Diagnosis & Progression

The diagnosis of Parkinson’s is a clinical one typically confirmed by a neurologist or a movement disorder specialist. The following criteria are used in determining if a person has Parkinson’s disease:

clinicianMedical History and Examination: Two of three movement problems must be present.

  1. Rest tremor- Found in the arm, leg, chin or mouth. It is present when the arm is in a resting position and improves with movement unlike familial tremor in which the tremor is worse with movement and not noted at rest.  Not everyone has tremor (found in 70-80% of people with Parkinson’s.)
  2. Bradykinesia- Slowness of movement
  3. Rigidity- Stiffness in the arms and legs

Click on the image to the right to learn more about this topic.

  • Symptoms start on one side of the body
  • Micrographia or small hand writing
  • Decreased arm swing when walk
  • Masked like or loss of spontaneous facial expression
  • No significant problems with balance, falls, cognitive difficulties, vision early in the course of symptoms.

Non-motor symptoms can precende movement problems. Although these problems are not diagnostic alone they can help support the diagnosis:

  • Depression or anxiety
  • REM Sleep Disorder
  • Constipation
  • Loss of smell
DaTSCAN Brain Imaging

DATScan (1)Nuclear medicine brain image measures the amount of dopaminergic nerve cells in the basal ganglia. The picture illustrates how a DaTSCAN can differentiate parkinson like conditions. However, at this point the scan is not able to diagnose Parkinson’s disease from atypical Parkinson’s but can differentiate Essential or familial tremor from tremor caused by Parkinson’s disease.

Supportive Tests

The following tests can be helpful to 'rule out' or eliminate other causes or conditions that mimic PD or assocatied symptoms:

  • Laboratory tests: 
    • Blood and urine copper studies can be helpful in younger people to test for Wilson’s disease (a genetic condition associated with abnormal body tissue copper levels.)
    • Vitamin B12, vitamin D, blood count and metabolic panel can identify problems associated with fatigue depression, cognitive change or balance problems.
  • Brain Imaging:
    • Brain MRI of CT Scan- These tests are typically normal in PD so not routinely done. However other conditions such as stroke or normal pressure hydrocephalus can be identified.  These conditions are described in the related article  atypical parkinsonism.
  • Unilateral symptoms
  • Bilateral symptoms
  • Motor Fluctuations and Dyskinesia
  • Axial symtpms; Speech, swallowing, balance, freezing of gait

Monique L. Giroux, MDMonique L. Giroux, MD
Guest Blogger, Former Medical Director of NWPF