How is the Diagnosis Made?
Dear Doctor,
As some Neurologists are not specialised with PD, they have wrongly or inaccurately diagnosed their patients as an ageing disease. Especially when the patients are at an early stage of PD or having stress and anxiety at work.
This is very common in our country, as there is a shortage of PD doctors.
Therefore some PD sufferers die from other diseases that were made worse by PD.
Kindly detail how to make an accurate diagnosis of PD?
Thanks.
TEO KIM HOE
Dear Teo,
These are based on the four cardinal symptoms:
- Slowness
- Stiffness
- Unsteady gait
- Resting tremors
Supportive evidence:
- One side of the body is more affected than the other
- Masked facies
- Shuffling gait
- Improvement with levodopa
Dr. Ramon L Rodriguez, MD
Dear Doctor,
What if there is no resting tremor but only an action tremor, along with stiffness and slowness? Does this indicate anything different?
TEO KIM HOE
Dear Teo,
It is common to have a little action tremor with PD. You may also have PD and ET. It is best to see a movement disorders neurologist and get this point sorted out. ET stands for essential tremor which is a postural-action tremor rather than a resting tremor. There are also other tremors.
Dr. Michael S. Okun, M.D.
I was finally diagnosed as a Parkinson’s patient in the year 2005. It took me seven years before being diagnosed as such. I had seen three neurologists over the seven-year period in three different countries.
The first neurologist told me that I was in the process of ageing and that I was normal. I was also treated as normal by the second neurologist in another country.
I was very fortunate that I was in the early stage of Parkinson’s and my disease progression was slow. Regular exercises and medications relieve me from body stiffness and mobility. I thank Dr. Chew Nee Kong (Kuala Lumpur, Malaysia) for his excellent medications in treating my Parkinson’s disease. He is actively involved in raising the awareness of Parkinson’s in Malaysia. I give him double bonus for his unselfish service for the care and welfare of Parkinson’s patients – to help PD patients be more aware of their own illness and to encourage the setting up of support groups to educate the patients and their immediate family members.
TEO KIM HOE
Diagnosis of PD – Disability Rating Scales
In helping the diagnosis of PD, there are two disability rating scales used:
1. Conventionally, diagnosis is assessed based on how the current symptoms respond to treatment, ie. whether symptoms are improved by adding levodopa. It is monitored over a period of time and how the patient responds to treatment;
2. In clinical assessment, a doctor may use the Hoehn & Yahr rating scale, named after the two doctors who devised it in 1967. The Hoehn & Yahr scale allocates stages from 0 to 5 to indicate the relative level of disability that the PD patient is experiencing.
TEO KIM HOE
Dear Teo,
Thanks! I’m not a big fan of rating scales for clinical use.
To me the most important is how my patients feel. We use them a lot however in clinical trials because this is one of the most objective ways of determining whether a drug or intervention is working or not. None of the current scales we use is perfect. They do not capture all the signs and symptoms of PD.
Yours,
Dr. Hubert H. Fernandez, MD
Checklist of Parkinson’s Disease
The following are signs that you may develop in Parkinson’s Disease:
1. Unexplained stiffness in arms, legs, feet or hands
2. Tremors in arms, legs, feet or hands
3. Muscle or joints freeze
4. Difficulty walking and balance
5. Stooped posture
6. Soft speech
7. Small handwriting
8. Insomina, anxieties and depression for the past few years
9. Masked face
Consult a Movement Disorder specialist for checkup.
http://www.stalevo.com/info/simplystated/what_is_parkinsons_disease.jsp
Are All Tremors the Symptoms of PD?
Dear Doctor,
Are all tremors are indicative of PD?
How to screen that they are PD?
How to classify those sickness that have symptoms similar to those of PD?
What is Wilson’s disease and is it a treatable disorder?
What is Atypical Parkinson and Parkinson-plus?
Is the treatment of PD so delicate and complicated that the doctor finds difficulty to diagnose and the late treatment aggravates the PD progression – as a result PD patients die from other diseases made worse by PD itself?
Are Essential Tremor common disorders of elderly people ? Are they classifed as PD?
What about at Young-Onset Parkinson Disease (YOPD)? Are they inherited? What is the percentage of this group?
Kindly eleborate.
Thanks.
TEO KIM HOE
Dear Teo,
You ask questions that are loaded, Teo. I’m afraid if I answer all your questions, the rest of the readers will fall asleep!
In brief, not all that shakes are from Parkinson’s. There are other shaking conditions that are not from parkinsonism –such as Essential Tremor and Wilson’s disease.
Parkinsonism is a general condition where someone either shakes, is stiff, or is slow. At least 2 of these need to be satisfied. Not all three symptoms are necessary.
The most common cause of parkinsonism is PD. But parkinsonism can also be from strokes, tumors, infections, medications, etc. In addition, PD has “brothers” that look like it, but are actually different disorders. They are more commonly referred to as atypcial parkinsonism or parkinson-plus disorders.
Sometimes, it is easy to diagnose the type of parkinsonism or the cause of tremor. Sometimes, it is more challenging and one needs the help of a Movement Disorders specialist.
Yours,
Dr. Hubert H. Fernandez
Are There Different Types of PD?
Dear Doctor,
Are there different types of PD?
Are some worse than others?
Thank you
TEO KIM HOE
Dear Teo,
Yes, we believe PD has many subtypes and some may even be genetic. We have identified many genes such as Parkin, LRRK2, DJ1 and PINK1. We have also noticed that PD with resting tremor may have a different prognosis (better) than PD without it. Finally there are several parkinsonian syndromes which seem to respond less well to PD medications (PSP, MSA, CBD, etc.).
Dr. Michael S. Okun, M.D.
Dear Doctor,
What does resting tremor mean?
Thank you.
TEO KIM HOE
Dear Teo,
A resting tremor is a tremor at rest (ie. when not performing action). It is the most common tremor associated with PD. There are other types of tremors when one holds a posture or performs an action.
Dr. Michael S. Okun, M.D.
Dear Dr. Okun,
In view to your article above, I am quite interested to find out from you what are the types of PD associated with genetic? My family has three PD patients and I am sure they are all interested to find out from you i.e. many genes such as Parkin, LRRK2, DJ1, and PINK1. As they are medical terms, it is difficult for us to understand. We would be pleased if you could elaborate further.
What are the types of PD that are not responding well to PD medications?
Lord bless. Thanks.
TEO KIM HOE
Dear Teo,
I rarely say this, but you are asking lots and lots of general questions and I would really like to be sure that you are not diverting attention from others who have important questions to ask about themselves and about others. You will find an update on genetics that I placed with a recent abstract. Thanks for your enthusiasm.
Dr. Michael S. Okun, M.D.
Although large investments are spent on Parkinson’s, there is still shortage of PD neurologists.
There are four PD neurologists in Singapore and one in Malaysia.
As a result, PD patients were wrongly diagnosed by doctors as a process of ageing. Such wrong diagnosis caused the patients’ suffering to be aggravated.
I feel sorry for them.
TEO KIM HOE
Dear Teo,
I am very sorry that information, resources, and neurologists specializing in PD are all so scarce.
I very much hope that this news will spur more research, and cause more physicians to become aware of PD and the need for accurate diagnosis.
Your posts have made me aware of the great need that exists in your area of the world, and doubtless, in other countries as well.
Best regards,
Dr. Kathrynne Holden, MS, RD
Shortage of Movement Disorder Doctors
PD is a progressive and chronic disease.
Unfortunately we do not have any way of checking from where it comes to our body?
While a human grows older, the chances of having PD are higher, as their movement goes slow as well as developing a bad body posture. Tremors are the common in old age or resulting from anxiety and depression at work.
It is difficult to check on people at the age above 60 years old whether they have PD or merely showing signs of old age.
With the growth of the aged population, there is a shortage of Movement Disorder specialists in our country. It makes it even more difficult to have a correct and accurate diagnosis of our disease.
Therefore most people die from aspiration pneumonia, a fatally complicated disease.
Besides, as we do not have enough Movement Disorder specialists, it takes 2 to 3 weeks to make an appointment. This is especially worse in the remote areas.
We only have four PD specialists in Singapore and one in Malaysia.
Best regards,
TEO KIM HOE
Dear Teo,
I did not realize there were so few Parkinson specialists in your country; that must make it even more difficult to get an accurate diagnosis of PD.
Good for you for taking such an active part in your own health care — you have studied and researched PD and learned the best ways to fight it and stay healthy, and minimize the symptoms.
That will certainly stand you in good stead!
Best regards,
Kathrynne Holden, MS, RD
In view of the growth of aged population in Singapore, there are shortages of Movement Disorder specialists.
It takes 3-4 weeks to make appointments with the doctors in the government hospitals.
Public and private charity organizations have been encouraged to give more scholarships to medical students to pursue the course in order to cope with the shortage. Support groups and caregivers of PD have to work hard to increase public awareness of PD and they are the sources of help for all PD patients and caregivers.
Thanks.
TEO KIM HOE
Dear Teo,
I agree with you. PD is a rich man disease and I feel that the support in Singapore is not sufficient too.
If you go to the government hospital, getting an appointment can be up to 4 weeks or even longer. Doctors are unreachable and when you page for the doctors, it is at their own discretion to return your call.
Unless you have the money to go to a private clinic, where the doctors are more willing to talk to you but for the long term, this is a very heavy burden for the average income family.
My mother had PD at a young age of 40 and she is now 48. Her health is deteriorating. Her medications are expensive and she now has muscle aches, hallucination and her emotions are often unstable.
Under the extreme working pressure in Singapore, it is difficult to dedicate enough time for her.
It makes me sad that I am unable to relieve her of pain and agony. PD would require the combined care of a nutritionist, psychiatrist, physiotherapist and a good PD doctor. In Singapore, all of them are expensive.
Yours sincerely,
Angeline Lua
Dear Angelina,
You might post your questions to “Ask the Doctor.”
The doctors are all excellent PD specialists, and may be able to give you some guidance for your mother’s next doctor appointment — perhaps questions to ask her doctor, comments regarding the kind and amounts of medications she is using, etc.
If you have nutrition-related questions, I will help if I can.
Best regards,
Dr. Kathrynne Holden, MS, RD
Dear Teo,
I hope very much that your information and posts will help to raise public awareness of PD in your country. You might like to let the support groups know that National Parkinson Foundation will send informative booklets at no cost, and will also answer questions here on the “Discussion Corner.” I wish you and the PD groups the very best!
Best regards,
Dr. Kathrynne Holden, MS, RD
Are There Resemblances between PD and Alzheimer’s disease?
Dear Doctor,
PD and Alzheimer’s Disease are related with the Body, Mind and Soul slowdown mechanism. It degenerates your nervous mechanism i.e Body, Mind and Soul.
PD develops Dementia. There are about 40-80% of PD patients who are facing difficulties in making judgment, calculating and abstraction.
Are there resemblances between PD and Alzheimer’s disease?
TEO KIM HOE
Dear Teo,
These diseases are very different. They are similar in that they are neurodegenerative, but their course, pathology, and manifestations are very different.
Dr. Michael S. Okun, M.D.
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