»   How A Diagnosis Is Made

  »   Conditions That Mimic Parkinson's

  »   Coping With A Diagnosis

There is no "one way" to diagnose Parkinson's Disease (PD). However, there are various symptoms and diagnostic tests used in combination to confirm this. Making an accurate diagnosis of Parkinson's Disease, particularly in its early stages, is very difficult, but a skilled practitioner can come to a reasoned conclusion that it is Parkinson's Disease. It is important to remember that two of the four main symptoms must be present over a period of time for a neurologist to consider a Parkinson's Diagnosis:

  »  Shaking or Tremor
  »  Slowness of Movement, called Bradykinesia
  »  Stiffness or Rigidity of the arms, legs or trunk
  »  Trouble with Balance and Possible Falls, also called Postural Instability

Often, a Parkinson's Disease diagnosis is first made by a General Practitioner (GP). Many people seek an additional opinion from a neurologist with experience and specific training in the assessment and treatment of Parkinson's. This is referred to as a Movement Disorder Specialist.

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How A Diagnosis Is Made

The bedside examination by a neurologist remains the first and most important diagnostic tool for Parkinson's Disease. Researchers are working to develop a standard biological marker such as a blood test or an imaging scan that is sensitive and specific for Parkinson's Disease.

A neurologist will make the diagnosis based on:
  »   A detailed history of symptoms, medical problems, current and past medications. Certain medical conditions, as well as some medications, can cause symptoms similar to Parkinson's Disease.
  »   A detailed neurological examination during which a neurologist will ask you to perform tasks to assess the agility of arms and legs, muscle tone, gait and balance, to see if:
    -  Expression and Speech are animated
    -  Tremor can be observed in your extremities at rest or in action
    -  There is stiffness in extremities or neck
    -  You can maintain your balance and examine your posture
  »   You may notice that a neurologist records your exam into a table, called Unified Parkinson's Disease Rating Scale (UPDRS). This is a universal scale used by neurologists and movement disorder specialists to comprehensively assess and document the exam of a person with Parkinson's Disease at a baseline, judge the effect of medication and track the progression of disease during future visits.
  »   Most commonly, people with Parkinson's Disease respond well to dopaminergic medications. Lack of response to medications may prompt the doctor to seek an alternative diagnosis such as atypical parkinsonism and order further testing such as an MRI of the brain.
  »   When unsure of a diagnosis, neurologists often refer patients to a movement specialist and order DAT scans.

What is a DAT Scan and What role does it play in a Parkinson's Diagnosis? DAT Scan

A DAT Scan is an imaging technology that uses small amounts of a radioactive drug to help determine how much dopamine is available in a person's brain. A SPECT Scanner is used to measure the amount and location of the drug in the brain.

While a DAT Scan cannot diagnose Parkinson's Disease, doctors can use them to confirm a diagnosis. A negative DAT scan result does not rule out a Parkinson's Diagnosis, but a positive result helps confirm it. The problem with positive results is that is does not differentiate Parkinson's Disease from other forms of Parkinsonism, such as multiple system atrophy (MSA) or Progressive Supranuclear Palsy (PSP), that can also produce a loss of dopamine in the brain. A positive DAT scan can differentiate Parkinson's Disease from Essential Tremor (ET) as there is no dopamine deficiency in the latter.

Are the risks associated with DAT Scans?

Possible adverse reactions such as headache, nausea, vertigo, dry mouth and mild to moderate dizziness were reported, hypersensitivity reaction adn injection site pain have also been reported.

I have Parkinson's Disease and Several Symptoms. Should I get a DAT scan?

Likely no. There is no need for a DAT Scan when your history and exam suggests Parkinson's Disease and you meet the diagnostic criteria. Occasionally, if signs and symptoms are mild or you don't meet the diagnostic criteria then your neurologist or movement disorder specialist will refer you for a DAT Scan. Keep in mind that ultimately the diagnosis is based on your history and physical exam and the DAT Scan is most commonly used to complete the whole examination and is not a necessary test for a diagnosis.

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Conditions that Mimic Parkinson's Disease

Parkinsonism is a term used to describe the collection of signs and symptoms found in Parkinson's Disease patients. These include slowness (bradykinesia(, stiffness (rigidity), tremor and imbalance (postural instability). Conditions other than Parkinson1s Disease may have one or more of these symptoms which mimic Parkinsons Disease.

Essential Tremor
  »   Essential Tremor (ET) is common amongst the elderly population, however it may begin at any age.
  »   Different from the Parkinson's tremor in that is generally affects both hands, often involving head tremor and a shaky quality to the voice.
  »   It is thought to be a different condition from Parkinson's although some of the symptoms can overlap.
  »   Research has suggested that those with ET may be at a higher risk of developing Parkinson's Disase than the general population.
  »   The diagnosis of Essential Tremor is clinical and treatment is generally with medications, though surgery can be used in severe cases.

Normal Pressure Hydrocephalus
  »   A person with Normal Pressure Hydrocephalus (NPH) has fluid inside the brain that does not drain properly. This results in difficulty in walking, slowed thinking and loss of bladder control.
  »   Specialized brain scans(lumbar puncture and a physical examination can lead to a diagnosis.
  »   Treatment often involves surgery where a shunt is placed to help drain excess fluid.

Dementia with Lewy Bodies
  »   Dementia with Lewy Bodies (DLB) is a progressive, neurodegenerative disorder in which abnormal deposits of a protein called alpha-synuclein build up in multiple areas of the brain.
  »   DLB first causes progressive problems with memory and fluctuations in thinking in thinking as well as hallucinations. These symptoms are joined later in the course of the disease by parkinsonism with slowness, stiffness and other symptoms similar to Parkinson's Disease.
  »   While the same abnormal protein is found in the brains of those with Parkinson's Disease, when individuals with Parkinson's develop memory and thinking problems it tends to occur later in the course of their disease.
  »   There is no specific treatments for DLB. Treatment focuses on managing the symptoms.

Multiple System Atrophy
  »   Multiple System Atrophy (MSA) may resemble Parkinson's Disease parkinsonism, but comes with additional symptoms and signs.
  »   Symptoms include incoordination (ataxia) and dysfunction in the autonomic nervous system, which automatically controls things such as blood pressure and bladder function. Diagnosis is made based on clinical features. There is no specific test that provides a definitive diagnosis.
  »   There is no specific treatment for MSA. Treatments focus on alleviating the symptoms.

Corticobasal Syndrome
  »   Corticobasal Syndrome (CBS) is a rare disease. It usually begins with symptoms affecting one limb.
  »  In addition to parkinsonism, other symptoms include abnormal posturing of the affected limb (dystonia), fast & jerky movements (myoclonus), difficulty with some motor tasks despite normal muscle strength (apraxia), difficulty with language (aphasia) among others.
  »   There is no specific test to diagnose CBD and the treatments focus on alleviating the symptoms produced.

Progressive Supranuclear Palsy
  »   Progressive supranuclear palsy (PSP) is a disease that mimics Parkinson's Disease. Particularly in the early course but thaht comes with additional distinctive signs and symptoms.
  »  Individuals with PSP may fall frequently early in the course of the disease. Later symptoms include limitation in eye movements, particularly looking up and down. This contributes to falls.
  »   Those with PSP also often have problems with swallowing (dysphagia), difficulty in producing speech (dysarthria), sleep problems and thinking problems

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Coping With A Diagnosis

When you or a fmaily member is diagnosed with Parkinson's Disease (PD), you will experience a range of emotions and go through several stages of adjustment to the disease. As Parkinson's Disase progresses, bringing new challenges, you will go through many of the emotions and stages of adjustment anew. Each person experiences stages in their own order and at their own pace. Remember, everything you feel is normal.

Denial, Disbelief, Shock
  »   This reponse may be prolonges if symptoms are mild or the correct diagnosis is not made early after symptoms arise.
  »   Denial can be a useful coping mechanism if it allows you to largely ignore symptoms and go on with life as usual. However, if denial leads to the refusal to take medication or go to extremes seeking second opinions, it may indicate denial as an unhealthy response.

What To Do

  »  Take time to explore your feelings and be honest with yourself and others. Journalling or telling your story may help.
  »   Knowledge is power. Learn about Parkinson's and focus on abilities rather than inabilities.
  »   Remember, each person's Parkinson's Disease experience is unique.

Discouragement, Searching for an Explanation

  »   In this phase, people look for some direct cause for the health problems they are experiencing
  »   You might become preoccupied with asking yourself "why me?"|, while searching for something or somebody to blame for the unwanted circumstances occuring in your life.

What To Do

  »   Symptoms of depression are common in any stage of Parkinson's Disease. In some cases, depression is an early symptoms. Don't be afraid to tell your doctor if you feel depressed.

Shifting Abilities, Role Reversals

  »   People with Parkinson's Disease often need more time to perform activities because of changes in hand coordination, muscle stiffness or slowness. Conflict may arise as it becomes necessary to reevaluate who is responsible for what tasks in the family and around the home.
  »   Changing abilities and assuming new roles can cause frustration and emotional upheaval.
  »   Stress can make Parkinson's Disease symptoms worse.

What To Do

  »   Maintain open communication with your loved ones.
  »   Prioritize daily tasks. Get outside help as needed for some tasks such as yard work, hoursecleaning or home maintenance.
  »   Regular exercise can help manage stress.
  »   Seek help from a counsellor to resolve relationship conflicts.

Identity Change

  »   At this stage you may realize that Parkinson's Disease has impacted on your life.
  »   You are willing to take on the work of achieving your optimal level of independence.
  »   You are also willing to seek out others with the same condition for education and encouragement.

What To Do

  »   Explore new opportunities to find self-fulfillment
  »  Adapt to the new circumstances
  »   You once again feel some control in your life
  »   Take an active role in your health and care. Work with you health care providers to optimize your medications
  »   Communicate openly about your priorities
  »   Set realistic expectations

Remember that you are not alone. There are many people in the Isle of Man and UK and an estimated 10 million people worldwide live with Parkinson's Disease. These estimates do not account for cases of Parkinson's Disease that are unreported, undiagnosed or misdiagnosed. With a diagnosis now in hand and the freedom to learn at your own pace, you can begin to understand Parkinson's Disease and its treatments and the role they will play in your life. Your diagnosis can be the first setp to taking charge of your life with Parkinson's Disease. What are some next steps?

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