Parkinson's Disease - Treatment

Diagnosis

Parkinson’s disease can be difficult to diagnose in its early stages. Doctors base their diagnosis on the patient’s medical history and symptoms evaluated during a neurological exam. No laboratory or imaging tests can diagnose Parkinson’s, although brain scans such as computed tomography (CT), magnetic resonance imaging (MRI), or positron-emission tomographic (PET) may be used to rule out other neurological disorders.

Medical History

A medical and personal history should include any relevant symptoms as well as any medications taken, and information on other conditions the patient may have.

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Neurological Exam

In a neurological exam, the doctor will ask the patient to sit, stand, walk, and extend arms. The doctor will observe the patient’s balance and coordination. Parkinson's may be suspected in patients who have at least two of the following four symptoms, especially if they are more obvious on one side of the body:

• Tremor (shaking) when the limb is at rest
• Slowness of movement (bradykinesia)
• Rigidity, stiffness, or increased resistance to movement in the limbs or torso
• Poor balance (postural instability)

Drug Challenge Test

A levodopa challenge test may confirm a diagnosis of Parkinson's disease. If patients' symptoms improve when they take levodopa, they likely have Parkinson's, ruling out other neurological diseases.

Tests for Depression and Dementia

The American Academy of Neurology (AAN) recommends the Beck Depression Inventory or the Hamilton Depression Rating Scale to screen for depression in patients with Parkinson's disease. The AAN recommends the Mini Mental State Examination (MMSE) and Cambridge Cognitive Examination (CAMCOG) tests to screen for dementia. During these tests, the patient answers a series of questions.

Ruling out Conditions that Mimic Parkinson's Disease

Parkinsonism Plus Syndromes. Parkinson’s disease is the most common type of parkinsonism. Parkinsonism refers to a group of movement disorders that share similar symptoms with Parkinson’s disease, but also have unique symptoms of their own. About 15% of parkinsonism cases are due to conditions called Parkinson’s plus syndromes (PPS) or atypical parkinsonism. These syndromes include:

• Corticobasal degeneration. Marked by apraxia (inability to perform coordinated movements or use familiar objects), stiffness that is more severe than typical Parkinson’s disease, and twitching or jerking in the hand.
• Lewy body dementia. One of the most common types of progressive dementia. Symptoms include visual hallucinations and loss of spontaneous movement.
• Multiple system atrophy. Symptoms include fainting, constipation, erectile dysfunction, urinary retention, and loss of muscle coordination.
• Progressive supranuclear palsy. Marked by frequent falls, personality changes, and difficulty focusing the eyes.