body more than the other and makes it difficult for patients to see and navigate through space
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Characteristics Of Atypical Msa: Parkinsons Disease Mimics
Case illustration
A 67-year-old female : presented with a 1-year history of worsening dexterity of her left hand. Examination revealed an asymmetrical tremor of the hand at rest with cogwheel rigidity and bradykinesia. Her symptoms and signs improved with levodopa therapy . Over the next 3 years, she developed motor fluctuations, generalized peak-dose dyskinesia, worsening dysarthria, urinary frequency and constipation. She also reported intermittent mild non-threatening visual hallucinations. Orofacial dystonia and urinary incontinence then became more intrusive. She died aged 75. The final clinical diagnosis was Parkinsons disease. Autopsy confirmed the pathological diagnosis of MSA . There were frequent depositions of neuritic plaques but no neurofibrillary tangles were found in the brain. Key clinical features of all Parkinsons disease mimics are provided in Supplementary Table 2.
Atypical MSA versus typical MSA or Parkinsons disease
Red flag features in atypical MSA versus typical MSA or Parkinsons disease
| Pathological diagnosis . |
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The Right Diagnosis Can Save Time
Because the symptoms of Parkinsons vary and often overlap other conditions, it is misdiagnosed up to 30% of the time, Dr. Fernandez says. Misdiagnosis is even more common in the early stages.
Patients who dont know where to turn may make appointments with a rheumatologist, or an orthopaedic or heart specialist, and undergo MRIs, EMGs and other expensive tests.
But only a neurologist can distinguish Parkinsons from essential tremor, drug-induced Parkinsons and Parkinsons plus syndromes, he says.
If patients come to us with typical signs of Parkinsons, we dont need to order expensive tests, he says.
Instead, neurologists base their diagnosis on a detailed patient exam and medical history, along with other information from the patient, family members or caregivers.
Thats all stirred into the pot, he says. Sometimes we can diagnose Parkinsons with one visit. Other times, several follow-up visits are necessary.
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What Are The Five Stages Of Parkinsons Disease
Neurologists use a number of scales and criteria to describe stages of PD. In my experience whilst these have clear utility in the context of observational research studies as well as prospective trials of treatment, on an individual basis they are not especially useful in day to day clinical practice. The key is to understand what the main symptoms affecting a persons quality of life are and to adjust treatment to try to improve those symptoms.If you are worried that either you or your loved one is showing early signs of Parkinsons disease, do not hesitate to book an appointment with Dr Paviour now for an assessment.
Parkinson’s Disease Diet And Nutrition
Maintaining Your Weight With Parkinson’s Disease
Malnutrition and weight maintenance is often an issue for people with Parkinson’s disease. Here are some tips to help you maintain a healthy weight.
- Weigh yourself once or twice a week, unless your doctor recommends weighing yourself often. If you are taking diuretics or steroids, such as prednisone, you should weigh yourself daily.
- If you have an unexplained weight gain or loss , contact your doctor. He or she may want to modify your food or fluid intake to help manage your condition.
- Avoid low-fat or low-calorie products. . Use whole milk, whole milk cheese, and yogurt.
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How Is Parkinsons Plus Diagnosed
People with Parkinsons plus syndrome are often diagnosed with Parkinsons disease in the early years of their condition. However, their condition wont progress like Parkinsons disease. It might progress faster, and they might start to develop symptoms that arent present in Parkinsons disease.
There is no definitive test for Parkinsons or Parkinsons plus syndrome. Instead, a doctor might conduct a series of tests that will look at your balance, ability to walk, and coordination. These are generally simple in-office tests involving the doctor watching you walk, sit, stand, and perform other movements. Youll likely also do some memory and cognition tests with the doctor.
The doctor might also order some imaging tests to get a closer look at your brain. These may include:
- MRI scan. An MRI uses magnetic waves to create images of your body.
- PET scan. A PET scan uses a special dye to look for damage to your brain.
- CT. A CT scan can check your brain activity.