Parkinson's Disease

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Diagnosis

Diagnosis is based on signs and symptoms and ruling out other disorders that produce similar symptoms. A patient must have two or more of the primary symptoms, one of which is a resting tremor or bradykinesia. In many cases, this diagnosis is made after observing that symptoms have developed and become established over a period of time.

After a thorough neurological exam and medical history, the neurologist may order computerized tomography (CT scan) or magnetic resonance imaging (MRI scan) to meet the other criterion for a diagnosis of Parkinson's disease: ruling out disorders (e.g., brain tumor, stroke) that produce parkinsonian symptoms.

As noted earlier, even experienced neurologists often find it difficult to diagnose the early stages of Parkinson's disease accurately. No blood or laboratory tests presently exist to aid in diagnosis, and the physician must rely on his or her observation of the patient. In many cases this must be done over a period of time, typically as tremor or other classic symptoms becomes consistently present. Accurate diagnosis is crucial, because other forms of parkinsonism often have similar features, but require different treatments.

In many cases, after a thorough neurological exam and history are performed, the neurologist can make a presumptive diagnosis of PD. There are a number of other disorders, which have some similar features and can be mistaken for Parkinson's disease. Specific diagnostic testing can rule these out in most cases. CT scan (computerized tomography) and MRI scan (magnetic resonance imaging) are often performed.

They can rule out brain tumor, stroke or other focal lesions that may cause a similar clinical picture. Laboratory analysis may also be done, looking for particular blood abnormalities that may be associated with other disorders.

Other Disorders with Similar Symptoms

The term Parkinsonism is used to describe the clinical features that are seen in true Parkinson's Disease, but occur because of some other etiology.

These other causes of rigidity, bradykinesia and in some cases of tremor, include:

• Side effects of medications: such as antipsychotic medications, and anti-nausea medications
• Multiple strokes located in the basal ganglia and appropriate brain regions
• Progressive supranuclear palsy a disorder with Parkinsonian features, plus dementia and abnormal movements of the eyes
• Shy-Drager Syndrome a disorder with Parkinsonian features plus severe orthostatic hypotension (low blood pressure when standing upright)
• Wilsons Disease a genetic disorder with some Parkinsonian features, liver dysfunction and tremors.

Parkinson's Disease, Diagnosis reprinted with permission from neurologychannel.com
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