The diagnosis of Parkinson’s disease is largely based upon the type of symptoms that the patient experiences. When someone has symptoms such as tremors or shaking of arms or legs while at rest, muscle stiffness or slow movements, Parkinson’s disease must be a consideration, particularly if the individual is at a typical age for the onset of the disorder. Not all patients have every symptom, and often the symptoms start on one side of the body and then progress over time to include the other side. A good response to a trial of Parkinson’s disease medication also helps to add confidence to the diagnosis.
The symptoms of Parkinson’s disease can be similar to the symptoms of other conditions, and it is frequently misdiagnosed. Skilled doctors who specialize in the treatment of Parkinson’s disease are the best practitioners to see for an accurate diagnosis.
The diagnostic process begins with a full medical history and neurological exam, testing movement, strength, coordination, balance, and reflexes. A doctor will often order additional tests to make sure that there are no other conditions present that could explain the patient’s symptoms. These tests may include an MRI of the brain and/or spine, or diagnostic tests of the electrical responses of muscles and nerves. In Parkinson’s disease, these are usually normal and are performed to make sure that there are not problems other than Parkinson’s disease that could explain symptoms.
Some specialized centers can perform specialized brain imaging to help with the diagnosis. PET and SPECT scans are images that show brain function. PET scans, which can examine dopamine production in the brain using a radioactive tracer, have been used for many years and were recently FDA approved. SPECT scans can image uptake of the radioactive tracer into dopamine producing neurons in the brain. Both of these are ways to determine whether and how much loss of dopamine producing neurons has occurred in the brain. More experimental PET scans can see the activity of brain cell networks that control movement. These are often abnormal in Parkinson’s disease and can help with making the diagnosis. While there is much data supporting the role of PET scans in Parkinson’s disease, they are still often considered experimental even with FDA approval and may not always be covered by all insurance companies.
While there is no cure for Parkinson’s disease, there are treatments that significantly improve symptoms.
Medications: There are oral and injectable medications that can help with the muscle stiffness and slow movements; in some patients these medications can be less effective for tremor. Some medications work by increasing the amount of dopamine in the brain. (Dopamine is a neurotransmitter involved with muscle movement.) For most patients with typical Parkinson’s disease, a proper dose of at least one accepted medication should lead to a noticeable improvement in symptoms early in the disorder. Over time, a patient may develop complications or experience reduced benefit from medications, but many people have good responses for years or even decades.
Physical and Speech Therapy: Regular physical therapy and speech therapy can help a patient to manage and improve the symptoms of Parkinson’s disease. These therapies can be particularly important for those who have problems with balance and walking, as well as problems with speech and voice.
Surgery: Deep brain stimulation (DBS) is a minimally invasive, reversible surgical procedure to treat neurological symptoms of Parkinson’s disease, including tremors and movement control. Focused ultrasound is a new method for non-invasive surgical treatment of movement disorders, which has been FDA-approved for treatment of a related disorder called essential tremor, and was more recently approved for use in Parkinson’s disease patients with tremor. Studies are ongoing examining the role of this approach for treatment of symptoms other than tremor. For more information, see Surgery for Parkinson’s Disease.
The Movement Disorder service of the Weill Cornell Brain and Spine Center is a leader in the diagnosis and treatment of Parkinson’s disease, and also conducts groundbreaking laboratory research and clinical trials to improve our understanding and treatment of this disorder. Led by pioneering researcher and neurosurgeon Michael Kaplitt, MD, PhD, the Movement Disorder service provides state-of-the-art options for Parkinson’s treatment, including minimally invasive deep brain stimulation surgery and focused ultrasound.
Reviewed by Michael Kaplitt, MD, PhD
Last reviewed/last updated: January 2021