Parkinson's Disease

How to Diagnose Parkinson's Disease?

Diane Carbo

24 Sep 2023 — 11 min read

Introduction to Parkinson’s Disease

Parkinson's disease is a progressive neurological disorder affecting movement, muscle control, and balance. It affects an estimated 7 million people worldwide. Symptoms of Parkinson’s disease include tremors, rigid muscles, slow movement, impaired posture and balance, and changes in speech and writing. It is a degenerative condition, meaning that it tends to get worse over time and until recently there was no cure.

Early diagnosis of Parkinson’s is critical for successful treatment. This is because it can take many years for the symptoms of the disease to become noticeable and by this time the damage to the brain may already be substantial. Early diagnosis also makes it more likely that treatments will be able to slow down or even stop the progression of the disease.

The goal of this guide is to provide an overview of the different diagnostic tests used to diagnose Parkinson’s disease, as well as information about genetic testing, differential diagnosis, and what to do after diagnosis. By the end of it, readers should have a better understanding of how to diagnose Parkinson’s disease and how to move forward after diagnosis.

Diagnosis Overview

Parkinson’s disease is a complex condition that requires careful and detailed diagnosis in order to obtain an accurate diagnosis. The good news is that there are a number of tests and procedures available to help diagnose the condition, making it possible for healthcare professionals to determine the best course of action for treatment.

The various types of diagnostic tests and procedures used to identify Parkinson’s disease include physical exams, imaging testing, laboratory tests, genetic testing, and differential diagnosis. Let’s take a closer look at each one:

Physical Exam – During a physical exam, a doctor will evaluate patient’s physical symptoms and perform neurological tests. This helps the doctor determine if the patient has the signs and symptoms of Parkinson’s disease.
Imaging Testing – Typically a CT or MRI scan is used to examine the brain for signs of Parkinson’s disease. These scans can help detect any changes in the brain that may indicate the presence of the condition.
Laboratory Tests – In some cases, a doctor may order blood tests or other lab tests to rule out other conditions that may be causing similar symptoms.
Genetic Testing – Genetic testing can help identify genes associated with Parkinson’s disease. This type of testing can help determine if the patient carries any of the known genetic markers that are associated with the condition.
Differential Diagnosis – This involves ruling out other conditions that could be causing the same symptoms as Parkinson’s disease. Differential diagnosis is important when diagnosing the condition so that the right steps can be taken for treatment.

Physical Exam for Parkinson’s Disease

Diagnosis of Parkinson’s disease can involve a physical examination. The physician will assess the patient's facial expression, gait, and posture, as well as examine the patient’s hands, arms, and legs. During this exam, the doctor will look for any signs of Parkinson’s disease, such as tremors, slowed movements, or stiffness.

The purpose of the physical exam is to help the doctor determine if the patient is exhibiting symptoms associated with Parkinson’s disease. It is also used to rule out other conditions that may have similar symptoms, such as multiple system atrophy, progressive supranuclear palsy, or essential tremor.

During the physical exam, the doctor will ask the patient to perform certain tasks. This includes walking in a straight line, turning around in a circle, and pressing on the thumb and forefinger together. The doctor may also ask the patient to move their head from side to side, to stand on one foot, or to raise their arms and keep them in a certain position.

It is important to note that the physical exam cannot definitively prove or disprove a diagnosis of Parkinson’s disease. However, the physical exam can provide the doctor with valuable information that can help in making a diagnosis. The physical exam results, along with other tests, can help the doctor determine if the patient is exhibiting signs and symptoms associated with Parkinson’s disease.

If the doctor suspects Parkinson’s disease, they may order additional tests or imaging studies to confirm the diagnosis. These tests may include MRI, CT scans, or laboratory tests.

Imaging Testing for Diagnosing Parkinson’s Disease

In diagnosing Parkinson’s disease, imaging tests such as magnetic resonance imaging (MRI) and computed tomography (CT) scans are used to evaluate brain structure, or any particular changes that might be detectable. It can help to rule out other diseases that can present similar symptoms.

MRI uses a magnet, radio waves, and a computer to create detailed images of the brain. The MRI scan often provides a more detailed look than a CT scan. CT scans use x-rays and computer technology to produce detailed images of the brain.

These imaging tests measure specific areas of the brain affected by Parkinson's disease. Usually, the area that is affected in Parkinson's disease is the substantia nigra, a part of the brain responsible for movement control. If these areas show any changes, it can indicate that a person has Parkinson's disease. Another important area of the brain affected by Parkinson's disease is the basal nuclei, which is responsible for producing dopamine, a chemical in the brain that helps with movement.

MRI and CT scans can also reveal any tumors, lesions, or internal bleeding that may be causing the symptoms. It's important to note that imaging tests cannot definitively diagnose Parkinson's disease, but they can provide more information to help diagnose the condition.

If an imaging test is ordered by a physician, the patient will first go through a preparation process. This can include changing into a gown and removing any metal objects from their body. Then, the patient will lay on the imaging table and the scan begins. The procedure usually takes between 15-45 minutes depending on the type of scan and the extent of the imaging. It is painless and non-invasive.

Lab Tests for Diagnosing Parkinson's Disease

Parkinson’s disease (PD) can be difficult to diagnose, as it has many symptoms that overlap with other conditions. However, laboratory tests can be used to help doctors identify signs that are specific to PD, while also ruling out other possible conditions. The purpose of these tests is to provide evidence that will aid in the diagnosis of PD.

Blood tests are often used to identify indicators of PD, such as specific biomarkers that may indicate a higher likelihood of having the disease. Additionally, genetic tests may be used to detect mutations or other changes related to PD. These tests can provide doctors with a more complete picture of the patient’s condition.

Neurological testing can also be used to assess the progression of the disease and to measure the effectiveness of therapies. Some common tests include electromyography (EMG), which measures electrical activity in the muscles; electromyograms (EMGs), which measure nerves in the arms and legs; and brain scans, which provide detailed pictures of the brain.

Psychological tests may also be administered to determine how PD is impacting quality of life. These tests can give doctors important insight into a patient’s mental state, so they can adjust treatments as needed. Additionally, psychological tests can help diagnose anxiety and depression, two common issues associated with PD.

The results of these tests can provide valuable information about the patient’s condition and help doctors determine an appropriate course of action. While tests cannot definitively diagnose PD, they can help doctors to rule out other conditions and better understand the patient’s overall health.

Diagnostic Criteria for Parkinson’s Disease

Diagnosing Parkinson’s disease (PD) is complex, as it involves recognizing and interpreting multiple clinical features. In many cases, PD is diagnosed after ruling out other conditions. As there is no single test available to diagnose PD, doctors use a combination of tests, physical exams, and patient evaluations to make a diagnosis.

It is important to understand the clinical features associated with PD, as these are used to make a final diagnosis.

Identifying Clinical Features

Clinical features are the observable and measurable signs and symptoms of a medical condition. In the case of PD, clinical features can include motor symptoms such as rigidity, tremor, bradykinesia, and impaired postural reflexes, as well as non-motor symptoms such as impaired odor identification, constipation, depression, and sleep disorders.

In order to make an accurate diagnosis of PD, patients must demonstrate a minimum of two of the following motor symptoms: tremor, rigidity, bradykinesia, and impaired postural reflexes. If these criteria are not met, it is likely that the patient does not have PD and other causes of the symptoms should be explored.

The presence of the above motor symptoms must be observed and confirmed by a healthcare provider during a physical exam in order for the diagnosis to be made. The examiner must also rule out any potential causes of the symptoms other than PD, such as drug reactions or side effects, and only then will the diagnosis be confirmed.

Diagnosing based on Symptoms

In some cases, the diagnosis can be based on the presence of specific non-motor symptoms as well as motor symptoms. For example, Prodromal (or early-stage) PD can be diagnosed with the presence of constipation, smell impairment, and REM sleep disorder, even in the absence of motor symptoms.

It is important to note that PD is a progressive disease, which means that it is expected to worsen over time. The severity of the symptoms at diagnosis can affect the prognosis, as can other factors such as age at diagnosis, sex, and duration of the illness.

In order to ensure an accurate diagnosis, it is important to seek medical help early and discuss all of your symptoms with your doctor. The earlier the diagnosis is made, the earlier treatment can begin and the better the long-term outcomes.

Differential Diagnosis

Diagnosing Parkinson’s disease generally involves ruling out other conditions. Differential diagnosis is a process of elimination where doctors take into consideration a patient’s overall medical history, family history, and symptoms to determine if something else is causing the symptoms. In order to do this, a doctor will usually start by listing potential causes and then eliminating them one by one until they are left with the most likely diagnosis.

There are a number of conditions that can be confused with Parkinson’s disease, such as essential tremor, dystonia, multiple system atrophy, vascular parkinsonism, and progressive supranuclear palsy (PSP). A doctor will use a variety of tests, including physical exams, imaging tests, and genetic testing, to help rule out other potential causes and narrow down the diagnosis.

It is important for a doctor to consider all potential causes and rule out diseases that produce similar symptoms, as each condition requires its own specific treatment. By eliminating other potential causes, the doctor can ensure that appropriate treatment is provided.

Genetic Testing for Parkinson's Disease

Genetic testing is used to detect mutations or other changes related to Parkinson’s disease. The goal of genetic testing is to identify the cause of a person’s Parkinson’s disease when it is not clear. Genetic testing can help doctors determine if a patient’s symptoms are due to Parkinson’s disease or another condition. It can also help doctors understand why a particular patient has developed the disease.

The most commonly used genetic test for Parkinson’s disease is known as “whole exome sequencing.” This test sequences the entire exome, which is the part of the genome that contains all the protein-coding genes. It is used to identify genetic mutations or changes in genes that are associated with the development of Parkinson’s disease.

Other tests such as gene panel testing and Sanger sequencing may also be used to confirm the diagnosis. Gene panel testing is used to look for certain genes known to be associated with Parkinson’s disease. Sanger sequencing is used to search for mutations in specific genes.

Genetic testing is not required for everyone with Parkinson’s disease. It is only used in cases where the cause of the disease is uncertain. In these cases, the test results can help doctors provide a more accurate diagnosis and better treatment options for the patient.

Moving Forward After a Parkinson’s Diagnosis

A Parkinson’s Disease diagnosis can be scary and overwhelming. It can be difficult to know what to do and where to go next. Fortunately, there are many resources available to help patients and their families manage the diagnosis and move forward in life.

It is important to start building a support system. This could include family and friends, as well as medical providers. A neurologist, who specializes in movement disorders, should be consulted for any questions or concerns about managing the condition. Primary care physicians, occupational therapists, physical therapists, speech therapists and other healthcare providers may all have a role in helping the patient manage their condition.

Patients should also seek out support groups, which can provide a great source of information and emotional support. These groups can provide a safe space for people to discuss their struggles and successes in dealing with Parkinson’s Disease, and to learn strategies for coping with the condition.

When it comes to managing the condition, patients should strive to maintain an active lifestyle. Eating a healthy, balanced diet and exercising regularly can help to reduce symptoms and improve quality of life. Medication prescribed by your doctor should also be taken as directed. It is important to seek out the advice of a medical professional before making any changes to the medication regimen.

In addition to seeking out medical professionals and support groups, there are a number of organizations dedicated to providing resources for those living with Parkinson’s Disease. These organizations offer educational programs, support networks, and access to research and clinical trials. They can be a great source of information and support.

No matter the stage of the disease, it is possible to live a full and meaningful life with Parkinson’s. With the right support and resources, patients and their families can continue to live life to the fullest despite the diagnosis.

Diagnosing Parkinson’s disease is vital to ensure that people with the condition can receive appropriate treatment and support. This guide has outlined the different types of tests and procedures that can be used to diagnose Parkinson’s disease. This includes physical examination, imaging testing, lab tests, and genetic testing. It also noted the criteria for diagnosis and differential diagnosis of Parkinson’s disease. Finally, it provided advice for patients and their families on how to proceed after diagnosis. This guide provides an overview of the diagnosis process, but there are more resources available to those seeking more information.

Resources

Diagnosing Parkinson’s disease can be a complex process, which is why it is important to have access to information and support. There are a number of resources available for patients, family members, and healthcare providers that provide valuable information about the disease and the diagnosis process.

Patients and their families can turn to organizations such as the National Parkinson Foundation and the Michael J. Fox Foundation for help with understanding the disease and the diagnosis process. Both organizations have websites with helpful information and advice.

Online forums such as The Parkinson's Network allow patients and family members to connect with others who are dealing with the disease and share experiences and advice. Doctor consultation services such as Zoemd provide access to medical experts, allowing individuals to ask questions and receive answers from experienced professionals.

For healthcare professionals, the American Academy of Neurology provides evidence-based diagnostic criteria and treatment guidelines, while the National Institutes of Health offers clinical trials and research findings. Additionally, the American Academy of Physical Medicine and Rehabilitation has established standards of practice for care related to the diagnosis and management of Parkinson’s disease.

These resources provide valuable information and support to those affected by Parkinson’s disease, aiding in the diagnosis and management of the condition.

The diagnosis of Parkinson’s disease involves more than just a physical exam and lab tests. It also includes linking to reliable sources with helpful information. Following are some websites which provide invaluable resources related to Parkinson’s disease diagnosis: