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The Diagnosis

Parkinson's is a chronic disease. It is not a terminal disease.

 

It's imperative that you take into account that everything you read does not pertain to your specific situation. Relevant information, along with the advice of your doctor, will put you on the path to making sound decisions about your own personal situation.

PD Defined

History of Parkinson’s disease

James Parkinson (1755-1824), an English surgeon, was the first to describe the symptoms we now identify with PD.  He wrote “An Essay on the Shaking Palsy” in 1817.  A milestone in Parkinson’s treatment was reached in 1960, when researchers first identified differences in the brains of people with PD related to dopamine deficiency. 

 

This discovery led to the development of the drug levodopa and the first human trials. In 1976, the first carbidopa/levodopa combination medication became commercially available, which reduced some of the side effects of taking levodopa alone. 

Causes of Parkinson’s disease

About 90% of cases of PD are idiopathic, meaning “without known cause”. 

  • Age is the only known risk factor for PD. Most people are over the age of 50 at diagnosis. People diagnosed before the age of 50 are considered Young Onset Parkinson’s Disease (YOPD)

  • Genetics- the study of heredity and the variation of inherited characteristics- more common in Young Onset (<50 years old) 

  • Drug-induced parkinsonism- caused by the use of certain drugs such as antidepressants and antipsychotics. 

  • Environmental toxins, such as pesticides and insecticides, may be linked to the development of PD 

  • Traumatic brain injury- associated with increased risk of developing PD later in life 

  • Cerebral anoxia (the absence or deficiency of oxygen in the brain) 

 

 

PD vs YOPD

The difference between a YOPD diagnosis and a Parkinson’s diagnosis.

YOPD is more likely to be genetic. A recent study found that 65% of people with PD onset under the age of 20 years old and 32% of people with PD onset between ages of 20-30 years old have a genetic mutation believed to increase PD risk.  (NPF)  

  • Scientists are studying the mutation of the PKRN, OPRK2, LINK1, LINK2, SNCA genes. 

  • Slower progression of PD symptoms in YOPD patients.

  • More side effects from longer use and higher doses of dopaminergic medications.

  • Tremor is present in 85% of YOPD patients.

  • More frequent motor symptoms of dyskinesia (involuntary, uncontrolled movements) and dystonia (cramping and abnormal postures) such as arching of feet.

  • People with YOPD are often better surgical candidates (DBS) and are better suited to try new medical therapies.                                                                                    

 

Why is distinguishing YOPD from PD important?

The younger a person is diagnosed the more likely the disease is genetic. It is recommended that if you have young children or planning to have children that you and your family have genetic testing or counseling. Scientists have discovered genes that can cause or increase the risk of developing Parkinson’s at a younger age.

 

The Parkinson’s Foundation Genetics Initiative is the first national Parkinson’s study to offer free genetic testing plus counseling for Parkinson’s related genes through medical professionals. Testing can be done through your doctor’s office but mainly is done through clinical studies. As part of research, genetic information offers valuable insights towards understanding the disease and potential therapies.

How common is Young Onset Parkinson’s disease?

  • Children (6-13 years): very rare

  • Teenagers (14-18 years): very rare

  • Young adults (19-40 years): rare

  • Adults (41-60 years): common

  • Seniors (60+ years): common

Diagnostic tests that I should know about.

MRI:

An MRI does not diagnose PD or assist in the clinical diagnosis of PD, but may be used to rule out other conditions. Magnetic Resonance Imaging (MRI) is a procedure where radio waves and a powerful magnet linked to a computer are used to create detailed pictures inside the body.

 

DaTSCAN:

A DaTSCAN test is now available to assist in the clinical diagnosis of PD.  A radioactive tracer, ioflupane (I123), is injected into the blood, where it circulates around the body and makes its way to the brain. It attaches itself to the dopamine transporter, a molecule found in dopaminergic neurons.

 

Several hours after the tracer has been injected, special imaging equipment scans the head to detect the presence of ioflupane. People with PD typically will have a smaller signal in a part of the brain called the striatum, indicating fewer dopaminergic neurons. A DaTSCAN cannot differentially diagnose between idiopathic PD and atypical PD. 

 

A DaTSCAN cannot differentially diagnose between idiopathic PD and atypical PD.   

Symptoms

Primary symptoms of Parkinson’s Disease

There are four primary motor symptoms of Parkinson’s disease: tremor, rigidity, bradykinesia (slow movement) and postural instability (balance problems). Observing two or more of these symptoms is the main way that physicians diagnose Parkinson’s.

It is important to know that not all of these symptoms must be present for a diagnosis of Parkinson’s disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinson’s disease has a tremor, nor is a tremor proof of Parkinson’s. If you suspect Parkinson’s, see a neurologist or movement disorders specialist.

This list is not to worry you, but to educate and give you the tools to be prepared. Especially with YOPD you can educate yourselves early, so you can look for signs and immediately and actively address symptoms.

More information is available.

Resource: 23 Parkinson's Symptoms to Look For

Motor Symptoms

  • Tremors

  • Rigidity

  • Bradykinesia

  • Postural Instability

  • Walking or Gait Difficulties

  • Dystonia

  • Vocal Symptoms

Non-motor Symptoms 

  • Disturbances in the Sense of Smell

  • Sleep Problems

  • Depression and Anxiety

  • Pain

  • Psychosis

  • Fatigue

  • Cognitive Changes

  • Weight Loss

  • Gastrointestinal Issues

  • Lightheadedness

  • Urinary Issues

  • Sexual Concerns

  • Sweating

  • Melanoma

  • Personality Changes

  • Eye & Vision Issues

More information is available.

Resource: APDA's Symptoms of Parkinsons

Cognition

Brain Scans

If you have Parkinson’s disease (PD), or know someone who does, you likely know that PD affects dopamine levels in the brain. But did you know that PD also alters serotonin, norepinephrine and acetylcholine levels? All are chemicals in the brain that affect mood, thinking and behavior.

Read the article at the Parkinson's Foundation blog:

Research Roundup: Cognition Changes and Parkinson’s 101

More Resources for YOPD

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THE
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