How to diagnose Parkinson’s

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.

  1. Bradykinesia HAS to be present.

    I do not get to wear the cool dress when I do my castanet test.

    I do not get to wear the cool dress when I do my castanet test.

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.

  1. One (at least) of the other motor symptoms needs to be present:
    –Tremor (especially unilateral, that is one side of your body).
    –Muscle rigidity
    –Stiff/ awkward gait

If you’re keeping score, I have all three (and did at the time of diagnosis.)

  1. 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.)
  1. 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).

  1. 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.

About Laura Kennedy Gould

Author of "The Magic Trick -- Life with Parkinson's"
This entry was posted in Parkinson's Basics and tagged , . Bookmark the permalink.

3 Responses to How to diagnose Parkinson’s

  1. Pingback: Parkinsonisms vs. Parkinson’s Disease | The Magic Trick – Life with Parkinson's

  2. Pingback: Do I really have Parkinson’s? | The Magic Trick – Life with Parkinson's

  3. Edmund Kennedy says:

    Very good stuff.

    Edmund R. Kennedy, PE Sent from my iPad


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s