Expert Column

Dr. Harvey Gilbert, MD

Medical and Policies Director
Harvey Gilbert, MD, is a radiation oncologist with over thirty-five years of professional experience...read more

Articles In This Column

Senior Health

Parkinson's Disease Diagnosis

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Parkinson's disease diagnosis has many variables—and as such the course of treatment chosen by patient and doctor depends upon many factors, but always starts with diagnosis of the type of Parkinson's disease. The multiple forms of Parkinson's disease are each associated with different symptoms. The most common forms are slowly progressive, but there are a few forms of Parkinson’s disease which are more rapidly progressive. These include:

Progressive supranuclear palsy (PSP). Patients with dementia who show abnormal protein

Lewy body dementia

Corticobasilar degeneration. Signaled by problems primarily with posture, asymmetry, speech and comprehension problems.
Dementia. Thought and memory dysfunction appear first, before motor problems.
Multiple system atrophy (MSA). Early symptoms include fainting and loss of erection.
Progressive supranuclear palsy (PSP). Starts with problems affecting posture and vision.

Diagnosing Parkinson's Disease

Because there are multiple forms of the disease, which exhibit different symptoms, one must get an accurate diagnosis that also distinguishes between Parkinson's disease and Essential Tremor, a condition that improves with beta blockers and alcohol.

In the U.S., diagnosis begins with the reviewing the patient's medical history, performing a neurologic exam and grading the patient according to the Unified Parkinson Disease Rating Scale. Most tests, such as a CT or MRI are not accurate and not diagnostic. There is a machine called a DaTSCAN—a SPECT scan— which is used in Europe to diagnose Parkinson's disease. Some people claim that the DaTSCAN is more accurate than the clinical exams used here, but the machine is not approved for use in the U.S., and it is not able to distinguish between Parkinson's disease dementia and dementia with Lewy bodies.

Author's Note: Sources: Compiled from information found at www.wikipedia.com; www.parkinson.org.; www.mayo.com; www.mccare.com, www.prescribersletter.com, www.bnet.com and the www.webmd.com; plus the Discovery edition of Brain magazine 2009.