Author: Dr. Jory Davis, DPT
Is it possible to diagnosis a person with Parkinson’s Disease without scans? Yes! In fact, Parkinson’s disease is generally diagnosed by a medical clinician based on presentation of symptoms. The prevalence rate has grown more than 50% in the last 5 years. Roughly 92% of people diagnosed are over the age of 60 years old. Knowing the signs and symptoms can aide in earlier detection. Many times people with Parkinson’s disease have had the disease for years prior to diagnosis. This is due to the fact that the disease progression does not usually have rapid changes in symptoms at onset. I remember a case when I was working in the outpatient clinic where a patient was diagnosed with frozen shoulder and sent to me for physical therapy. As I began my assessment of the patient, it soon became clear to me that this was not an orthopedic issue but rather a neurologic problem, more specifically signs and symptoms of Parkinson’s disease. If more people were able to identify signs and symptoms, then this could lead to earlier detection and ultimately help people with Parkinson’s Disease get earlier intervention. So what are some of the signs and symptoms of Parkinson’s disease?
The most common symptom that people associate with Parkinson’s Disease is a resting tremor. This generally occurs in the hand and can have a classic “Pill rolling” appearance. In addition to the hand, this can be seen in the jaw. There are some people that do not present with a tremor at all and these cases can be misdiagnosed or untreated for years. Muscle rigidity can be another early symptom. The patient I mentioned earlier that was diagnosed with frozen shoulder had muscle rigidity on the upper extremity which had resulted in loss of movement. Parkinson’s disease is initially unilateral and progresses to bilateral. When observing someone’s gait it is important to notice if one arm is no longer swinging. The rigidity can cause the arm to become stiff which will look as though someone is walking without moving their one arm. Another common symptom that can be easily detected, even to the non-clinical eye, is a “masked face.” This is due to decreased expression in the face and it can often seem that the person is angry or unamused in conversation. Another symptom that may be easy to detect is when a person starts to demonstrate slowed movement known as Bradykinesia. Other symptoms include loss or altered sense of smell, impaired posture, speech changes, writing changes, drooling, dizziness and dystonia ( a severe muscle cramp generally in the feet.) People do not need to present with all of the symptoms and may only present with one or a few.
Patients are generally diagnosed by a neurologist and are most often diagnosed based on symptoms. Although there are scans that are sensitive for detecting a loss of dopamine that is associated with Parkinson’s disease, this is not 100% reliable or always done. This indicates a need to do our due diligence to be aware of early signs and symptoms which will ultimately lead to earlier detection and intervention.