Diagnosing Parkinson's Disease - An Overview

Not such an easy process!

Diagnosing PD not an easy prospect. Dr. S. Mathur

Some of you have ended up here at this site as a result of your search for answers. You’ve noticed your hand or finger is shaking or perhaps your arm no longer swings when you walk. Maybe you’re having trouble with your gait or your balance. It may be that you see similarities between yourself and a parent or grandparent or another relative that had been diagnosed with Parkinson’s Disease in the past.

Or it may be that you’ve seen a primary care physician and they’ve suggested that you go see a neurologist because of the possibility of such a diagnosis. Or perhaps you’re farther along in your diagnosis but just aren’t sure it’s the correct one. Regardless of how you ended up here, you are looking for more information regarding Parkinson’s Disease and how can this progressive, degenerative neurological disease be diagnosed?

A Brief History of Parkinson's

Although known since ancient times (an Indian Ayurvedic record recounts a similar constellation of symptoms in 10th century BC), Parkinson’s Disease was first described in detail as we know it, by James Parkinson in 1817. He wrote his famous description of patients with a shaking tremor, abnormal posture and gait, paralysis and diminished muscle strength in his publication “An Essay on the Shaking Palsy.” It was based on his close observation and documentation of six of his patients.

The role of diminished dopamine levels and the development of Sinemet followed in the 1960s, to date the gold standard treatment of this disease.

It is now ranked as the second most common neurological disease. An estimated 7 to 10 million people worldwide are affected by this disease. Given the lack of readily available and good health care in many parts of the world, underreporting by patients themselves, misdiagnosis and no global database, this number is very variable depending on the source.

Although Parkinson's disease ranks among the most common late-life neurodegenerative diseases affecting mainly people over the age of 65, 20% of people are under the age of 50 and what’s labeled as Young Onset Parkinson’s before age 40 occurs in 5-10% of people diagnosed.

No Definitive Diagnostic Test

Despite the ongoing progress of research, there is no definitive diagnostic test or curative treatment yet - the complexity of the disease hindering the development of both. Much of the evaluation you go through is clinical in nature with physicians using a series of questions and examination techniques as well as standardized scales to come to a diagnostic conclusion. Although neurologists and movement disorder specialist are fairly experienced and adept at diagnosing Parkinson’s Disease, it is still a subjective process to some extent and early stages of the disease may be difficult to conclude with certainty.

Once diagnosed, treatments can be implemented that help to control the motor symptoms to a significant degree although the line between symptom relief and sometimes debilitating side effects is quite fine.

  But before these can be started, the diagnosis has to be made. What do we as physicians look for?  What symptoms do we ask about? These topics will be explored in the next series of articles.

Continue Reading