Symptoms for Diagnosing Parkinson’s Disease

• Diagnosis is made more difficult in the early stages of Parkinson’s disease since there may not be any of the typical symptoms initially and only a few non-specific symptoms may be present such as tiredness, depression, or mental slowness, which may be mistaken for normal signs of aging.
• Symptoms of Parkinson’s disease usually start on one side of the body but gradually affect both sides.
• Parkinson’s disease is a disease of old age, rarely starts before the age of 50 and is more common after the age of 65. However, early onset of Parkinson’s disease before the age of 40 years is possible.
• Of the three major signs – tremor, rigidity and bradykinesis – at least two need to be present to confirm the diagnosis of Parkinson’s disease.
• One of the earliest symptoms is tremor present at rest, starting in the upper limb and gradually involving the legs, mouth and tongue. It is a coarse tremor with a “pill rolling” action of thumb over fingers commonly referred to as the Parkinson’s tremor.
• The rigidity, or increased muscular tone, causes an increase in resistance to the passive stretching of muscles, which may be continuous and is called ‘lead pipe’ rigidity or may be interrupted by tremors and is then called ‘cogwheel’ rigidity.
• Bradykinesia, or slowness of initiation or repeating of movements, develops gradually and results in slowness of gait. Difficulty with fine rapid movements, especially of the fingers, results in problem in performing tasks such as shaving, fastening buttons or writing.
• Expressionless face, drooling, soft indistinct speech, and short shuffling steps are all features that may develop in Parkinson’s disease.
• Dementia may be a late feature of the disease, often associated with depression and psychosis.

Other diseases with similar symptoms like Parkinson’s disease

• Alzheimer’s disease – this is also a disease of old age and diagnosis may be further complicated since Alzheimer’s and Parkinson’s disease may co-exist.
• Diffuse vascular disease.
• Lewy body disease – here dementia is an early symptom.
• Essential tremor – tremor is more of the head, worsening on motion and less on rest
• Wilson’s disease
• Multiple system atrophy
• Drugs such as certain antipsychotics and antiepileptics.
• Hyperthyroidism

Final Diagnosis of  Parkinson’s Disease

• Diagnosis of Parkinson’s disease is based mainly on the history, symptoms, and neurological examination of the patient.
• Blood tests, EEG, CT scan or MRI of brain show no definite abnormality in patients with Parkinson’s disease but may be done to rule out other diseases.
• Levodopa challenge test – patients with Parkinson’s disease show dramatic and significant improvement on starting treatment with levodopa, thus differentiating them from other neurological diseases.

References

1. Diagnosing Parkinson’s Disease. University of Maryland
2. Parkinson’s Disease. Medline Plus

When a person is first diagnosed with Parkinson’s disease it can seem for them like the world is coming to an end, this isn’t the case however for once diagnosis is made although there isn’t a cure steps can be taken to treat it. Research into Parkinson’s disease is coming along in leaps and bounds and new drug treatments are being continually developed.

In the meantime there are several ways that the symptoms of those suffering from Parkinson’s disease can be helped. Here is some practical advice for those suffering from the disease and for their family and friends.

A person’s circumstances will differ

Everyone’s experience with Parkinson’s disease will vary greatly depending on their circumstances; the majority of sufferers will be over the age of 60, an age when various other health conditions can also have an affect on the disease.

Also the health of other people living in the same house will play a crucial role for instance if the person diagnosed as having Parkinson’s is already looking after a family member with an illness.

Younger people also get Parkinson’s disease and for these people different worries will surface, loss of earnings due to the progression of the disease, forced early retirement and coping with young children can all be issues.

The loved ones of sufferers

Family and friends of those diagnosed with the disease can be greatly affected, they will have thoughts and worries of how they will cope with their loved ones illness, particularly with its progressive nature.

If the person diagnosed is a younger person with young children then concerns of whether they should tell their children of the disease will be present. Family and friends may also not want to be the first to broach issues about the disease for fear of making their loved ones worse.

These are all concerns which can become overwhelming when not discussed openly, many people who have been diagnosed with this illness have found their worries are unfounded if they are broached and talked about with the sufferer instead of hiding them.

The outlook

What the future will bring of course will be foremost on the minds of those having being diagnosed with Parkinson’s disease, not only will the person worry what the future holds for them with the disease but also how their loved ones will cope.

Having a better understanding of the disease and the treatments for the disease will go a long way to easing worries and therapy not only for the sufferer but also their loved ones is advisable, therapy of this nature is usually by way of a family therapist, where the family as a whole can openly discuss with a therapist any worries and fears they may have.

There are many support and advice centres that can point you in the right direction and help you to gain an understanding of Parkinson’s disease and the outlook for those suffering.

Parkinson’s disease is a disease which affects the control of muscles and affects the movement, speech and posture. It is a degenerative disease of the body’s central nervous system and one which is often characterised by hand tremor, slow physical movement and rigidity of the muscles.

The excessive muscle contraction that is foremost in Parkinson’s disease is caused by insufficient formation of Dopamine, which is a chemical which is naturally produced in our body. While the majority of Parkinson’s disease has no known cause it can sometimes be caused through head trauma, toxicity, genes and other medical disorders.

The main symptoms of Parkinson’s disease

The number one symptom of Parkinson’s disease is how it affects the movement; other typical symptoms are mood disorders, changes in the behaviour, changes in the ways of thinking and changes in sensation. Symptoms occurring can range from person to person with progression of the disease also being distinctly individual.

The motor skills symptoms

The symptoms which are chiefly present are:

• Tremor – one of the most common symptoms of Parkinson’s disease is tremor of the hands, this is more noticeable when the hands are at complete rest. However it is thought that around 30% of the people who have Parkinson’s disease have very little tremor, these people are generally classed as akinetic-rigid.
• Rigidity – this includes stiffness of the joints and when combined with tremor will produce a ratchety rigidity when the limbs are passively moved.
• Akinesia – this is slowness or absence of movement * Postural instability – this often results in the person falling due to impaired balance down to the loss of postural reflexes.
• Shuffling – the person when walking will very often take short steps with their feet barely leaving the ground, very often the person will trip over small obstacles in their path.
• Problems turning – the person will keep their neck and trunk rigid when turning instead of just turning their head to look, this usually requires the person to take several small steps to make a turn.
• Stooped posture – in severe or progressive forms of Parkinson’s disease the person’s head and upper body may become bent at a right angle to the trunk.
• Speaking softly – the speech of the person may become hoarse, quiet and monotonous.
• Drooling – the person may often drool, this is thought to be down to the inability to swallow properly and the persons gait.
• Dysphagia – the person can lose all ability to swallow and this can lead to aspiration and eventually death.
• Fatigue – the person will easily get tired over 50% of sufferers are thought to be affected by tiredness and fatigue.

Non motor skill symptoms

• Depression – depression is thought to affect between 30 to 80% of all people suffering from Parkinson’s disease.
• Slowed reaction times – the persons voluntary and involuntary responses will show a significant delayed reaction.
• Dementia – dementia will often occur in about 20 to 40% of all people suffering, this will be a later development in the disease.
• Memory loss – memory loss is common particularly procedural memory loss rather than declarative.
• Pain – sufferers can experience pain in their joints, muscles and tendons.

Diagnosis

Currently there are no tests which can accurately determine Parkinson’s disease; it is usually diagnosed by way of medical history and a neurological examination. Parkinson’s disease is one disease that is hard to diagnose as the early onset and symptoms of the disease are often mistaken as the effects of normal ageing.

There are no specific tests used to aid in the diagnosis of Parkinson’s disease, a correct diagnosis relies on two out of three major signs being met. The three major signs of Parkinson’s are, tremor of limbs while resting, rigidity in the muscles and bradykinesia.

Other factors will also be taken into account such as the absence of secondary causes such as multiple small strokes and antipsychotic medication. Of the three conditions those suffering from Parkinson’s are usually more generally aware of tremor and bradykinesia.

In order to make a correct diagnosis the doctor will perform a neurological examination which is of a set standard. This examination will involve a variety of simple tests based on reactions, reflexes and movement.

The simple tests involve

• Testing for bradykinesia is determined by how quickly the person can tap their finger and thumb together or stamp their foot on the ground.
• Tremor is diagnosed by simple inspection of the hands at rest.
• Rigidity is testing by turning the patients neck, upper limbs and lower limbs while the patient is in a relaxed position.

Postural instability is tested by performing a pull test on the patient, during this test the patient will stand in front of the doctor and they will then ask the patient to try and maintain their balance while being pulled backwards towards the doctor. The pull will be made briskly in order to access the patient’s ability to recover, while of course making sure that the patient is actually prevented from falling.

The examination will take into account of course the full medical history of the patient, with care being taken for exposure to medications that could block the dopamine function of the brain. There are several other drugs which can have the same properties and your doctor will always ask for a full history of any medications you are not only currently taking but also those which the patient has taken in past years.

It is worthwhile mentioning that there are several other conditions which give very similar symptoms to Parkinson’s disease and which can sometimes be mistakenly diagnosed as Parkinson’s.

These include

• Essential tremor – the only symptom present in this disease is tremor.
• Progressive supraneuclear palsy – this disease is often characterized by the inability to look downward .
• Multiple system atrophy – this disease is characterized by prominent autonomic symptoms.
• Vascular parkinsonism – this is caused by the person having multiple small strokes.
• Carbon monoxide poisoning.
• Manganese poisoning.
• Certain pesticides.

Denial is often a major barrier when the person is first diagnosed with Parkinson’s disease, they will often refuse to admit they have the disease and refuse to even tell friends and family particularly if the disease is diagnosed in a younger person. The thought of going from a well individual to someone with a progressive chronic illness such as Parkinson’s is often unthinkable and unbearable for them.

Why does Parkinson’s disease happen?

During this early stage it is the psychological issues associated with the disease rather than the motor skills problems which will develop later, which have to be addressed first. Probably the biggest issue which the person will have to come to terms with is the reality that they won’t get better but only worse as the disease progresses. They will have to come to terms with and adjust to the fact that the treatment they receive will not make them better but rather help them to maintain functionality in life.

Fears for the future

The person suffering may refuse point blank to tell friends and even family members of the diagnosis in order to avoid being treated and labelled as an invalid. Many fear that they will be treated differently in society and by those they love; this fear will depend on factors such as the age of the person, the point in their life when the disease was diagnosed and fears of what the future will hold for them.

Many people who are diagnosed with this disease will ask themselves questions such as

• Will the disease interfere with my career.
• Will it interfere with my role as father or husband.
• Will it interfere with other relationships such as friends.
• How will it affect my independence.
• How quickly will the disease progress.
• Will I eventually become a total invalid.
• How will I manage this disease.

Any chronic illness which is progressive by nature will bring about certain fears and worries, this is only natural until the person realises and accepts the form of the disease and how treatment can help to control its advancements. Once they have done this they can regain some control over their life and adapt to the inevitable changes while recognising that at times they may need help from friends and family and they can adapt and live a full life.

As the disease progresses it is inevitable that the person will be faced with new fears and concerns and have difficulty in adjusting to the psychological changes that will occur. It is during this stage that people close to the person fully realise the disease and the problems associated with it.

Difficulties could include

• Increasing and persistent high levels of anxiety.
• Withdrawal from social activities.
• Intrusive thoughts.
• Anger.
• Depression.
• Hypersensitivity.
• Body self absorption.

When problems such as these start occurring help and advice should be taken from a therapist or Doctor, this can give the person and their loved ones insight and a better understanding of what is happening. Seeking help and advice isn’t a sign of weakness or failure by any means.