What are the main symptoms?
Symptoms tend to appear gradually, normally in just one side of the body at first, although both sides will be affected as Parkinson's progresses. Each person will encounter different symptoms, in terms of severity and rate of progression, and there may be fluctuations from day-to-day, with 'good' and 'bad' days being experienced.
Loss of smell is now recognised as being one of the earliest symptoms. A reduced ability to smell will probably have been present for a considerable time before more obvious symptoms (listed below) are noticed, but often goes undetected for some time. Researchers are now beginning to realise that early symptoms such as this may be useful in aiding diagnosis and highlighting those at risk of developing Parkinson’s. Neuroprotective strategies are continually evolving and it is hoped that development of a reliable smell test could be an invaluable tool for early diagnosis and prompt neuroprotective treatment, which could in turn slow or prevent the progression of the disease.
The three main physical, motor-symptoms are:
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tremor: this can affect the hands and feet. The tremor is most marked at rest, and actually improves when performing a task. Another condition known as Essential Tremor (ET) is often misdiagnosed as Parkinson's as it too causes a tremor, but one which is absent at rest and most marked when performing a task
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muscular rigidity: this causes stiffness during movement
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bradykinesia: causing slowness, this symptom makes initiating movements very difficult.
Balance and posture can deteriorate as Parkinson’s progresses, resulting in problems with walking, turning around, rolling over in bed, and transfers, such as getting in and out of a chair or bed. Postural imbalance is therefore sometimes quoted as the fourth main symptom.
Communication difficulties are also common. Speech, facial expressions, body language and handwriting are affected in many people. Facial expression and body language are very important as they reveal emotions; people with Parkinson’s can be misunderstood because changes in facial expression are slow and limited, and body language is considerably diminished. Some people with Parkinson's say they can’t show on the outside how they feel on the inside.
Other symptoms include sleep disturbances, depression and anxiety, pain and fatigue. Swallowing and memory problems may also occur in the later stages of the condition.
As Parkinson's progresses
Progression is usually very gradual. Many people believe they had Parkinson's for some time - often two to three years - before seeking a formal diagnosis. Often it is only when the symptoms become noticeable or begin interfering with daily activities that a visit to the doctor is prompted.
Symptoms and responses to treatment are different for each individual, so it is not possible to accurately predict progression. For some it may take many years for the condition to develop, for others it may take less time.
How is Parkinson's diagnosed?
Because Parkinson's has symptoms similar to a number of other neurological disorders and because every case is unique, diagnosis of the disease can be difficult. There are similar conditions, often referred to as Parkinson’s Plus syndromes or atypical-Parkinson syndromes, which make diagnosis and treatment problematic. As such, a thorough examination is required by a specialist doctor or neurologist. Sometimes it may take several examinations over a period of time (perhaps several years) before the diagnosis can be made confidently.
The doctor will discuss your general medical history looking for the main Parkinson’s symptoms. Certainly he or she will be looking for slowness of movement (bradykinesia) accompanied by at least one of the following: tremor, rigidity and/or difficulty with balance.
Diagnosis may be further confirmed if there is a positive response to medication used to treat Parkinson’s, whereas other similar conditions may not respond well to such treatments.
Blood tests may be carried out to eliminate other causes of symptoms. ‘Neuro-imaging’ may also be performed which shows and assesses the anatomy and functioning of the brain and other parts of the nervous system, and can effectively rule out conditions that have similar symptoms.
Neuro-imaging that may be performed (but not in all cases) are:
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CT (computerised tomography) scan: x-rays are passed through the body from different angles to build up a cross-sectional anatomical picture of the brain. This scan may be used to exclude vascular disease and tumours as the cause of Parkinson-type symptoms
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MRI (magnetic resonance imaging) scan: uses magnetic charges rather than x-ray to form images of the brain or other parts of the body. This can be helpful in differentiating between Parkinson’s and Parkinson’s-like conditions such as PSP and MSA by revealing structural differences. Accuracy is thought to be around 60-80%
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DaTSCAN™-SPECT: this involves injecting the patient with a product containing a small amount of radioactivity which then binds itself to dopamine-releasing neurons. The signal is measured with a SPECT (single photon emission computed tomography) camera: a high signal indicating that there are many surviving dopamine neurons, and a low signal indicating a depleted level of these neurons. A low signal suggests Parkinson’s syndromes, but does not differentiate between different types of the disease. DaTSCAN can, however, be used for differentiating Parkinson’s from Essential Tremor. It can also be used for specifically identifying Lewy body dementia as opposed to other types of dementia
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IBZM-SPECT: other types of tracers, such as IBZM (iodobenzamide) and SPECT, can also be used to help in differentiating different types of Parkinson’s syndromes
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PET (positron emission tomography) scan: another type of scanning technique, PET can be used for helping with Parkinson’s diagnostics. But as it is more expensive and not as readily available as SPECT, PET is predominantly used as a research instrument.
New imaging techniques are being developed and research is also under way into new blood tests which can detect Parkinson’s, but it may be some years before these become available.
How is Parkinson's treated?
Whilst treatment is constantly improving, researchers have not yet been able to find a way to prevent or cure Parkinson's. But the symptoms can be effectively controlled, often using a combination of the following:
- medication
- conventional therapies, such as physiotherapy, occupational therapy, speech and language therapy
- complementary therapies, such as aromatherapy, reflexology, yoga and Tai Chi
- surgical treatments.
There is no single, optimal treatment because the condition affects each individual differently. You will need to work with your doctor to find the right balance of treatments for your specific symptoms. Regular reviews will be required and adjustments made as symptoms alter.
Who is involved in managing Parkinson's?
Many different professionals will be able help you. Your ‘multidisciplinary team’ includes a wide range of professionals – some who will help you now, others later on. But your most regular contacts will be your family doctor and a doctor with a special interest in Parkinson’s. They will check your symptoms, prescribe and adjust medication when necessary and give general advice on day-to-day living with Parkinson's. It is important to have a good relationship with them, so you feel comfortable discussing any problems.
The multidisciplinary team is the group of professionals who will be able to provide a complete programme of care that should tend to all your current and future needs. For example, dieticians will help you to eat the right foods to keep healthy, pharmacists will offer advice on taking your medication, and physiotherapists can help you to stay active.
The Multidisciplinary Team
Ask your doctor about the services each of these professionals provide and don’t be afraid to request a referral if you think they will help your specific needs.
