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Parkinson’s Disease - Misdiagnosis

It is an irrefutable fact that diagnosis is vital to medical care. It creates pathways for creation and implementation of treatment plans. Conversely, we have all heard stories of people suffering due to misdiagnosis of their condition. Being not prescribed a treatment to being given wrong treatment to being confused and even worsening of their condition are all too common in all medical setups, small and big - could all stem from being misdiagnosed.

This has been observed many times with patients having Parkinson’s Disease . In a survey of 2000 people in UK, with PD, it was found that more than quarter (26%) reported they were misdiagnosed with a different condition before receiving the correct PD diagnosis.

There can be either of the below types of misdiagnosis of PD:

Initially a PD diagnosis is given, but later it turns out that it was not PD but some other condition.

Person is diagnosed with another condition, but later found that it was actually a case of PD.

There are few reasons sighted for the misdiagnosis of PD:

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What Is Parkinson’s Disease? #Parkinsonsdisease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.

[lifesparktech]

Parkinson's 101

There is no simple way to deal with the life-changing event of a Parkinson’s diagnosis. The good news: Most people find acceptance and quality of life after the initial adjustment period.

What Is Parkinson's Disease?

Parkinson’s disease (PD) occurs when brain cells that make dopamine, a chemical that coordinates movement, stop working or die. Because PD can cause tremor, slowness, stiffness, and walking and balance problems, it is called a “movement disorder.” But constipation, depression, memory problems and other non-movement symptoms also can be part of Parkinson’s. PD is a lifelong and progressive disease, which means that symptoms slowly worsen over time.

The experience of living with Parkinson's over the course of a lifetime is unique to each person. As symptoms and progression vary from person to person, neither you nor your doctor can predict which symptoms you will get, when you will get them or how severe they will be. Even though broad paths of similarity are observed among individuals with PD as the disease progresses, there is no guarantee you will experience what you see in others. Estimates suggest that Parkinson’s affects nearly 1 million people in the United States and more than 6 million people worldwide.

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Who Can Diagnose Parkinson's disease and How ?

In earlier articles, we have seen early signs of Parkinson's disease (PD) as well as some guidelines when one should seek a PD diagnosis. In this article, let us understand who is qualified to diagnose PD and what are the measures they use to do so.

Most current understanding of PD says that for a person to be diagnosed as PD affected, the person must have these (International Parkinson and Movement Disorder Society (MDS)) :

Bradykinesia (slowness of movement) AND one or more of the following

Shaking or tremors in a limb that occurs while at rest

Stiffness, rigidity of arms, legs or trunk

Trouble with balance and falls

Even though your loved one may be experiencing the above, it is best to get him/her diagnosed, so that proper treatment and other lifestyle measures can be employed and better understanding of the way forward is sought. In addition, appropriate lifestyle changes and medications can slow progression of PD. Also, be aware that some symptoms that look like PD could also be caused by other medical conditions.

Whom do you approach?

If symptoms are noticed over weeks, then the first doctor you could see is your family physician. They would ideally refer you to a neurologist. Depending on where you are based, you may have access to a neurologist who is further specialised in ‘movement disorders’.

How is it diagnosed?

Note that there is no specific lab test or imaging test that can conclusively diagnose PD. This means that the diagnosis is made were ‘clinically’ - ¹Conduct detailed assessment of the symptoms - there could be simplest of questions like :

Are you having trouble with buttoning or dressing

Do you see any changes in your handwriting

Do you have trouble brushing your teeth

And more.

Take the person’s medical and family history

Lifestyle factors that may impact the condition

Current and past medications

Do a physical examination which would centre around :

Agility of arms and legs

Any impact on expression and speech

Tremor in your extremities at rest or in action

Any stiffness in your extremities or neck

Person’s walking - step size, and ability to turn

Ability to maintain balance and examine your posture

Are there specific tests?

While there is no conclusive test so far, certain tests such as magnetic resonance imaging of the brain (MRI brain), a dopamine transporter scan (DaT scan), or blood work can be used. MRI looks at the structure of the brain, whereas DaT scan looks at the function of the brain (as the name suggests).

Note that, none of these tests may be ordered and that is fine if the neurologist is fully satisfied about his/her clinical diagnosis.

Lastly:

The process of PD diagnosis is lengthy, as it would require more than one visit to the physician, but on a positive note it does not involve too many tests.

A proper diagnosis is key to management of PD in ensuing months and years.

References:

https://www.parkinson.org/understanding-parkinsons/getting-diagnosed

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/how-parkinson-disease-is-diagnosed

https://www.webmd.com/parkinsons-disease/guide/diagnosing-parkinsons

[lifesparktech]

Symptoms of Parkinson's Disease

Parkinson's disease symptoms are different for different people. Some are hard for even doctors to detect. Others are obvious even to an untrained eye. Visit a movement disorder specialist if you think you're experiencing Parkinson's symptoms.

Motor Symptoms

People are usually more familiar with the motor (movement) symptoms of Parkinson's disease (PD). These signs are noticeable from the outside and are used by doctors to make a diagnosis. The three "cardinal" motor symptoms of PD are:

Stiffness (rigidity): muscle stiffness detected by a doctor on examination

Slowness (bradykinesia): decrease in spontaneous and voluntary movement; may include slower walking, less arm swinging while walking, or decreased blinking or facial expression

Resting tremor: a rhythmic, involuntary shaking that occurs in a finger, hand or limb when it's relaxed and disappears during voluntary movement .

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