In its early stages, Parkinson's disease is difficult to diagnose. Early symptoms may come and go. Here are some things to consider when you think you may have PD but neither you nor your doctor is sure about the diagnosis: Diagnosing PD may be difficult even for a neurologist familiar with the disease. There are no blood or lab tests than can definitively diagnose PD. It is typically diagnosed on the basis of the history and variety of symptoms and a clinical examination. The four classic symptoms of PD are tremors, rigidity, slowness of movement, and postural instability. If you have these symptoms and they are persistent and they started on one side of your body, your doctor may be more likely to diagnose PD.

 

When Struggling With Potential Diagnoses

It’s always hard on you and your loved ones when you are struggling to find out what’s causing those troublesome movement problems. Be persistent in that struggle -- no matter how upsetting and trying it may be. The earlier you find out what’s wrong, the more effective the treatments will be for whatever problem you have.

Here are some things to consider when struggling with potential diagnoses:

• Take control of the situation. Make a list of all the symptoms you have noticed and when you first noticed them. Then read the list over. Do you have any of the “classic” PD symptoms: tremor, slowness of movement, or stiffness?

• Ask friends and family for their opinions. Ask them when they first noticed any troubles. In addition to the motor symptoms, ask them about whether they think your personality and mood have changed. Share all this information with your doctor.

• Get a second and even third opinion, if needed. Once you have a certain diagnosis you may even feel a certain relief. At least you now know what you are dealing with. Remember, you are not your disease. Do not let it dictate to you. There are many effective treatments available. 

 

 

Early Singnal of Parkinson's disease

 

As you read through these early signs of PD, do not jump to any conclusions about your particular case. You need to be evaluated by a specialist, in this case a neurologist, who specializes in PD in order to know for sure if you have the disease. Keep in mind also that everyone is different. You need not have all of these signs to be diagnosed with PD. Some persons with PD never develop one or another of these signs. On average, however, most people who end up getting PD reported several of these signs before receiving the actual diagnosis.

 

That Usually Start on One Side of the Body

The symptoms typically appear on only one side of the body in early PD. Later, they appear on both sides, but at the beginning of the disorder the signs are one-sided.

 

Resting Tremor

Resting Tremor is a slight shakiness in the hand when the hand is at rest. The shakiness or trembling goes away when you move the hand to do something. For example, the shakiness stops when you pick up a book or a cup and so forth. The tremor may extend to the leg or foot on the same side and sometime to the lips and jaw. You might even feel an internal tremor as if the trembling is deep within your body.

 

Rigidity

Rigidity, or muscle stiffness typically occurs in the limbs but full body rigidity is possible as well. Cog-wheel rigidity refers to a body motionthat resembles cogs in a wheel -- it's very jerky and similar to a spring-like action. T

 

Bradykinesia

You might notice slow movements, otherwise known as bradykinesia. Does it take you longer to do things than it used to? Is dressing more of a chore? Have you lost the swing in your arm when you walk?

 

Postural instability

You might have problems with balance. You have trouble walking a straight line. You stumble often. You sometimes lean too far forward when you walk.

 

Generalized fatigue

Parkinson's can cause fatigue that persists for greater than two weeks. Do you feel persistently worn-out and tired, despite lots of sleep?

 

Gastrointestinal problems

Do you feel constipated and has this been going on for weeks or longer?

 

Less facial expressions

You might notice lack of emotional expressions on your face. Loss of dopamine leads to less control over the facial muscles and loss of eye blinks, so when you feel an emotion it may not necessarily be revealed through your facial expression. Have your family members or friends begun to say to you that you appear to be staring or that you rarely smile?

 

Slurred speech

Your friends and family may also notice that your voice is softer and does not express as much emotion as it used to. Do your friends and family repeatedly say that can’t hear you? Do you stumble over words more frequently than you used to?

 

Personality change

Friends and family sometimes say you has changed to be a bit more rigid, less flexible, more withdrawn.

 

Cramped handwriting

Have you noticed that it is more difficult for you to write or sign your name? Do you start out OK but then notice that the letters become smaller and closer together?

 

Anxiety or depression

Anxiety of early PD is usually experienced as free-floating and vague feelings of uneasiness and fear. Sometimes you might even experience a full-blown panic attack when for no apparent reason. Your heart starts racing, your breathing becomes labored and you start to imagine all kinds of horrible things. The attack lasts only a few minutes but it is unforgettable. Depression, on the other hand, manifests itself as a day-to-day loss of interest in normal activities, and an inability to experience the same sense of pleasure in the things you used to love to do.

 

Sleep disturbances

Do you have problems during the day with an intense sleepiness? Do you take more naps during the day than you used to? Does your bed partner tell you that you have bad dreams at night and that you sometimes "act out" those dreams during the night? Without waking up you seem to be seeing things and reacting to them as if they were real. Then you awaken and remember a dream where you were being attacked by someone or some animal?

 

 

Further Diagnosis of Parkinson's disease

 

Response to Drug Therapy

Even if you have the three classic symptoms of PD, you may still not have PD. To decrease the chances of making an inaccurate diagnosis, your doctor will very likely suggest a trial of antiparkinsonism drugs, usually levodopa.

• If your symptoms improve with the drug, PD is likely the diagnosis.

• If after a fair trial with the drug you still do not get better, the tremor, slowness and rigidity may be due to some other problem besides PD.

 

At this point your doctor may order further tests such as scans of your brain. Here are some things to remember about these tests:

• Computed tomography (CT) and magnetic resonance imaging (MRI) cannot diagnose PD, but they can help to rule out other diseases that may produce PD-like symptoms.

• Positron emission tomography (PET scans) or single photon emission tomography (SPECT scans) using specialized isotopes can visualize dopamine levels in the brain and can therefore help diagnose PD and distinguish PD from other PD-like disorders. However, these tests are expensive and not widely available. They may be unnecessary if simpler diagnostic tests can do the job.

 

PD versus Progressive Supranuclear Palsy (PSP)

The three cardinal symptoms of PD (tremor, rigidity and slowness of movement) are collectively called “parkinsonism,” but not all people with parkinsonism have PD. In fact, all three of these cardinal signs of PD may be present in other diseases, the pathology, course and causes of which are different from PD. As mentioned above one way to decrease the likelihood of making an inaccurate diagnosis is to begin a trial of levodopa. If you improve on levodopa, there is an increased likelihood that you have parkinsonism. If your symptoms do not improve after levodopa, then other diagnoses should be considered:

 

Progressive Supranuclear Palsy (PSP)

The most common mistaken diagnosis when PD is a possibility is progressive supranuclear palsy (PSP) -- an akinetic-rigid syndrome. For every 100 people with PD, there are five with PSP.

• The most distinguishing characteristic of PSP is that you become unable to move your eyes. Upward gaze in particular becomes difficult.

• If you have PSP you will very likely also have major problems with balance -- even early in the disease, so you may find yourself literally falling down.

• Unlike PD, PSP begins on both sides of the body at the same time, occurs without tremor, and responds poorly or not at all to levodopa.

• PSP progresses more rapidly than PD.

• You may also find that your ability to focus and be attentive fluctuates throughout the day. Sometimes it’s fine, while other times it’s impossible to stay focused.