There is no special test for Parkinson’s disease, which sometimes makes diagnosis difficult, especially at an early stage. Parkinsonism includes a group of signs and symptoms. This may have other causes, such as dementia with Lewy bodies, progressive supranuclear palsy, as well as some antipsychotic drugs, toxins, head injuries and some types of stroke.
A general practitioner (family doctor, primary care physician) will establish the diagnosis based on signs and symptoms, the patient’s medical history, the results of the clinical examination.
Initially, when the symptoms are mild in the early stages of Parkinson’s disease, it will be difficult for the doctor to definitively diagnose the condition. If Parkinson is suspected, he is likely to refer the patient to a specialist (neurologist).
It is very important that the doctor has experience with all possible disorders that may hide Parkinson’s disease.
As part of the medical history, the doctor will need to know about any medications the patient has taken, as well as whether close relatives have Parkinson’s disease.
A neurological examination usually evaluates gait, coordination, and some simple manual tasks. The doctor may also check the patient’s sense of smell. He/she can also prescribe a cure for Parkinson’s disease. If it alleviates the symptoms, it will help to find out if the person has this neurological disease.
The following tests may be prescribed:
- a blood test is usually to rule out any other condition, such as abnormal levels of thyroid hormones or liver damage.
- MRI or CT scan – to check for signs of a stroke or brain tumor. If there is/did not have a stroke or brain tumor, most MRI or CT scans of people with Parkinson’s disease will seem normal.
- positron tomography. This imaging technique can sometimes detect low levels of dopamine in the brain. Because these scans are expensive and not available in all hospitals, this option may sometimes not be available. PT is a highly specialized imaging technique that uses radioactive substances to create three-dimensional color images of those substances that act in the body. Information on body chemistry can be obtained using such a scan, which is not found in other imaging methods.
2 out of 4 main symptoms are required for the neurologist who should confirm the diagnosis of Parkinson’s disease. They must be present for a certain period of time. The 4 main symptoms include:
- tremor or trembling;
- bradykinesia (the slowness of movement);
- rigidity (stiffness) of the arms, legs or corpus;
- postural instability.
The following will be done to help the doctor diagnose Parkinson’s disease:
- collect a detailed patient history;
- conduct physical examination;
- check the medication list that is currently being taken and those that have been taken prior.
carry out a detailed neurological examination, during which the patient performs tasks to assess the mobility of the legs and arms, muscle tone, gait, and balance.
Typically, examination results are entered into a table called the Parkinson’s Disease Rating Scale (UPDRS). UPDRS was created to comprehensively evaluate and document the examination of patients with Parkinson’s disease, as well as to compare the data entered with subsequent examinations, or to transfer data to other neurologists.
Observe the patient’s response to drugs for Parkinson’s disease (drugs that stimulate or mimic dopamine production). An example of a drug for Parkinson’s disease is levodopa.
A diagnosis of Parkinson’s disease is more likely if:
- 2 out of the 4 main symptoms of Parkinson’s have been present for some time.
- symptoms appeared only on one side of the body.
- tremor (trembling) is more noticeable at rest;
- Parkinson’s drug (e.g., levodopa) gives a strong positive response.
The doctor may need to monitor the patient for some time before the symptoms are considered constantly present. The clinical practice guidelines that were introduced in 2006 state that the diagnosis and follow-up of Parkinson’s disease should be performed by a specialist – usually a neurologist or geriatrician. Neurologist – a doctor specializing in the diagnosis and treatment of disorders of the nervous system. A geriatrician is a doctor specializing in the treatment of older people.