Parkinson’s Diagnostic Overview; A New Neurodegenerative Aid
Navigating the diagnosis of a potential or confirmed Parkinson’s disease case can leave the mind reeling and the heart overwhelmed. Questions abound, and it is difficult to determine which path on the journey is best to take. Well, you have come to the right place! This post will provide some fascinating insights into this debilitating neurodegenerative condition. We’ll examine how it can be identified, categorized, and managed.
Parkinson’s disease (PD) is a movement disorder. Most of you have probably seen someone with Parkinson’s disease at some point in your life.
When you think of Parkinson’s Disease, what comes to mind most likely is a tremor. It may be surprising – but over 70% of people with the disease do, in fact, experience tremors. This particular type is known as a resting tremor, and it can range from mild twitches to larger movements.
When the hands are gently rested, for example, on the lap, then the tremor tends to appear. We call this a pill-rolling tremor. It has a certain frequency and a certain pattern. This tremor may disappear as soon as the person starts to use their hands.
This is very different from an essential tremor, which is not a tremor at rest. An essential tremor appears as the person starts to move their hands or hold their hands in a certain position. Therefore, a person with essential tremors often says, “I struggle to bring a cup of coffee to my mouth without spilling it,” for example.
Moving with Parkinson’s
There are many other characteristic features of Parkinson’s disease.
I think of one as a syndrome whereby the person appears rigid and has a slowness or paucity of movement. We call it bradykinesia.
They have what’s called a masked facial expression. Some may, in fact, have difficulty with their voice—either it gets almost slurred or it stutters. You may even see some drooling. This is a part of the difficulty with swallowing aspect of Parkinson’s disease.
There are also effects on their gait and posture. There’s typically a forward-leaning posture. The gait itself is described as shuffling. People with Parkinson’s often experience a quirky phenomenon as they move forward—it almost feels like they’re racing across the ground, yet that same momentum can make them lose their balance when coming to an abrupt stop. It appears this awkward dance keeps repeating itself.
As a neurologist, it can be truly eye-opening to observe someone living with Parkinson’s. From the outside, I might see an imbalance in arm swing where one side of the body is more rigid, swings less, and shows signs of tremor. It really brings home how this condition has such varied effects on each individual.
But, again, tremor does not always have to be present on the exam for the person to be diagnosed with Parkinson’s Disease.
When it comes to Parkinson’s, finding a diagnosis can be an incredibly frustrating experience for the patient. However, what’s key here is that diagnosing this condition usually involves more than just one specific test; instead, professionals rely on taking a close look at medical history and physical tests too, which helps give them an all-inclusive understanding of the case.
I understand how many people prefer treatment that doesn’t involve medication. However, I want to make a point about a specific medication called Carbidopa/levodopa (AKA levocarb and co-careldopa) or Sinemet®. This is the gold standard for the treatment of Parkinson’s disease. Oftentimes, when neurologists suspect the diagnosis of Parkinson’s, they will prescribe this drug. A robust response to levodopa, at least early on in the disease, really supports the suspicion of the diagnosis. Personally, I call it a diagnostic/therapeutic challenge.
But here’s the rub: A trained neurologist can accurately diagnose Parkinson’s and tailor a personalized approach to treatment, whether it be conventional medicine, physical therapy with an allied health professional, or our innovative Brain Tune-Up program. No matter your needs, there is something here for everyone!
However, there are times when the diagnosis of Parkinson’s disease is challenging. And there may even be some hesitation to offer diagnostic, therapeutic, and drug challenges. So we really look for an alternative to make the diagnosis of Parkinson’s disease and Parkinson’s-related disorders of the brain.
A Neurodegenerative Disorder
Now, why do I say: “Parkinson’s-related disorders of the brain”? It is because, first of all, it’s important to remember that Parkinson’s disease is a neurodegenerative disorder.
In other words, ultimately what happens in Parkinson’s disease is the loss of nerve cells in a specific area at the top of the brain stem, called the substantia nigra. The substantia nigra is dense with neurons that produce the neurotransmitter dopamine. It is said that by the time a person is just diagnosed with Parkinson’s (we’re talking about early-stage Parkinson’s disease), they have lost as many as 50 to 80% of their dopamine-producing cells in the brain.
While Parkinson’s disease is distinct in its neurological decline, there are a number of conditions that have overlapping features. Some other neurodegenerative diseases bear similarities to PD and may initially be confused about it; however, these aren’t the only potential lookalikes out there—there are non-neurodegenerative disorders with similar characteristics as well.
For example, it’s possible to have a patient come into the clinic with a very complex tremor presentation, and the neurologist is not completely sure whether this tremor is an essential tremor or whether it’s Parkinson’s disease. There are other situations where drugs are prescribed to treat unrelated conditions, such as schizophrenia, gut dysmotility (the GI tract isn’t moving as it should), or bipolar disorder. These drugs can, over time, trigger Drug-Induced Parkinsonism. This is distinct from the neurodegenerative Parkinsonism disorders.
Neurodegenerative Parkinsonism disorders include Lewy Body Dementia (LBD) or Lewy Body disease, and a group of disorders lumped together under a broad heading called Multiple Systems Atrophy (Multiple System Atrophy, sometimes also called Multisystem Atrophy).
All neurodegenerative Parkinsonism disorders can be identified through an analysis of the Lewy body, a protein composed of Alpha-synuclein that is easily discovered under both light and electron microscopes. Depending on which of these neurodegenerative Parkinsonism disorders a person has, the distribution of Lewy bodies or Alpha-synuclein in the brain may be different. But they’re all characterized by Alpha-synuclein.
What is also very interesting is Alpha-synuclein in its insoluble form (the form that we find in diseases like Parkinson’s Disease), is found in other parts of the body. It’s similarly interesting to note that Alpha-synuclein has been found in the digestive tract as well as in the skin layers. Some recent reports suggest we may be able to diagnose Parkinson’s disease or those at risk for developing the condition by doing a stool analysis looking for Alpha-synuclein.
Differentiating between Parkinson’s Disease, essential tremor, and drug-induced Parkinsonism can be a tricky endeavor. In times gone by—and up until now—if I suspected that my patient could have any one (or all!) of these conditions, I would send them off for specialized nuclear medicine scans, which give us a more accurate insight into their situation. This helps me ensure an informed diagnosis is made so they receive appropriate treatment.
The Dopamine Transporter Scan
The specialized nuclear medicine scan is called a DaTscan (dopamine transporter scan). This is a type of nuclear medicine scan that goes under the broad term Single Photon Emission Computerized Tomography (SPECT). This relates to a specific nuclear medicine tracer produced by General Electric.
For me to confirm or rule out a suspicion of Parkinson’s disease, I would have been sending my patients for DaTscans over the years. I recommend this for the more complicated cases or situations where the person is just not comfortable with a bedside diagnosis and wants a more objective confirmation.
Let me tell you some exciting news: no more expensive scans or exposure to radioactivity. We now have a way for doctors like myself to identify the presence of this insoluble alpha-synuclein protein in the layers of your skin with an easy, nearly painless procedure called a skin punch biopsy. All that’s required is one trip to my office, and it can be done safely and quickly.
In conclusion, being diagnosed with a neurodegenerative disorder like Parkinson’s Disease is overwhelming and a bit frightening. However, with today’s technology and medical leaps forward, we are able to take steps towards understanding how it works and managing it for better health. Tremors, difficulty moving, and the accumulation of alpha-synuclein proteins can be effectively detected through new, compassionate innovations. After reading this blog post, you should now feel more informed on how PD is diagnosed and have an idea of what medical professionals are looking for. Ultimately, this information should leave you feeling more confident in taking control of your healthcare outcomes. Don’t hesitate to reach out for an experienced team on your side—schedule a discovery call today to learn more about what the diagnosis process may look like for you!
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DISCLAIMER: The information in this email is not intended nor implied to be a substitute for professional medical advice, diagnosis, or treatment. All content is for general informational purposes only and does not replace a consultation with your own doctor/health professional