How is Parkinson's Disease Diagnosed?

Diagnosis

Making an accurate diagnosis of Parkinson’s — particularly in its early stages — is difficult, but a skilled practitioner can come to a reasoned conclusion that it is PD. You may have experienced this frustration. Perhaps it took years for you to receive a diagnosis. Perhaps you have been diagnosed, but with Parkinsonism, not Parkinson's, and are confused about the implications.

How is Parkinson’s Diagnosed?

Often, the diagnosis of Parkinson’s is first made by an internist or family physician. Many people seek an additional opinion from a neurologist with experience and specific training in the assessment and treatment of Parkinson’s disease — referred to as a movement disorder specialist.

To diagnose Parkinson’s, the physician takes a careful neurological history and performs an examination. There are no standard diagnostic tests for Parkinson’s, so the diagnosis rests on the clinical information provided by the person with Parkinson’s and the findings of the neurological exam.

• The doctor looks to see if your expression is animated.
• Your arms are observed for tremor, which is present either when they are at rest, or extended.
• Is there stiffness in your limbs or neck?
• Can you rise from a chair easily?
• Do you walk normally or with short steps, and do your arms swing symmetrically? The doctor will pull you backwards.
• How quickly are you able to regain your balance?

The main role of any additional testing is to exclude other diseases that imitate Parkinson’s disease, such as stroke or hydrocephalus. Very mild cases of PD can be difficult to confirm, even by an experienced neurologist. This is in part because there are many neurological conditions that mimic the appearance of Parkinson’s.

A person’s good response to levodopa (which temporarily restores dopamineaction in the brain) may support the diagnosis. But this is not relevant if your doctor thinks you do not need any medication at this time. If you are in doubt of your diagnosis or if you need further information, you may want to seek a second opinion.

PDF recommends that a person with symptoms resembling those of PD consider making an appointment with a movement disorder specialist.  To find a specialist in your community, call PDF's HelpLine at (800) 457-6676 from Monday to Friday, 9:00AM ET to 5:00 PM ET and our staff can help you locate one.

Why Aren’t There Tests to Diagnose Parkinson’s?

There is no standard diagnostic test for Parkinson’s. Researchers are working to develop an accurate “biological marker,” such as a blood test or an imaging scan. To date, the best objective testing for PD consists of specialized brain scanning techniques that can measure the dopamine system and brain metabolism. But these tests are performed only in specialized imaging centers and can be very expensive.

Symptoms Associated with Parkinson's Disease

Symptoms

The diagnosis of PD depends upon the presence of one or more of the four most common motor symptoms of the disease. In addition, there are other secondary and nonmotor symptoms that affect many people and are increasingly recognized by doctors as important to treating Parkinson’s.

Each person with Parkinson's will experience symptoms differently. For example, many people experience tremor as their primary symptom, while others may not have tremors, but may have problems with balance. Also, for some people the disease progresses quickly, and in others it does not.

By definition, Parkinson’s is a progressive disease. Although some people with Parkinson’s only have symptoms on one side of the body for many years, eventually the symptoms begin on the other side. Symptoms on the other side of the body often do not become as severe as symptoms on the initial side.

Your Traditional Medical Perspective and Treatment Options

Causes

What Causes Parkinson's?

To date, despite decades of intensive study using the BEST Medical minds and technology, the causes of Parkinson’s remain unknown. Many experts think that the disease is caused by a combination of genetic and environmental factors, which may vary from person to person.

In some people, genetic factors may play a role; in others, illness, an environmental toxin or other event may contribute to PD. Scientists have identified aging as an important risk factor; there is a two to four percent risk for Parkinson’s among people over age 60, compared with one to two percent in the general population.

The chemical or genetic trigger that starts the cell death process in dopamineneurons is the subject of intense scientific study. Many believe that by understanding the sequence of events that leads to the loss of dopamine cells, scientists will be able to develop treatments to stop or reverse the disease

Read more below about each of these:

• Genetic Factors
• Environmental Factors

Genetic Factors

The vast majority of Parkinson's cases are not directly inherited. About 15 to 25 percent of people with Parkinson’s report having a relative with the disease. In large population studies, researchers have found that people with an affected first-degree relative, such as a parent or sibling, have a four to nine percent higher chance of developing PD, as compared to the general population. This means that if a person’s parent has PD, his or her chances of developing the disease are slightly higher than the risk among the general population.  in order to manage the symptoms.

Researchers have discovered several gene mutations that can cause the disease directly, but these affect only a small number of families. Some of these mutations involve genes that play a role in dopamine cell functions. Parkinson’s has developed at an early age in individuals with mutations in genes for parkin, PINK1, LRRK2, DJ-1, and glucocerebrosidase, among others.

Because genetic forms of a disease can be studied in great detail in the laboratory, and because understanding the rare genetic forms of Parkinson's may help us to understand more common forms of the disease, genetics is currently the subject of intense research.

Environmental Factors  

Some scientists have suggested that Parkinson's disease may result from exposure to an environmental toxin or injury. Epidemiological research has identified several factors that may be linked to Parkinson’s, including rural living, well water, manganese and pesticides.

Some studies have demonstrated that prolonged occupational exposure to certain chemicals is associated with an elevated risk of PD. These include the insecticides permethrin and beta-hexachlorocyclohexane (beta-HCH), the herbicides paraquat and 2,4-dichlorophenoxyacetic acid and the fungicide maneb. In 2009, the US Department of Veterans Affairs added Parkinson’s to a list of diseases possibly associated with exposure to Agent Orange.

A synthetic neurotoxin agent called MPTP can also cause immediate and permanent parkinsonism. The compound was discovered in the 1980s in individuals who injected themselves with a synthetic form of heroin contaminated with MPTP. Cases of MPTP-induced Parkinson’s in the general population are exceedingly rare.

It is noted that a simple exposure to an environmental toxin is never enough to cause Parkinson’s. Most people exposed to a toxin do not develop the disease. In fact, there is no conclusive evidence that any environmental factor, alone, can be considered a cause of the disease.

However, environmental factors have been helpful in studying laboratory models of Parkinson's. Scientists continue to pursue these clues to understand why Parkinson’s disease occurs.

Progression 

The progression of Parkinson’s disease varies among different individuals.  Parkinson's is chronic and slowly progressive, meaning that symptoms continue and worsen over a period of years.  Parkinson's is not considered a fatal disease. And the way that it progresses is different for everyone:

• Movement symptoms vary from person to person, and so does the rate at which they progress.
• Some are more bothersome than others depending on what a person normally does during the day.
• Some people with Parkinson's live with mild symptoms for many years, whereas others develop movement difficulties more quickly.
• Nonmotor symptoms also are very individualized, and they affect most people with Parkinson's at all stages of disease.  Some people with Parkinson's find that symptoms such as depression or fatigue interfere more with daily life than do problems with movement.

Rating Scales

That said, there are tools that your doctor may use to understand the progression of your Parkinson's.  The stages of Parkinson's correspond both to the severity of movement symptoms and to how much the disease affects a person’s daily activities.  The most commonly used rating scales are focused on the motor symptoms, but new scales include information on non-motor symptoms (such as problems with sense of smell).

1. The first, known as Hoehn and Yahr, will rate your symptoms on a scale of 1 to 5.  On this scale, depending on a person’s difficulties, 1 and 2 represent early-stage, 2 and 3 mid-stage, and 4 and 5 advanced-stage Parkinson's.
2. Another scale commonly used to assess the progression of Parkinson's is the United Parkinson’s Disease Rating Scale (UPDRS).  It is more comprehensive than the Hoehn and Yahr scale, which focuses on movement symptoms.  In addition to these, the UPDRS takes into account cognitive difficulties, ability to carry out daily activities, and treatment complications.

Severity of Parkinson's

Below are some descriptions of mild, moderate and advanced Parkinson's.  As disease progresses differently in different people, many do not progress to the advanced stage. 

Mild Parkinson’s

• Movement symptoms may be inconvenient, but do not affect daily activities
• Movement symptoms, often tremor, occur on one side of the body
• Friends may notice changes in a person’s posture, walking ability or facial expression
• Parkinson's medications suppress movement symptoms effectively
• Regular exercise improves and maintains mobility, flexibility, range of motion and balance, and also reduces depression and constipation

Moderate Parkinson’s

• Movement symptoms occur on both sides of the body
• The body moves more slowly
• Trouble with balance and coordination may develop
• “Freezing” episodes — when the feet feel stuck to the ground — may occur
• Parkinson's medications may “wear off” between doses
• Parkinson's medications may cause side effects, including dyskinesias (involuntary movements)
• Regular exercise, perhaps with physical therapy, continues to be important for good mobility and balance
• Occupational therapy may provide strategies for maintaining independence

Advanced Parkinson’s

• Great difficulty walking; in wheelchair or bed most of the day
• Not able to live alone
• Assistance needed with all daily activities
• Cognitive problems may be prominent, including hallucinations and delusions
• Balancing the benefits of medications with their side effects becomes more challenging
• At all stages of Parkinson's, effective therapies are available to ease symptoms and make it possible for people with Parkinson's to live well.

Medications & Treatments

There are many medications available to treat the symptoms of Parkinson’s, although none yet that actually reverse the effects of the disease.

It is common for people with PD to take a variety of these medications – all at different doses and at different times of day – in order to manage the symptoms of the disease.

While keeping track of medications can be a challenging task, understanding your medications and sticking to a schedule will provide the greatest benefit from the drugs and avoid unpleasant “off” periods due to missed doses.

Medicines Two Choices for You

Dr. Huntoon's Alternative Medical Treatment Options

Dr. Huntoon’s Alternative Medical Treatment Options

Dr. Huntoon has seen success in helping people who have tremors and who have been diagnosed with Parkinson’s Disease.  What his highest level of understanding is currently, which has proven to be accurate, was given to him by Dr. Dick Versendaal of CRA (Contact Reflex Analysis).  Dr. Versendaal was a founder an innovator who worked with thousands of different health issues and was gifted at developing nutritional protocols for various health concerns. 

Specifically for Parkinson’s Disease, he had a reflex known as the Cerebellum/Parkinson’s Reflex and when it was positive, it equated to the cerebellum being low in stored electricity.  He equated the cerebellum as the battery of the brain, which holds electricity for the body in reserve so it is available on demand.  He said that symptoms of this imbalance could and does show up as numerous Central Nervous System conditions such as Parkinson’s, Multiple Sclerosis, Muscular Dystrophy and ALS.  Other symptoms include the palsies, muscle weakness, fatigue, poor equilibrium, and a feeling of falling backwards.

He recommended, and Dr. Huntoon has found the same when applying CRA Protocols to his patients, the need for a specific nutrient called Ribonucleic Acid (RNA) and maintained it would take 12 months to turn these syndromes around.  RNA is like a computer chip to the brain.  It is also an electrolyte that helps the brain hold its charge. 

When committing to the protocol and assessing the rest of the health of the individual, Dr. Huntoon has seen the condition go away.  And with continuous support of the person with the proper nutritional supplements has proven to be fully effective.

Another breakthrough in Parkinson’s Disease has been the use of the Neurologic Relief Center’s Technique (NRC).  What Dr. Huntoon has witnessed in his caring for people with Parkinson’s is nothing short of a miracle.  One particular individual had his Parkinson’s eliminated in as little as 2 treatments.  Go to www.nrc.md and watch any of the videos related to Parkinson’s as found on the site.

Having a Consultation and Examination with Dr. Huntoon would prove beneficial and he will be happy to administer the NRC TEST to see if you or your loved one is a candidate for this form of care.  He will also evaluate the appropriate nutritional supplements for a positive Parkinson's Reflex using CRA as taught to him by Dr. Dick Versendaal.

Others have benefitted from Acupuncture, Naturopathy and Homeopathy.

What's New In Parkinson's Medical Research?

What's New In Parkinson's Medical Research?

This article was originally published in spring 2016.

What’s new in Parkinson’s disease (PD) research? At the Parkinson’s Disease Foundation (PDF), this is the question we are often asked by people with Parkinson’s and their loved ones. How soon and in what ways will scientific research help my life with Parkinson's disease? Recently, we sat down with James Beck, Ph.D., PDF’s Vice President of Scientific Affairs, to ask him some of the questions that you, our readers, most frequently ask us about the state of Parkinson’s disease research.

Q. How has Parkinson’s research evolved over the past ten years?

The focus of the field has shifted in new and exciting ways. When I first came to PDF, scientists were very focused on the idea of using antioxidants to treat Parkinson’s disease. In fact, there were several large clinical trials underway to test whether compounds such as creatine and Coenzyme Q10 could treat the disease by stopping a process called oxidative stress. To everyone’s disappointment, these clinical trials failed. But there remains hope for one potential treatment of this kind that works by raising blood levels of an antioxidant called urate. As we go to press, a phase III clinical trial for that potential drug is getting underway.

At about the same time as the antioxidant trials were going on, two independent lines of research changed the focus of the field. Both were led by scientists at PDF Research Centers: Jeffrey Kordower, Ph.D., at Rush University Medical Center, and David Sulzer, Ph.D., at Columbia University Medical Center. Their results both pointed to the protein alpha-synuclein as a likely culprit in the development of PD.

Alpha-synuclein is a protein that is found naturally in the brain and body. But in Parkinson’s disease, it clumps together abnormally. We have known about the protein for quite some time, but the research of Drs. Kordower and Sulzer changed our understanding of its early role in PD, and in turn, shifted the attention of many PD researchers.

Running parallel to this research, there has been an increased focus on the genetics of Parkinson’s. We now know that for many people, small genetic variations may combine with other factors to increase the risk for, but not directly cause, Parkinson’s disease. Closer to the clinic, we have seen increased focus on research to ease the disabling nonmotor symptoms of PD, such as cognitiveissues and fatigue.

Another exciting development is an increased focus on something that PDF has long believed to be central to the effectiveness of PD research: the role of people living with PD. Listening to the concerns of the community has played an important role in the development of medicines to address some of the disabling daily aspects of PD, such as dystonia, fatigue and dyskinesia.

The result of these advances is that the PD pipeline is strong, solidly based upon basic research and likely to address unmet needs in the community.

Q. What is the one single thing you find most exciting about PD science right now?

The focus on alpha-synuclein. The protein was first discovered to play a role in PD by Roger Duvoisin, M.D., whose career was launched with PDF support. Twenty years later, it has become a major target in the search for game-changing PD therapies.

The research is still at an early stage, but it is exciting. Scientists are already studying several types of drugs that would target the protein in the brain in different ways. Some of these aim to change how much alpha-synuclein is made; others, how it folds; still others, to stop it from spreading in the brain. For all of these, the goal is the same: to slow or stop PD.

The result is that we have more drug targets for anti-PD therapies than we had 10 years ago, and today’s targets are better. The PD drug pipeline is strong, and that’s exciting news for future therapy development.

Q. It is still a mystery as to how Parkinson’s begins and develops. Which theories are most intriguing to you? Are we closer to solving the mystery?

These are two critical unanswered questions. The first, understanding how PD begins, is difficult to answer. We have made progress; for example, we have discovered rare individuals who have certain inherited genetic mutations that cause PD. But even in these cases, we continue to struggle to determine just how PD starts.

The second question, understanding how PD progresses, may be easier to answer. One intriguing theory is called the prion hypothesis, which suggests that alpha-synuclein, by spreading throughout the brain, may be responsible for the progression of PD. The theory states that alpha-synuclein becomes damaged in PD and folds into an abnormal shape. This damaged form wreaks havoc on brain cells, causing them to die.

Here is where it gets interesting: the misshapen alpha-synuclein escapes the brain cells it has damaged, enters new healthy cells and damages (or infects) them too. The theory says that this cycle continues, with the protein slowly spreading PD throughout the brain, leading to disease progression and worsening symptoms.

I am hopeful that we will soon discover exactly how PD progresses and how we can interfere in this progression. It is possible that understanding this process may give us enough information to find better treatments for PD without having to understand or eliminate its root causes.

Q.You said the PD drug pipeline is stronger than ever. Among the experimental treatments that are now in development, which is closest to market?

There are several potential new drugs in clinical trials that we hope will soon be up for approval by the US Food and Drug Administration (FDA). Of these, the one with the best chance of becoming available soon is called pimavanserin (Nuplazid^TM). If it is approved, this drug will be the first to specifically treat the hallucinations that are experienced by many people with PD (also known as PD psychosis). Hallucinations are the number one reason for which people with PD are placed into nursing homes, and better medications are sorely needed.

In addition, there are several drugs in development that are designed to ease more well-known PD symptoms (such as tremor and stiffness) and several designed to improve upon the effects of levodopa. Time (and clinical trials) will tell how well each may help in PD.

Q. Our community urgently needs better treatments and a cure. What are the main obstacles to getting there and how can we confront them?

There are two types of obstacles: those related to our limited scientific understanding of PD and those related to how research gets done. We have already discussed several in the first category. In the second, a major obstacle is the erratic nature of funding for science. In today’s environment, support for research is hard to come by even for the most worthy projects. And when it is available, it can be difficult to keep. This means that researchers spend too much time and energy looking for funding, and not enough focused on research.

This unreliability in funding has several serious consequences, which in turn, slow scientific progress. The first is that scientists leave the field of PD. Think for a moment about typical young scientists — smart and dedicated thirty-somethings. What will they do if they cannot depend on their jobs? Unfortunately, they often take their talents elsewhere. The second is that for scientists who do stay in the field, erratic funding hampers their ability to conduct long-term projects — the type that are crucial to solving a chronic disease like Parkinson’s. This is why PDF provides long-term, stable support to teams of scientists at our two Research Centers — allowing them to focus the bulk of their energy on doing research, instead of on writing grants.

A second related obstacle, which leaves us in danger of drying up the PD pipeline, is a lack of sufficient support for basic science. Basic science is the foundation upon which all discoveries are based. It studies the building blocks of PD (the brain, neurons and chemical reactions), to provide clues that help us better understand PD. Basic science is also critical to finding new therapies. We often hear that drug research is a pipeline. At the beginning of that pipeline is basic research and at the end are clinical trials, where new drugs are tested before getting approved by the FDA. We need to keep the beginning of the pipeline well-stocked with ideas. But funding often focuses on the end of the pipeline.

Without investment in basic science, we will have nothing to test in clinical trials. PDF invests most of its annual $4 million research budget on basic science to fill the gap and keep the new ideas coming.

In addition to funding, a third but equally important obstacle is finding ways to engage people with PD in research. Over the past decade, PDF has led the way in ensuring the patient community is a part of research. We have done so in part through a program known as Parkinson’s Advocates in Research, which brings together patient advocates and researchers. In a related program, known as Community Choice Research Awards, PDF funds research based on the priorities of the community. Both of these initiatives are designed to ensure that the insights of people with Parkinson’s are shared with the researchers who are developing their new treatments. It is a powerful concept. Already, PDF has invested in four conferences to study issues the community has identified as important, including fatigue, constipation, dystonia and dementia. This will help to speed research and improve treatments.

Q. How confident should people feel about the state of PD science?

Very. Over the past ten years, progress may have been difficult to see — there were only a handful of new drugs approved. But behind the scenes, scientists have made progress in understanding how PD develops and how to stop it. More importantly, we have built a strong pipeline, filled with novel compounds that tackle PD symptoms and some that may even halt the disease itself. The future is bright.