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Parkinson’s disease diagnosis

Parkinson's disease diagnosis

Parkinson’s disease develops slowly and gradually with atypical symptoms such as shoulder pain, numbness, clumsiness. With time to develop and the main symptoms of the disease as characteristic of Parkinson’s disease is asymmetrical start. With the evolution of the disease leads to severe motor disability of the patient.

Formed four cardinal symptoms:
Static tremor (tremor at rest) – in 70% of patients this is the first clinical sign. Usually begins unilaterally distally, most often by hand. Tremor has a frequency 3-7Hz. Typically, it is rhythmic, disappears in movement during sleep. Growing from emotional stress. Over time may be extended to the whole arm, leg, contralateral limbs.
Rigidity – expressed by an increase in muscle tone of the different muscle groups. In a study of muscle tone rigidity exhibits a constant resistance to outward movement of the limbs. The resistance may occur smoothly, but often is obtained stepwise “Phenomenon of the toothed wheel”, that can be reinforced when the passive movement of one limb against the active movement of the other.
Bradykinesia – is to delay voluntary movements, difficulty in initiating and implementing automated movements. Clinical manifestations include loss of spontaneous facial ekspresiya- hipomimiya or “masked face” reduced frequency of blinking, hypophonia in speech, monotonous speech micrograph reduced to missing physiological synkinesis hands when walking, loss of normal gestures, difficulty self. Hypokinesia is presented with reduced amplitude of movements.
Postural instability – the result of loss of postural reflexes, rigidity.

Patients experience a change in posture with flexion of the head and body as the hands are close to the body, bent at the elbow joint. Gait becomes slow, small steps with difficulty departure, turning, braking. Pulsed appear phenomena. In pushing the patient, he staggers and began making small quick steps to steady himself. Depending on the direction denotes this phenomenon as retro-, antero- or lateropulsio.

In about half of patients develop a number of additional symptoms that are considered secondary. These include cognitive impairment, dementia, in which it is necessary to make a differential diagnosis of Alzheimer’s disease and progressive supranuclear palsy. There are also violations by the autonomic nervous system, which are expressed in the presence of orthostatic hypotension, constipation, urinary and sexual dysfunction. If these secondary symptoms occur early in the disease it is necessary to make a differential diagnosis with other neurodegenerative diseases where also develop some of the cardinal symptoms of Parkinson’s disease.

To diagnose Parkinson’s disease is a necessary presence of at least two of the cardinal symptoms. Typical is unilateral onset of symptoms in early disease. Most often initially detectable tremor at rest. Severity of symptoms increases by about 8-9% per year. Patients are confined to bed due to disability after an average of 14 years. Progression of the disease is individual and faster during the first 4-8 years. The form of the disease is also important for the progression of the disease. The progression is slow in onset before the ’50 age and initial appearance of tremor. Faster is in late onset of disease and prevalence of rigid-bradikinetichen syndrome and dementia. Neuroimaging techniques (computed tomography, and magnetic resonance imaging are primarily used for the exclusion of any other neurodegenerative disease, wherein it can be observed characteristic of Parkinson’s disease symptoms.

Differential diagnosis should be made with other diseases, which show parkinsonian syndrome. Parkinson’s syndrome is characterized by the presence of resting tremor, bradykinesia and / or hypokinesia, and muscular rigidity. This syndrome can not enter into the clinical picture of other disorders in which is accompanied by various symptoms.

Multisystem atrophy – combines three different diseases – Shy-Dreger syndrome striatonigral degeneration olivopontotserebelarna atrophy. Characterized by the presence of parkinsonian, cerebellar and pyramid syndromes and the presence of autonomous violations. The symptoms, however, is two-way, no tremor, is not affected by levodopa preparations. The progression is rapid. CT research visualized atrophic changes in the cerebellum, vermis and Pons.
Progressive supranuclear palsy – combines Parkinson, pseudobulbar and demented syndromes and vertical supranuclear palsy looked at look down. There is a characteristic posture of the head extension due to an increased muscle tone axial more in the upper part of the body.

Patients with these diseases often manifest initially typical Parkinson’s disease symptoms. Therefore an accurate diagnosis can be placed over time in the expression of specific clinical signs of these conditions. These diseases usually progress more rapidly than Parkinson’s disease and the usual anti-parkinsonian medications are not effective to address the typical symptoms.

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