Diagnosing Parkinson's Disease
by Dr. Patrick Sweeney

Diagnosing Parkinson's disease is sometimes difficult, since early features may be difficult to assess and may mimic other disorders. For example, tremor may not be apparent as a person is sitting at rest, or posture changes may be written off as osteoporosis or simply a sign of aging.

There are currently no sophisticated blood or laboratory tests available to diagnose the disease. Some laboratory tests, such as a CT scan (computed tomography) or MRI (magnetic resonance imaging), may be used to rule out other disorders that cause similar symptoms.

Given these circumstances, a physician may need to observe the patient over time to recognize signs of tremor and rigidity, and pair them with other characteristic symptoms.

The physician will also compile a comprehensive history of the patient's symptoms, activity, medications, other medical problems and exposures to toxic chemicals. This will likely be followed up with a rigorous physical examination with concentration on the functions of the brain and nervous system. Tests are conducted on the patient's reflexes, coordination, muscle strength and mental function.

Because the diagnosis is based on the physician's examination of the patient, it is very important that the physician be experienced in evaluating and diagnosing patients with Parkinson's disease. If there is any question whether a patient has Parkinson's disease or not, the patient should see a specialist, preferably a Movement Disorders trained neurologist. The treatment decisions made early in the illness can have profound implications on the long-term success of the treatment.

Common symptoms of Parkinson's disease include tremor, or a shaking that begins on one side of the body. In some cases, this tremor is confined to only one body part, such as the hand or foot. However, it may spread as the disease progresses and it can worsen with stress. Tremor rarely disables a patient and often disappears during sleep and when the arm or leg is being moved.

Bradykinesia, another common symptom, is a generalized slowness of movement. Common activities, such as getting dressed or bathing, may take a patient several hours to complete.

Most patients with Parkinson's disease develop some degree of rigidity, or stiffness of limbs. This rigidity is caused by uncontrolled tensing of muscles and results in the patient being unable to move about freely. Also, patients may experience aches or pains from affected muscles.

Balance and coordination problems are additional symptoms of advancing Parkinson's disease. Patients typically develop a forward or backward lean that makes them more likely to fall when bumped. Additionally, a posture is often developed in which the head is bowed and shoulders are slumped (stooped posture).

Other symptoms include:

• Decreased facial expressions
• Speech changes
• Handwriting changes
• Urinary problems
• Constipation
• Skin problems, such as dandruff
• Sleeping problems