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Parkinson's Disease: Parkinson's Early Symptoms

Description

An in-depth report on the causes, diagnosis, and treatment of Parkinson's Disease

Alternative Names

Pallidotomy

Diagnosis of Parkinson's Early Symptoms

It is difficult to diagnose Parkinson's in early stages. At this time the disease is diagnosed almost primarily by its symptoms, and studies indicate that physicians make an incorrect initial diagnosis of Parkinson's disease in between 8% and 35% of cases. Even general neurologists have difficulties in correctly identifying the disease. Researchers are hopeful that objective and simple blood or imaging tests will be available in the near future to identify the disease early in its development.

Medical and Personal History

A medical and personal history should include any relevant symptoms as well as any medications being taken, and exposure to environmental toxins is very important.

Diagnosing by Symptoms

Parkinson's Early Symptoms. Early treatment may help slow progression, so an early diagnosis of Parkinson's is highly desirable. Parkinson's early symptoms are often mild however, so Parkinson's disease can be missed, particularly in young adults. Repeated assessment of symptoms over time is important to improving the accuracy of diagnosis. Too often, for example, a younger person with Parkinson's may be diagnosed with mental illness, because even the physician may suspect the disease only in older people.

Parkinson's may be suspected in patients with the following symptoms:

  • Slowness and difficulty of movement. These are usually the first symptoms, so the patient will be asked to walk and probably to get out of a chair, preferably a deep one. (Early gait disturbance, however, often indicates a disease other than Parkinson's disease.)
  • A tremor when their limb is relaxed. (As many as 25% of Parkinson's patients, however, will not have a tremor.)
  • Symptoms on one side of the body.
  • A powerful early response to the drug levodopa (the primary treatment for Parkinson's). It should be noted that some patients with a very similar condition called multiple system atrophy will have a good initial response to levodopa, but it is not usually sustained.

Later Symptoms. In later stages of Parkinson's disease, the symptoms are usually unmistakable, and the problem can often be diagnosed using simple physical tests and a medical and personal history.

Imaging Techniques

Imaging techniques, such as computerized tomography (CT), magnetic resonance imaging (MRI), or positron-emission tomographic (PET) may be very useful in ruling out disorders with similar symptoms, such as progressive supranuclear palsy. They are not usually necessary when physical symptoms of Parkinson's disease are obvious.

Parkinson's Early Symptoms: CT scan
CT stands for computerized tomography. In this procedure, a thin X-ray beam is rotated around the area of the body to be visualized. Using very complicated mathematical processes called algorithms, the computer is able to generate a 3-D image of a section through the body. CT scans are very detailed and provide excellent information for the physician.
Parkinson's Early Symptoms: MRI of the brain Click the icon to see an image of an MRI of the brain.

Research is ongoing to determine how well imaging tests can detect early and late stages of Parkinson's and allow physicians to gauge disease progression and effectiveness of treatment. Single photon emission computed tomography (SPECT) and PET, the best neuroimaging techniques available today, are playing a vital role in Parkinsons research as well. By enabling the detection of small changes in brain function early on, they are paving the way for studies of neuroprotective agents. Before these imaging methods were available, there was no adequate way to determine if neuroprotective drugs could slow the progression of early disease.

Ruling out Causes of Parkinsonism and Diseases that Mimic Parkinson's Disease

When symptoms resemble Parkinson's disease but have an identifiable cause, the syndrome is known as parkinsonism. People who have parkinsonism, but not Parkinson's disease, often have additional neurologic symptoms. A number of conditions can also have similar or some of these symptoms.

Other Neurologic Conditions. Many medical conditions may cause symptoms of Parkinson's disease:

  • Hardening of the arteries (arteriosclerosis) in the brain can cause multiple small strokes, which can produce loss of motor control.
Parkinson's Early Symptoms: Developmental process of atherosclerosis Click the icon to see an image of plaque in an artery..
  • Alzheimer's disease can be very similar. In one study 23% of people with Alzheimer's also met the criteria for Parkinson's disease. The two diseases also often coexist, and research suggests that Alzheimers and Parkinsons disease may sometimes share a common biologic origin, the accumulation of the protein alpha synuclein and Lewy bodies in the brain.
  • Lewy bodies variant (LBV), also called dementia with Lewy bodies, is a separate disease from both Alzheimer's and Parkinson's disease. It has similar symptoms to both but is marked by early dementia.
  • Encephalitis caused by influenza has been known to cause parkinsonism.
  • Primary progressive freezing gait is a progression condition, in which freezing gait occurs at the onset. Other Parkinson-like features, such as slow movement, often develop. Although very similar to PD, this condition does not respond to L-dopa or other PD medications.
  • Essential tremor, unlike the tremor of Parkinson's disease, often occurs in the head and voice and is usually worse during motion, as opposed to rest.
  • Progressive supranuclear palsy has similar symptoms, but involves less tremor and earlier rigidity, and it tends to affect both sides of the body symmetrically. Magnetic resonance imaging scans that measure parts of the midbrain may be a reliable method for distinguishing between PD and progressive supranuclear palsy.
  • Multiple system atrophy (previously called Shy-Drager syndrome) is a degenerative nerve disease that also affects movement and blood pressure and has many of the symptoms of Parkinson's disease. Some research suggests that a trial using the drug apomorphine may help differential between the two.
  • Other problems that may mimic Parkinson's disease include Wilson's disease, thyroid abnormalities, hydrocephalus, tumors, having the fragile X trait (but not the full disorder), and a number of degenerative neurologic diseases.

Drugs. Certain drugs or medications account for about 4% of all cases of parkinsonism. According to some studies, patients who experience drug-induced parkinsonism may actually be at an increased risk of developing Parkinson's disease later in life. A number of drugs can cause these symptoms, including antipsychotic and antiseizure agents. Any with parkinsonism should discuss their medications with their physician.

Immune Reaction to Gluten. One study found that an immune response to a protein found in gluten, a substance in wheat, rye, and barley, can cause muscle weakness and neurologic problems similar to parkinsonism.

Parkinson's Early Symptoms: Celiac sprue - foods to avoid Click the icon to see an image of the types of food that can contain gluten.
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