Diagnosis of Parkinson's disease
The warning signs of Parkinson’s disease are nonspecific and appear up to 10 years before the diagnosis. Very often these signs are subtle and people with the disease do not know they are linked to Parkinson’s disease. Therefore, it is important to know how to recognize these signs and to discuss them early with your doctor.
You are having difficulty buttoning your shirt, you have noticed a slight tremor in your hand, and your handwriting is not so legible. Or, you are having a depressive episode and you feel like you can no longer detect smells. These are all symptoms associated with aging, but which together can help make a diagnosis of Parkinson’s disease.
Having any of these symptoms does not mean you have Parkinson’s. But if you have more than one, you should make an appointment with your doctor to discuss it further.
The progression of Parkinson’s disease is slow. The first symptoms are often subtle and can go unnoticed. It may take years before the signs become concerns to prompt you to see a doctor. This makes early diagnosis difficult since the diagnosis of Parkinson’s disease is largely based on describing your symptoms.
If you are worried, see your GP. He will be able to support you and refer you to appropriate specialists.
The diagnosis of Parkinson’s disease is based on your doctor’s description of symptoms and his neurological examination. There is no blood test or x-ray examination to confirm the diagnosis.
The first symptoms of the disease are not specific. Taken one by one, they do not make it possible to rule on the disease. However, it is the general portrait of the symptoms that will concern your doctor.
If your doctor suspects that you have Parkinson’s disease, they will put you on a waiting list to get an appointment with a neurologist. Depending on the availability of resources in your area, you should get an appointment within 6 months. If you have had a fall in the past few weeks, tell the doctor. This could reduce your wait time.
Keep a symptom diary and bring it to your appointment. This will help you describe the changes you have observed.
- What are your concerns?
- What medications do you take?
- What changes have you observed?
- Are there any situations that make your symptoms worse?
- Are your daily activities affected? Which ones?
- Do you have difficulty smelling certain smells?
- Do you have trouble sleeping?
- Have you noticed any changes in your memory or mood?
Have someone accompany you to your appointment. Not only will your loved one be able to provide important information during the meeting, but will also be able to support you in the process of accepting the diagnosis.
The doctors who treat Parkinson’s disease are neurologists. Some of them are specialized and work in clinics for movement disorders.
In these clinics, interdisciplinary teams made up of health professionals, such as physiotherapists, speech therapists, specialist nurses, can help you manage the symptoms of the disease as they appear.
First, your neurologist will ask you about your medical history and the symptoms you have observed.
Then, he will examine you by looking for common signs of the disease through simple activities such as:
- The speech
- Dexterity exercises with your fingers
Your neurologist will also assess your tremors, the stiffness of your limbs, the speed of your movement, and test your ability to maintain your balance.
During this exam, your neurologist will also try to rule out other possible causes for your symptoms.
Depending on your symptoms, your neurologist may ask you to take levodopa for a period of time.
Parkinson’s disease is characterized by a deficiency of dopamine in the brain and mainly in the substantia nigra.
Taking levodopa, a precursor to dopamine, can reverse the symptoms of Parkinson’s disease. One dose is not enough. You will need to take several weeks of treatment with increasing doses until you get a result that will confirm your diagnosis.
This test, when negative, can also invalidate the trail of other diseases related to Parkinson’s disease
Imaging tests (ex: X rays) cannot confirm the diagnosis of Parkinson’s disease. On the other hand, they allow the exclusion or investigation of other possible causes for the symptoms observed.
The most widely used technique is used to visualize the integrity of the dopaminergic system by injecting, intravenously, a radioactive product (DaTScan) that binds to dopaminergic neurons. In those affected, these neurons are less numerous, which then becomes apparent during the assessment. This technique mainly distinguishes Parkinson’s disease from essential tremor.
About 25% of people who are diagnosed with Parkinson’s disease do not have it. If your diagnosis was made by your general practitioner, it is important to see a neurologist.
If it was a general neurologist who made the diagnosis, you might be interested in meeting with a neurologist who specializes in movement disorders. Because they are trained to specifically diagnose and treat movement disorders. They are better equipped to distinguish Parkinson’s disease from other related diseases with similar symptoms.
The announcement of the diagnosis leads to strong emotional reactions both for the person affected and for those around them.
This information will change your life, but you have the power to act on the disease through available treatments, exercise, and your social network.
Your family and loved ones will be more or less affected by this diagnosis. Talk to them to discover the solidarity and support resources that are around you. You are not alone.
Parkinson Québec has set up an information and telephone support service to help you.
You can also join self-help and support groups near you to share the experience with others.
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