Dr. Weiner examines patient.
Parkinson's disease is just one of several neurologic movement disorders that produce similar symptoms.
It is important that the physician you are seeing has experience with all of the different disorders that can masquerade as Parkinson's disease.
In some of these diseases people quickly become totally disabled; in others, the disease progresses extremely slowly; and in yet others, illness is chronic (always present) and may have more severe symptoms as time goes on. Because the natural history, or progression, of these diseases varies greatly, proper diagnosis is crucial. People need to know which disease they have.
When performing a neurologic examination to evaluate a patient with a movement disorder, the doctor takes a medical history and performs a physical examination. The doctor asks the patient and the family members or friends about symptoms and observes the patient, asking him or her to walk around the room, sit down, stand up, turn around, and so on.
The neurologic exam is a thorough evaluation of the nervous system. In particular, the neurologist observes aspects of the patient's movement, coordination and balance.
Unfortunately, there is no diagnostic test that can confirm Parkinson's disease. Laboratory testing of the blood of patients with the symptoms typical of Parkinson's only rarely uncovers any abnormality.
Electroencephalograms (EEGs) record some aspects of brain electrical activity, but they are not effective in spotting Parkinson's.
The MRI and CAT scans of the brain produce remarkable and exquisite anatomic pictures.
The MRI and CAT scans of the brain of people with Parkinson's disease appear normal. The brain of people with Parkinson's disease appears normal.
Dr. 's Weiner and Shulman review MRI scans.
The brain changes that create neurodegenerative diseases such as Parkinson's are microscopic, on a chemical level, and are not revealed by these scans.
With no diagnostic tests to provide specific answers, physicians must base their diagnosis of Parkinson's on judgment. Physicians are intimately familiar with the characteristic history and the signs and symptoms found when examining a person with Parkinson's.
They then must judge how closely the history of symptoms and the neurologic findings (from the physical examination) of any specific person match those of typical Parkinson's disease. This determination through the judgment of the doctor (the clinician) is called a clinical diagnosis.