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Evaluation and Diagnosis of Parkinson’s Disease
Parkinson’s disease is difficult to diagnose because the symptoms of many degenerative diseases are closely similar to those of Parkinson’s disease. No single test can be used for the diagnosis of Parkinson’s disease directly. The disease can only be fully determined only by cerebral anatomy performed by pathologists. According to the related studies, 20% of the patients with Parkinson’s disease do not actually have the disease. Because different disease progressions may have different drug effects, the accurate diagnosis of the disease will allow the patient to receive the appropriate drug to alleviate the symptoms or even slow the disease progression. Therefore, the patients should seek a neurological specialist for professional experience and observation to correctly diagnose Parkinson’s disease.
Clinical Diagnosis
When the patient and the doctor meet for the first time, the doctor will determine the possibility of Parkinson’s disease based on the clinical diagnosis. The major clinical signs of Parkinson’s disease include rigidity, tremors, bradykinesia, and postural instability. During the diagnosis, the doctor will determine the possibility of Parkinson’s disease based on the following observations:
1. Are the patient’s fingers or toes agile?
2. Can both arms of the patient fully swing when walking? Can the patient stride?
3. Do the hands or feet of the patient tremble when at rest?
4. Does the patient experience any difficulty when turning around?
5. Does the patient appear rigid, as if stuck to the floor?
6. Does the patient’s facial expression appear lively? Does the patient speak clearly?
Moreover, the doctor will examine the disease progression, the family history, and the histories and medicine used for other diseases as the references for the diagnosis. The diagnosis of Parkinson’s disease is a great disappointment for most people. The medical caretaker plays an important role in fighting the disease. Therefore, family members should accompany the patient to meet the doctor for the clinical diagnosis. The doctor must acquire a more comprehensive understanding on the conditions of the patient based on the third party’s observations.
Examinations
If the clinical diagnosis is unable to confirm Parkinson’s disease, the doctor will use various examination tools to make the final judgment. A blood test, urine test, X-ray, CT, or MRI may be required to exclude the possibilities of other diseases. Sometimes PET or SPECT scans or the patient’s responses to levodopa will be required to exclude or confirm Parkinson’s disease.
Nevertheless, these examinations may not be necessary. The symptoms of the most Parkinson’s disease patients are very noticeable. The doctor does not need to go through a lot of trouble to confirm the disease. Some doctors believe that it is necessary to wait for a certain period of time to observe the disease progression in order to determine the disease. However, some patients notice other patients receiving CT, MRI, PET, or SPECT scans or their friends or family members go to the large hospitals to see the professors for the examinations and decide they should also do so. Some patients even think the doctor’s medical skills are no match for the delicate instruments and believe they should receive the medical examinations. In fact, Parkinson’s disease is a custom-made disease. Every patient has a different disease progression and it is not necessary to compare the clinical examinations or drugs. In order to allow the patients and their family members acquire the correct understanding, these clinical examinations are described below:
Blood Test: The amounts of copper ion and ceruloplasmin in the blood are used for the diagnosis of Wilson’s disease; unusual infections such as Syphilis or AIDS are also examined.
Urine Test: The copper content in the urine is used to determine Wilson’s disease.
Genetic Test: The genetic test is used for the determination of genetic diseases such as Huntington’s disease or spinocerebellar ataxia.
CT and MRI Scans:
Because the site of Parkinson’s disease is too small and located in the center of the brain, it is rather difficult to examine by the traditional neurological imaging such as CT or MRI scans. They are mostly used to exclude the possibilities of other brain diseases.
1.Computerized Tomography (CT)
The CT scan uses the scanner to acquire the X-ray images of the cerebral sections from different angles. These X-ray images are processed to generate the 3D images of the brain by the computer. The CT scan can help detect the brain tissue atrophy, brain tumors, cerebral haemorrhage, or hydrocephalus.
2. Magnetic Resonance Imaging (MRI)
MRI uses a scanner to capture the excitation of the hydrogen atom of the water molecules in the body by the magnetic field to generate the images of the organs. The resolution of the MRI images, especially of the soft tissues, in the brain is higher than that of the CT images without using the radioactive substances. However, MRI is unable to recognize the dopamine cells of putamen in the brain of the Parkinson’s disease patient. It is more suitable for the determination of stroke or the diseases of the brain or spinal cord.
3. Positron Emission Tomography (PET)
PET uses a radioactive drug synthesized from the radioactive isotope that emits positrons to detect the metabolic reactions in the organs of the body. The signals are used to generate the images of the disease progression. By using the radioactive drug, the PET images are able to display the activities of glucose, levodopa, and dopamine in the brain. The progression of Parkinson’s disease is thus detected. PET is the most sensitive method for the determination of the reduction of dopamine secretion.
4. Single Photon Emission Computed Tomography (SPECT)
SPECT uses a radioactive drug that emits gamma radiation to reach the disease site in the body via oral or intravenous administration. After the administration, the tomographic images of the disease site are generated by the scanner at the appropriate intervals to detect the disease. SPECT is more commonly used than PET. It can be used to detect the dopamine activities but is not as sensitive as PET.
The applications of PET and SPECT are not regular examinations for the diagnosis of Parkinson’s disease. They are mostly used for the medical or scientific research. In fact, they have made very valuable contributions to the studies of the new drug or treatment for the increase of dopamine. Although PET or SPECT can display the images of the disease progression, they do not have the related anatomical locations for comparison. Therefore, they are unable to pinpoint the exact location of the disease. Currently, scanners that combine the PET or SPECT images with the CT images by computer programs to locate the exact location of the disease are being developed.
Preparation for the Clinical Diagnosis
In addition to the clinical examinations by the doctor, the patient’s and the care taker’s observations can aid in the doctor’s diagnosis. Due to the healthcare system in Taiwan and the general public’s habits of seeking medical treatments, hospitals are always full of patients. As a result, the patient hardly has sufficient time to communicate with the doctor for detailed examinations. In order to make the best use of the minutes earned through a lot of efforts, we list the following questions that can aid in the diagnosis of Parkinson’s disease. We hope the patient can write down the results and doubts of the listed questions for the doctors based on their experiences and the observations of their family members. The doctor will be able to choose the most critical examinations for the patient and make the accurate diagnosis quickly and efficiently.g
Questions that Allow the Patient to Help the Doctor in the Determination of Parkinson’s Disease
1. Does tremor occur on one side of the body when you are at rest? Did tremor occurred during the past 1~2 years? Has tremor gradually become more serious?
2. Do you feel less agile when buttoning, brushing teeth, combing hair, or eating meal?
3. Does a leg feel weak when you walk?
4. Does a hand feel weak and not swing when you talk?
5. Do you stand or walk in a hunchback posture?
6. Does your voice become weak and faint?
7. Do family members notice the lack of facial expressions?
8. Do the words you write become smaller as the symptoms progress?
9. Do you feel that you smile less?
10. Do your eyes stare frequently without blinking?
In addition to the questions above, do you notice any changes of the symptoms? Do the symptoms improve or worsen?
Questions for the Exclusion of Parkinson’s Disease
1. Did the symptoms appear after the brain surgery?
2. Do you have any history of multiple strokes?
3. Do your grandparents, parents, or children have the similar symptoms?
4. Do you have any history of long-term exposure to manganese, carbon monoxide poisoning, drug abuse, use of anti-psychotic drugs, or long-term use of gastrointestinal drugs?
5. Do your friends or family members notice any change of personalities?
6. Are you unable to remember what just happened?
7. Do your friends or family members notice any disordered personalities?
8. Do you feel your eyes are unable to move freely or your eyesight is impaired?
9. After the symptoms appear, is your body unable to remain balanced? Do you fall occasionally?
10. Do you feel dizzy or experience hypotension after standing up from sitting in the chair?
11. After the symptoms appear, do you experience speaking or swallowing difficulty?
12. Before or after the symptoms appear, do you feel dizzy when standing? Do you experience any urination difficulty or sexual dysfunction?
13. Do the major symptoms include bradykinesia, rigidity, and lack of facial expressions but not tremors?
14. Does your hand shake when picking up things but not at rest?
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