Parkinson's Disease

Symptoms & Causes Diagnosis & Treatment Doctors

Diagnosis of Parkinson's Disease

Currently, there is no single test that definitively diagnoses Parkinson's disease. Diagnosis is typically made by a neurologist— a doctor specialised in nervous system disorders— based on a detailed medical history, symptom review, and thorough neurological and physical examinations.

Diagnosing Parkinson's disease can be a gradual process. Neurologists specialising in movement disorders may recommend regular follow-up visits to monitor symptoms and confirm the diagnosis over time.

Common Diagnostic Methods for Parkinson's Disease

A thorough diagnosis often involves the following assessments:

Physical and Neurological Examination: This involves evaluating your medical history and conducting tests to assess cognitive function, sensory responses, coordination, and reflexes.
Blood and Laboratory Tests: These help exclude other conditions that might cause similar symptoms.
Imaging Tests: MRI scans, brain ultrasounds, and PET scans are generally used to rule out other disorders, as they are not definitive for Parkinson's diagnosis.
Dopamine Transporter (DAT) Scan: This specialised SPECT imaging can support the suspicion of Parkinson's by showing dopamine activity in the brain and help differentiate types of tremors. However, diagnosis mainly depends on clinical symptoms and neurological findings, and most patients do not require this scan.
Genetic Testing: Recommended if there is a family history of Parkinson's or if symptoms appear at a young age.
Medication Trial: Sometimes, doctors prescribe Parkinson’s medications to observe if symptoms improve, which can support the diagnosis. Adequate dosing and duration are essential for reliable results.
Alpha-Synuclein Testing: This emerging test detects clumps of the alpha-synuclein protein, a hallmark of Parkinson's, in skin or spinal fluid. Recent studies show promising accuracy in identifying Parkinson's disease and those at risk, though further research is ongoing.

At SJMC, our neurologists use a combination of these methods to ensure a comprehensive and accurate diagnosis. Regular follow-ups with movement disorder specialists help refine the diagnosis and monitor disease progression.

Treatment Options for Parkinson's Disease

While Parkinson's disease currently has no cure, various treatments can help manage symptoms and improve quality of life. Treatment plans are tailored to individual needs and may include medications, surgical options, and supportive therapies.

Medications for Parkinson's Disease

Medications aim to increase or mimic dopamine in the brain, as dopamine levels are reduced in Parkinson’s disease. Commonly prescribed medications include:

Carbidopa-Levodopa: The most effective treatment, levodopa, converts into dopamine in the brain. Carbidopa helps levodopa reach the brain and reduces side effects like nausea. Side effects may include dizziness upon standing (orthostatic hypotension) and involuntary movements (dyskinesia), especially at higher doses or over time. The effectiveness may fluctuate, a phenomenon known as "wearing off."
Inhaled Levodopa: Used for quick symptom relief when oral medications wear off during the day.
Carbidopa-Levodopa Infusion: Administered via a feeding tube directly into the small intestine for advanced cases requiring steady medication levels. This method involves minor surgery and carries risks such as infection or tube displacement.
Dopamine Agonists: These drugs mimic dopamine effects without converting into dopamine. They last longer but are less potent than levodopa and may be combined with it. Examples include pramipexole, rotigotine (patch), and apomorphine (injection). Side effects can include sleepiness, hallucinations, compulsive behaviours, and nausea.
Monoamine Oxidase B (MAO-B) Inhibitors: Medications like selegiline, rasagiline, and safinamide slow dopamine breakdown, extending its action. They may cause headaches, insomnia, or hallucinations and have interactions with some antidepressants and pain medications.
Catechol O-Methyltransferase (COMT) Inhibitors: Drugs such as entacapone and opicapone prolong levodopa’s effect by blocking dopamine breakdown enzymes. Side effects include digestive issues and increased involuntary movements.
Anticholinergics: Older medications like benztropine and trihexyphenidyl may help control tremors but are less commonly used due to side effects like memory problems and dry mouth.
Amantadine: Used alone for mild symptoms or with levodopa to reduce involuntary movements. Side effects may include swelling, hallucinations, and skin discolouration.
Adenosine A2A Receptor Antagonists: Istradefylline is an example that helps reduce the "wearing off" effects of levodopa.
Pimavanserin: Specifically treats hallucinations and delusions associated with Parkinson's.

Discussing potential side effects and medication interactions with your healthcare provider at SJMC ensures safe and effective treatment tailored to your needs.

Surgical Treatments

For patients whose symptoms are not adequately managed with medications, surgical options may be considered:

Deep Brain Stimulation (DBS): This procedure involves implanting electrodes in specific brain areas connected to a device under the skin near the chest. Electrical impulses help regulate abnormal brain activity, reducing tremors and involuntary movements. DBS requires ongoing adjustments and carries risks such as infection, bleeding, or mood changes. It is most effective for patients who respond well to levodopa.
MRI-Guided Focused Ultrasound: A minimally invasive technique that uses targeted ultrasound waves to destroy brain areas causing tremors. Side effects may include speech or walking difficulties and new involuntary movements.

Research is ongoing to improve surgical techniques and discover new therapies that can better manage symptoms.

Lifestyle and Home Care Support

Lifestyle adjustments can complement medical treatments and help ease symptoms:

Healthy Diet: While no specific diet cures Parkinson's, consuming fibre-rich foods and staying hydrated can prevent constipation. Nutrients like omega-3 fatty acids may support overall health.
Exercise: Regular physical activity improves strength, balance, flexibility, and mood. Activities such as walking, swimming, dancing, and stretching are beneficial. Physical therapists can design personalised exercise programs.
Fall Prevention: Tips include moving slowly, using handrails, avoiding clutter, and using assistive devices like canes or walkers if recommended.
Daily Living Support: Occupational therapists can assist with adapting daily activities like dressing and cooking, while speech therapists can help with communication and swallowing difficulties.

Alternative Therapies such as massage, tai chi, yoga, meditation, and relaxation techniques may reduce muscle tension, improve balance, and enhance well-being when used alongside medical treatment.

Emotional and Mental Health Support

Living with Parkinson's disease can be emotionally challenging. Depression and anxiety are common but treatable with medication and counselling. Support groups offer a valuable community for sharing experiences and practical advice. Maintaining social connections and engaging in meaningful activities can improve quality of life.

At Subang Jaya Medical Centre (SJMC), we offer mental health support and family education to ensure comprehensive care for both patients and caregivers.

Preparing for Your Medical Appointment

If you suspect Parkinson's disease, consulting a neurologist is the first step. Here’s how to prepare for your visit:

What to Do Before the Appointment:

Record all symptoms, including those that seem unrelated.
Note recent stresses or life changes.
List all medications, supplements, and vitamins you take.
Bring a family member or friend for support.

Questions to Ask Your Doctor:

What could be causing my symptoms?
What tests will I need?
How might the disease progress?
What treatment options are available?
How can I manage other health conditions alongside Parkinson's?

Your healthcare team at Subang Jaya Medical Centre may ask about symptom onset, frequency, triggers, and relief factors. Being prepared helps ensure a thorough and efficient evaluation.

FAQs About Parkinson's Disease Diagnosis and Treatment

Early signs include tremors, stiffness, slowed movement (bradykinesia), and changes in posture or balance. If these symptoms are persistent, consulting a neurologist is recommended for further evaluation.

Genetic testing is typically recommended if there is a family history of Parkinson's or if symptoms appear at a young age. It helps identify genetic mutations associated with the condition but is not required for most cases.

A DAT scan evaluates dopamine activity in the brain and helps distinguish Parkinson's disease from other types of tremors. While it supports the diagnosis, it is not routinely required, as most diagnoses rely on clinical symptoms.

Yes, the effectiveness of medications like Carbidopa-Levodopa may fluctuate over time, a phenomenon known as "wearing off." Adjustments to dosage or additional medications may be required to manage symptoms effectively.

Emerging treatments include alpha-synuclein testing for early detection and advanced surgical techniques like focused ultrasound. Research is ongoing to develop therapies that slow disease progression.

Physical therapy improves strength, balance, and flexibility, helping to manage symptoms like stiffness and movement difficulties. Therapists can design personalised exercise programs to enhance mobility and reduce fall risks.

Lifestyle changes such as regular exercise, a fibre-rich diet, and fall prevention strategies can complement medical treatments. Occupational therapists can assist with adapting daily activities to maintain independence.