Parkinson's Disease Diagnosis: From Symptoms to Treatment Options

June 22, 2023

Coping with Illness

Parkinson’s Disease (PD) is a challenge for individuals, doctors, and researchers alike. While many questions about the disease—first recognized as a “shaking palsy” by London physician James Parkinson in 1817—have been answered, many more remain about its causes, diagnosis, and treatment.

Dr. Robert Martin, a neurologist and movement disorders specialist at Baystate Neurology, notes, “The image so many of us hold in our minds of PD—tremors, uncontrolled movement, and difficulty walking—really only reflects one stage of the disease. By the time someone has developed those symptoms, they’ve actually been living with the disease for a long time, often without realizing it.”

Martin likes to compare Parkinson’s disease to a slow-moving freight train. “You don’t wake up one day and have full-blown PD,” he explains. “Rather, it develops slowly over a long period of time. You add symptoms like a freight train adds cars. You slowly chug along with the signs growing stronger, louder, and greater in number. And like a train, the more cars, or symptoms, you add to it, the harder it is to stop. “Which is why, says Martin, recognizing the signs of Parkinson’s disease early is so important.

Causes, signs, and symptoms of Parkinson’s Disease

Parkinson’s disease is caused by an issue with cells in the midbrain. Martin explains, “The brain produces a number of proteins that keep the rest of the body functioning properly. Sometimes the proteins become mis-folded and begin to clump together. The trouble begins when those clumps interfere with cells that produce dopamine, a chemical that regulates movement. As less and less dopamine is produced, symptoms of PD emerge.”

Some of the earliest signs of Parkinson’s disease include:

Loss of smell
Constipation
Sleep disorders
Orthostatic hypotension (becoming lightheaded or passing out when moving from seated to standing position)
Mood disorders

Additional signs and symptoms that develop over time include:

Tremor in hands, arms, legs, jaw, or head
Muscle stiffness, where muscle remains contracted for a long time
Slowness of movement
Impaired balance and coordination, sometimes leading to falls

Martin notes, “Just because you have one of these symptoms does not mean you have Parkinson’s. Very often, symptoms are caused by a range of conditions, which are often lumped together under the umbrella term Parkinsonism. These conditions involve slowed movements, stiffness, and even a tremor at rest. Like PD, they tend to be lifelong conditions and are often treatable.”

Causes of non-PD Parkinsonism conditions include:

Drug side effects
Vascular disease
Trauma to brain
Stroke
Less often:
Dementia with Lewy bodies
Multiple systems atrophy
Progressive supranuclear palsy 
Corticobasal degeneration

Diagnosing Parkinson’s Disease

Because there is no one test that conclusively determines if someone has PD, making an accurate diagnosis can be complicated, especially in the early stages. Martin says, “The process of diagnosing PD is really a balance of identifying symptoms and ruling out other conditions.”

The current standard diagnosis of Parkinson’s disease begins with a physical examination, including a detailed review of a patient’s personal and family history, a review of symptoms, and, in some cases, diagnostic testing, such as a DaTscan.

The DaTscan involves an injection and imaging. Martin explains, “We inject a small amount of a radioactive drug into the patient. The drug travels to the brain and binds to dopamine transmitters in the brain which ‘light up’ on images we then take of the brain. While we can’t declare someone has PD from these images, the information moves us closer to it or to ruling out a condition that appears like PD.”

An exciting new development in Parkinson’s diagnosis is a test that looks for an abnormal protein in the skin. The test involves taking small samples of the skin from the thigh, just above the ankle, and the back of the neck. Patients do not require anesthesia and are usually in and out of the office in 30 minutes. The samples are sent to a specialized lab for testing with results ready within a month. Like the DaTscan, the test cannot provide a conclusive diagnosis of PD but does help differentiate between potential conditions.

Treatment options while living with Parkinson’s Disease

Because PD impacts people differently, possible treatment options vary. As Martin explains, “Individual patients develop varying degrees of disability over varying timelines. Issues can range from trouble walking, swallowing, thinking clearly, and issues with balance. The goal of treatment is to limit the complications those disabilities present.”

Regardless of symptoms, all patients are encouraged to engage in regularly physical exercise which has been shown to slow the progression of the disease.

Other Parkinson’s disease treatment options include:

Medication

There are numerous medications available to help with symptoms of Parkinson’s disease. Your doctor will work with you to determine the correct dosage and make necessary adjustments as the disease progresses. The decision as to when to start medication is up to the individual. Patients who begin medication in the early stages may not see much benefit as the brain is still actively working to compensate for the lack of dopamine. In later stages, medications typically take effect in 30-45 minutes and should be taken on a regular schedule to keep symptoms under control.

Various therapies

In addition to working with their doctor, patients are encouraged to engage as needed with a team of medical professionals to address specific issues. These might include:

movement specialist
physical therapist
occupational therapist
speech therapist
behavioral health specialist
social worker

For patients with advanced Parkinson’s disease, treatment options include:

Deep brain stimulation (DBS)

Essentially a pacemaker for the brain, a DBS device is implanted in the brain where it delivers a low current to the area of brain that was previously triggered by dopamine and works to restore some of the connectivity between the brain and body.

Intestinal gel

Operating much like an insulin pump for diabetes, this technology provides a continuous dosage of a prescribed medication delivered through a surgically implanted tube directly into the small intestine. The infusion provides a constant dose of medication over 16 hours each day, eliminating the need to take medication 3-5 times per day.

Focused ultrasound (FU)

A non-incisional surgical procedure, focused ultrasound involves using guided ultrasound beams to destroy tiny areas of cells that cause motor symptoms. Different areas of the brain are targeted for different symptoms. This therapy is ideal for patients who are unable to undergo the anesthesia necessary to implant a DBS device.

Finding support, finding answers

“My philosophy regarding PD is that it’s a life-long disease but it doesn’t have to be life-limiting,” says Martin. “With the right treatments and support, patients can remain engaged in their work, hobbies, and other activities that bring meaning to their life.”

For those looking for additional support and answers, Martin recommends the following online resources:

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