How is Parkinson's Disease Diagnosed?

Ashok remembers quite clearly the day he first noticed that his left hand shook. It was a Monday; the day he was to make a sales presentation he’d spent a month preparing. Sitting quietly at his desk, this 54-year-old businessman felt his hand trembling, slightly but persistently. “I put it down to nerves, fatigue, whatever. I’d been feeling depressed and more tired than usual, but otherwise, I was in great physical shape. I was only 54. I didn’t give it a second thought – until it kept happening.”

For Sunitha, a 68-year-old retired schoolteacher; the onset of her condition was much more gradual, occurring over the course of more than a year. “I tired easily and moved much more slowly. My gardening chores became more difficult and painful to perform. I thought it was just the price I had to pay for getting on in years,” she recalls. “But my husband became alarmed when he saw me dragging my right leg, and he complained that I wasn’t smiling as much and that I seemed to be staring off into space all the time. When I noticed that I was sort of shuffling when I walked, I became alarmed, too.”

Ashok and Sunitha were later diagnosed as having Parkinson’s’ disease, a degenerative brain disorder suffered by around 100 lakh people worldwide, most over the age of 50. They would learn that certain cells in a part of their brain were dying – cells essential to the process of normal human movement. As the cells continue to die, proper movement and balance deteriorate. But neither of them received the diagnosis of Parkinson’s on the first visit to a doctor. Here’s why -

It’s important to rule out other conditions which mimic the symptoms of Parkinson’s disease

Ashok’s doctor put him through a complete checkup: blood test, chest x-rays, urinalysis. The doctor also asked him endless questions about his work routine, what foods he eats, and what kind of stress he was under. Because he was feeling so depressed, the doctor referred him to a psychiatrist, whom he saw for about 6-7 months. The psychiatrist prescribed antidepressants, but Ashok still wasn’t feeling any better. Then he went to a neurologist, who was unable to diagnose. It took about another year and two other neurologists before the diagnosis of Parkinson’s disease was confirmed.

Also Read: 10 Early Signs of Parkinson’s disease

Sunitha’s experience was a bit less complicated, but still involved different tests. Her physician suspected Parkinson’s disease almost from the start but he knew it was important to rule out other conditions that might account for Sunitha’s symptoms. Hence, she was referred to a neurologist, who confirmed the diagnosis of Parkinson’s disease.

Diagnosing Parkinson’s disease

No simple blood test or x-ray will confirm Parkinson’s disease: the diagnosis is arrived at primarily through observations by a healthcare professional trained in nervous system conditions and the elimination of other diseases.

A complete neurological exam is an intense, often time-consuming, but never a painful experience. It usually begins with the specialist taking a thorough medical history. He or she will probably ask what other medical conditions you have or had in childhood, your family’s medical history, what drugs you may be taking, and if you have had any accidents that involved head or spinal injury. This information may help the doctor rule out other inherited conditions that may resemble Parkinson’s disease.

Then the doctor performs the physical exam where he pays special attention to your muscles since Parkinson’s is a motor (movement) disorder. Eye movements are also studied. Next, the doctor often likes to see how you move around, sit and stand, how you open and close your hands, and tap your feet.

Many doctors, especially when they suspect Parkinson’s, will request a sample of your handwriting. Also, the doctor will take special note of your body language: How often do you blink? Do you smile, frown, or otherwise show emotion when you are speaking or listening?

Your memory, your ability to do simple mathematical equations may also be measured at this time. One test for mental function requires you to spell a 5-letter word such as “world” forward and backward. This test requires not only memorization technique but the ability to juggle things in your mind, remember them, and rearrange them.

Don’t be surprised if the exam involves a bit of philosophy as well. To measure your powers of abstract thinking, the doctor may ask you to interpret a proverb/cliche: What does “A rolling stone gathers no moss” mean to you? for instance. Of course, no right or wrong answer exists to such a question, but how you describe your reaction to it may tell the doctor a great deal about the way your brain is functioning.

Imaging tests such as MRI, CT, ultrasound of the brain, and PET scans may also be suggested to rule out other disorders.

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