Diagnosing Parkinsons can be difficult. With no test available to diagnose the early signs of Parkinsons, observation over time is often necessary.
-The neurologist will also need a complete medical history, as well as a list of all current medications taken.
Next, a thorough neurological exam is necessary.
-An evaluation of the coordination, walking motion and simple hand movements of the individual is recorded.
Possible MRI or CT scans may be used under certain conditions, or if the patient is young. These may also help to rule out other disorders.
Dopamine and Other Considerations
How an individual responds to dopamine medications, and if a significant improvement in symptoms is seen while taking these medications, this may lead to the Parkinsons diagnosis.
-It's also important in diagnosing Parkinsons that there be at least 2 of the following primary symptoms present to consider a Parkinsons diagnosis:
-Bradykinesia: slowness of movement.
-Tremor: Shaking (more pronounced at rest).
-Rigidity: Stiffness of the body, arms or legs.
-Balance and coordination problems. (postural instability)
A Tremor Symptom occurring on one side, while at rest (or resting tremor) is the most common presentation in diagnosing Parkinsons.
Parkinsonism: Means that a person has signs similar to Parkinsons symptoms, but the symptoms may not be due to the degeneration of dopamine in the brain.
-About 15% of those with Parkinsons symptoms, do not have the disease.
-Brain Tumor: Depending on the location of the tumor, can cause many of the same symptoms of Parkinsons.
-Head Trauma: Due to a serious automobile or other accident or fall may result in a Parkinsons diagnosis.
-Wilson's Disease: A genetic disorder that has some Parkinsons symptoms, may exhibit tremors, liver dysfunction
-Progressive Supranuclear Palsy: Disorder with Parkinsons features in addition to abnormal eye movements and dementia.
Disorder with Parkinsonian features, also displays very low blood pressure when standing up (severe postural hypotension)
-Multiple Strokes: Located in the similar regions of the brain often associated with the signs of Parkinsons.
-Side Effects of Medications: Some anti-nausea and anti-psychotic medications may cause similar symptoms.
-Normal Pressure Hydrocephalus (NPH):
Fluid inside the brain that does not drain properly, that can result in a loss of bladder control, slower thinking, and a difficulty in walking.
-Essential Tremor (ET): In diagnosing Parkinsons, a resting tremor is a common symptom. This symptom is also present at times in essential tremor. It may begin at any age, but is more common in the elderly and usually affects both hands rather than just one side.
Essential tremor often includes a shaky characteristic in speech, as well as head tremors.
Research shows ET may possibly be a precursor in diagnosing Parkinsons or may be a risk factor for Parkinsons, as those with Essential Tremor have about a 4 times greater likelihood of a Parkinsons diagnosis.
Parkinsons Sub-Types - Stages of Parkinsons - Parkinsons Prognosis ______________________________________________________________
This is the most common type of Parkinsons diagnosis. Encompassing 75% of the cases seen. It usually starts with a slight hand tremor on one side only. It is also the most treatable with the best prognosis.
-PIGD (Partial Instability Gait Difficulty): Less common type, often begins with a shuffling gait, progresses to balance difficulties and falling.
PIGD progresses rapidly, and often does not respond well to Levodopa; as a result the prognosis for this type is not as favorable as with the tremor dominant type.
-It usually occurs with late onset Parkinsons disease.
By Age of Onset:
-Juvenile Parkinsons: As young as childhood, an extremely rare form.
-Young onset: Diagnosed in the 20's or 30's, usually tremor dominant.
More likely to be PIGD type with gait difficulties and balance problems early on (possibly cognitive), with dementia in the advanced stages.
-Stage 1: Symptoms typically appear, usually a tremor on 1 side only.
-Stage 2: The Parkinsons symptoms spread to both sides, balance and coordination is still fine.
-Stage 3: Mild to moderate stage, progression to problems with balance, but still functionally independent.
-Stage 4: Severely disabled, the person will need assistance at this stage of Parkinsons, but can still walk and stand independently.
At stage 5, the patient is bedridden or confined to a wheelchair.
Most people receiving a Parkinsons diagnosis are of the tremor dominant type, and this type responds well to Levodopa, although this varies for each individual.
-How long medications continue to relieve symptoms also varies, and the side effects of medications can also be quite severe for some over time.
Undetected and untreated, Parkinsons can leave a person totally disabled, and could lead to a deterioration of all brain functions, and an early death as a result.
-In the later stages of Parkinsons, complications from falls, choking, pneumonia, and various infections may lead to death.
Overall, life expectancy with Parkinsons disease is actually only slightly less than normal, with generally a better prognosis, the later in life in diagnosing Parkinsons.
Parkinsons progresses at much different rates for different people.
-It can be very difficult to predict the stages of Parkinsons for any given person; the progression may take over 20 years for one, and advance more quickly for another.
The Good News:
As demonstrated by Michael J. Fox, many can continue very productive lives for many years with treatment. (see video on treatments page.)
And, for those who remain involved in current activities, as well as with an eye towards the future, it truly appears to progress more slowly.
-A positive mental attitude and outlook can definitely go a long way!
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