Parkinson Disease: Early Signs, Tremor and Slowed Movement Evaluation

What it involves

MedlinePlus explains that Parkinson disease results from certain brain cells dying. These cells make dopamine, a chemical that helps control movement and coordination, so the disease leads to tremors and trouble walking and moving. It most often develops after age 60, affects men more often than women, sometimes runs in families, and can occur in younger adults, where genes are often involved.

Who this is for

• Adults with a tremor that appears when the hand or leg is at rest.
• Patients whose handwriting has become small or whose movements have slowed.
• People with stiffness, a stooped posture or a shuffling walk that is new.
• Families concerned about changes in a parent's movement, voice, balance or facial expression.

What to expect

• Questions about which side the symptoms began on, when you noticed them, and what makes them better or worse
• A hands-on exam of muscle tone, reflexes, movement, walking and blood pressure on standing
• A medicine review, since some prescriptions can cause shaking or stiffness, and blood work for other causes
• A referral to a neurologist to confirm the diagnosis and begin treatment

Movement signs MedlinePlus lists

MedlinePlus lists problems with balance and walking, rigid or stiff muscles, a stooped posture, slow or infrequent blinking, a masklike face without expression, slowed and quieter speech, and very small handwriting called micrographia. Movement problems include difficulty starting to walk or getting out of a chair, slowed movements and loss of fine hand movements. Symptoms may affect one or both sides. The muscle weakness guide and balance problems guide describe two of the lookalikes.

The resting tremor

MedlinePlus says Parkinson tremors usually occur when the limbs are not moving, go away when you move, and may be worse when you are tired, excited or stressed. Some people rub the finger and thumb together without meaning to, called pill-rolling tremor. A tremor that appears mainly when you use your hand, such as holding a cup, usually has a different cause. The hand tremor guide explains how providers tell tremors apart and what else can cause shaking.

Signs beyond movement

The encyclopedia also lists constipation, low blood pressure on standing, sweating and trouble controlling body temperature, muscle aches, difficulty swallowing, drooling, disturbed sleep, anxiety, depression, confusion and memory loss. Many of these have common causes of their own, which is why a primary care provider looks at the full picture. The constipation guide, difficulty swallowing guide and memory loss guide cover three of them.

How it is diagnosed

MedlinePlus says a provider may be able to diagnose Parkinson disease from symptoms and a physical exam, but symptoms can be hard to pin down, particularly in older adults, and are easier to recognize as the illness worsens. Tests are done to check for other conditions that mimic it, and a DaTscan imaging study is only needed in some situations. Serenity By A Dr. Sareen lists blood work among its services, while the neurological diagnosis and imaging are made by referral to a specialist.

Treatment a neurologist directs

There is no cure, but MedlinePlus says treatment can help control symptoms. Medicines for shaking and movement can wear off during the day, so type, dose and timing may need adjusting, and others treat mood, sleep, pain and drooling. Side effects can be serious, including confusion, hallucinations and lightheadedness, and stopping some medicines suddenly can cause a severe reaction. Surgery such as deep brain stimulation may help some people. Your primary care provider coordinates the rest of your health.

Safety at home and long-term care

MedlinePlus advises staying active when you feel well, resting as needed, using physical and occupational therapy to stay independent, placing handrails in bathrooms and along stairways to lower the risk of falls, and using speech therapy for swallowing and speech changes. Complications can include falls, trouble swallowing and pneumonia from breathing in food or saliva. Support groups help patients and families. A family member can attend visits and take notes, which helps when memory or concentration is affected.

Sources

• MedlinePlus: Parkinson's Disease (health topic)
• MedlinePlus: Parkinson disease (medical encyclopedia)