What is the current protocol for a PD diagnosis? As I joked in my earlier post, I nurse the small hope that I have some benign disease called (say) zatzsiosis. However, after receiving a detailed description of the diagnostic process, I have so many of the signs that I can’t deny I have PD (even though the signs are mild and the progression of the disease is very early). This information was from a October 2014 presentation by Dr. Daniel Burdick, movement disorder specialist at Evergreen Hospital’s Booth Gardner Center, describing the standard diagnostic critieria.
- Bradykinesia HAS to be present.
Bradykinesis literally means “small movement” in Greek. Your movement gets slower and smaller as you keep repeating the pattern (at last, an excuse for why I can’t dance). The classic test (which I do every time I visit the neurologist) is what I call the “castanet test”. You tap your forefinger on your thumb as fast as you can, as if you were using castanets. My right (dominant) hand is slower than left and I quickly “run out of gas”, although not so quickly as I did before medication. I used to “run out of gas” when I was applauding, but I’m able to clap now (through standing ovations!) with medication.
- One (at least) of the other motor symptoms needs to be present:
–Tremor (especially unilateral, that is one side of your body).
–Stiff/ awkward gait
If you’re keeping score, I have all three (and did at the time of diagnosis.)
- The clinician will spend some time on your medical history, especially to pick up clues about non-motor symptoms. My neurologist was interested that I had a poor sense of smell and that the water I drank for the first seven years of my life was from a rural private well (potential pesticides). He also noted my medical history included ten plus years of stiff-muscle-of-the-month (hips, shoulders, etc.)
- Then, other diseases have to be ruled out. Essential tremors (see my earlier post) is characterized by — guess what — tremors, but is totally different than PD, and is treated with different medicines. There is also a whole family of “Parkinsonisms” with scary names like:
— Dementia with Lewy bodies
— Progressive supranuclear palsy
— Multiple systems atrophy
Since my strongest symptom was a tremor, I was run through the MRI to determine if I had had a stroke (one of the many possible causes of a tremor — why a tremor alone is not sufficient to diagnose PD).
- Finally, the clinician observes your response to medication. If your symptoms diminish upon receiving PD therapies (e.g., Levadopa or a dopamine agonist), that is another verification that you have Parkinson’s, not zatzsiosis. I was prescribed a dopamine agonist and yes, the tremoring went down to nearly nothing.