Parkinson's disease can be challenging to diagnose,
because it shares signs and symptoms
with other conditions that affect the nervous system.
For example, multiple sclerosis, or MS,
can cause some similar symptoms.
The four main cardinal signs of Parkinson’s disease are:
• Shaking or tremor – especially in a hand or foot when you are relaxed;
• Unusually slow movements;
• Stiffness and resistance, or rigidity,
in your arms, legs, or the rest of your body; and
• Loss of balance – although this can be a symptom of later Parkinson’s disease.
There is no specific test for Parkinson’s disease.
Your doctor will determine if you have Parkinson’s
based on your medical history,
signs and symptoms and
a careful neurological examination.
To learn if you have Parkinson’s or another condition,
your doctor may ask you a series of questions
about your health and medical history.
They will also ask about the health
of other family members,
such as your parents, grandparents, aunts, and uncles.
Among other things, your doctor wants to know
if anyone in your family may have had Parkinson’s in the past.
Most Parkinson’s is related to a combination
of genetic factors and environment exposures.
Your doctor will also examine you carefully.
This should include observing for resting tremor
and slowness of movement that affects one side of the body more than the other,
as well as checking for stiffness in your limbs.
Additionally, he or she will look for any postural or balance issues.
The presence of 2 or 3 of these symptoms is suggestive of Parkinson’s.
In addition to the cardinal motor symptoms described earlier,
your doctor may want to determine the response
of your symptoms to Parkinson’s medications
such as levodopa, which replaces dopamine in the brain.
People with Parkinson’s have less dopamine
due to the loss of dopamine secreting neurons.
Improvement on Parkinson’s medications further supports the diagnosis.
Signs that may be inconsistent with a diagnosis of Parkinson's disease include:
• Only having symptoms in the legs and feet;
• A rapid deterioration of your walking and balance
that requires significant use of a walker or wheelchair
within 5 years of symptom onset; or
• Developing symptoms on both sides of your body all at once.
Besides your doctor's examination,
you might have an imaging test such as a brain MRI.
This does not show that what you have is definitely Parkinson’s disease,
but it screens for any structural abnormalities
that could cause similar symptoms.
Another imaging test is called a DaTscan.
A DaTScan examines the integrity of the dopamine system
by scanning the brain after injection of a dye through the vein
and watching it bind to the neurons that secrete dopamine.
Although a positive DaTScan alone
is not enough to diagnose Parkinson’s –
because other diseases and conditions
can produce a positive result –
it can help support the clinical diagnosis.
Other scans include PET scans
and functional MRI, which show brain activity.
However, these are not widely used for diagnosis
and are primarily used in the research setting.
Unfortunately, there is no simple test for Parkinson’s,
such as a blood test.
If you do have Parkinson’s,
your doctor will probably like to see you
anywhere from 3-6 months based on your symptoms,
to evaluate your symptoms and monitor treatment response.
After learning you have Parkinson's, however,
your first question might be, “How long will I live?”
In general, Parkinson’s is a disease that gets worse slowly,
so most people live about as long as normal.
Recently, researchers found that Parkinson’s tends
to shorten life expectancy by about one year.
With advancing Parkinson’s,
it is important to reduce the risk of falls
and screen for swallowing issues –
both of which places patients at risk
for life threatening injury such as hip fractures,
or infections, such as aspiration pneumonia.
Parkinson's affects each person differently.
For example,
people who get Parkinson’s at younger ages
tend to live with it longer and have a slower progression.
The presence of cognitive impairment,
depression, anxiety, and hallucinations
can also be seen in someone with longstanding Parkinson’s,
along with other non-motor symptoms
such as constipation,
blood pressure fluctuations,
urinary problems,
and sleep disorders
which can affect their quality of life.
Identifying and treating the non-motor symptoms of Parkinson’s are just as important
as managing the motor symptoms long term.
How long you live might depend on
how well your symptoms are controlled.
Talk to your doctor about the best treatments
to manage symptoms and slow down the disease.
Once you have it, Parkinson’s is a lifelong condition.
But with the right care,
you can make the most of your abilities
and live as fully as possible.