Getting a Parkinson’s Diagnosis

Overview: There is no definitive test for Parkinson’s (PD), so getting a Parkinson’s diagnosis can be a long – and sometimes frustrating – process. Below, you will learn about the various steps to getting a Parkinson’s diagnosis, as well as the importance of pursuing an accurate diagnosis. 

Early Diagnosis – Especially in the early stages, making an accurate Parkinson’s diagnosis is difficult. Often, a family physician or generalist will make the initial diagnosis after individuals or family members notice tremors, changes in gait, speech, or behavior, or other subtle symptoms. The physician may refer the patient to a neurologist or movement disorder specialist for further diagnosis and to discuss treatment. 

Movement Disorder Specialist – A movement disorder specialist is a neurologist with specific training and experience in the field of Movement Disorders, including Parkinson’s, essential tremor, Parkinsonisms, ALS, etc. 

Criteria for Diagnosis – A physician, neurologist, or movement disorder specialist will review a number of criteria to deliver the diagnosis. Per the International Parkinsons and Movement Disorder Society, a person is considered for a Parkinson’s diagnosis if they have Bradykinesia (slowness of movement) AND at least one of the following: 

● Shaking or tremor in a limb at rest 

● Stiffness or rigidity of arms, legs, or trunk 

● Trouble with balance and falling 

Diagnostic Tools – Because there is no definitive test for Parkinson’s, a PD diagnosis is considered a ‘clinical diagnosis’ – it is achieved through observation, testing, and process of elimination. Diagnosis usually, although not always, follows a few steps: 

1. Detailed history of symptoms, medical history, pre-existing medical conditions, current and past medications, family history, and lifestyle. 

2. Neurological examination testing agility of arms and legs, muscle tone, gait, and balance. 

3. Medication prescription to help replace dopamine or increase its efficacy in the brain. A positive response to the medication indicates Parkinson’s, while lack of response may indicate that further testing is required. 

Additional Testing – Additional testing may come in the form of a DaTscan, or dopamine transporter scan, as well as a Skin Biopsy Test. 

● A DaTscan is used when doctors are unsure of Parkinson’s diagnosis and is not always needed. Similar to an MRI, the DaTscan can show if there is reduced function of the dopamine system in the area of the brain involved in controlling movement. It is important to note that a negative DaTscan does not rule our PD, especially early in the disease process. Further, a positive DaTscan cannot differentiate between Parkinson’s and Parkinsonisms like Progressive Supranuclear Palsy, Multiple System Atrophy, etc. 

● Syn-One (Skin Biopsy) Test uses a skin sample to confirm the presence of a protein called alpha-synuclein in the nerve fibers of the skin, which indicates it is also present in the brain. A biopsy will be taken from the upper back, lower thigh, and lower leg. Again, the test only confirms the presence of an abnormality and cannot differentiate between Parkinson’s and Parkinsonisms like Lewy Body Dementia, MSA, etc. 

Preparing for a Parkinson’s Diagnosis – When you or your doctor suspect you have Parkinson’s, it’s important to prepare for your visit. Come to your appointment with a list of your current and previous medications, symptoms of concern, and as much of your family’s medical history as you can manage. It is recommended to have a friend or loved one accompany you on the visit to take notes, assist you in relaying your concerns, and provide support. 

Remember – only a neurologist or movement disorder specialist can tell you with reasonable accuracy whether you have Parkinson’s or not. Always pursue a second opinion if you feel uncomfortable with your initial diagnosis.