Diagnosis and Symptoms of Parkinson Disease
There is no single test for Parkinson's disease, but symptoms and treatment response can help guide diagnosis.
There are 2 classifications of Parkinson disease signs and symptoms:
1. Motor symptoms (affecting physical movement), and
2. Non-motor symptoms (affecting thinking, mood, sleep, sense of smell, and a variety of other body parts and functions).
There 4 cardinal signs of Parkinson disease, but the disease can cause a wide range of other signs and symptoms.
1. Muscle stiffness
Many people with Parkinson's disease experience arm, leg, or torso stiffness.
2. Slowness in movements (Bradykinesia)
A slowing of movement that affects all Parkinson's patients. It can make coordinated arm and hand movement difficult, making walking and standing difficult.
3. Tremor (Shaking)
These shaking movements, which do not occur in all Parkinson's patients, are most noticeable when you are at rest. Tremors frequently affect only one hand, but they can also cause shaking of the chin, lips, face, and legs. When only the hands or fingers are affected, the tremor is sometimes referred to as "pillrolling," because the person appears to be rolling small objects or pills in their hand.
4. Balance problems
Loss of balance is common in the later stages of Parkinson's disease.
While each person with Parkinson's is affected differently, the majority of people's signs and symptoms tend to progress or worsen over time.
There is no single diagnostic test for Parkinson's disease, and because of the wide range of symptoms it can cause, as well as the number of other diseases that cause similar symptoms — known as parkinsonism — a Parkinson's diagnosis can take months or years.
Other Motor symptoms of Parkinson Disease include:
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Loss of automatic movements: Actions that may no longer occur include spontaneous smiling and walking with your arms swinging. A decrease in the rate at which the eyes blink can also occur, sometimes leading to dry eyes.
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Freezing: This describes the inability to take a step, usually the first one. It's possible that your feet are glued to the floor.
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Micrographia: Some Parkinson's patients notice that the size of their handwriting shrinks over time.
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Mask-like expression (hypomimia): A reduction in the range of facial expressions is common in Parkinson's patients.
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Unwanted accelerations: You may experience festination, which is an uncontrolled acceleration in your walking.
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Parkinsonian gait: This is a common stooped-over walking style caused by a combination of freezing and festination.
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Difficulty speaking: This can include having an unusually soft voice or slurring your words.
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Difficulty swallowing: This can cause drooling and put you at risk of choking. Drooling can also be caused by a decrease in automatic movements, such as saliva swallowing.
Common non-motor symptoms of Parkinson Disease include:
Cognitive problems and dementia Problems:
With thinking, memory, multitasking, and judging distances are estimated to occur in 40% or more of people with Parkinson Disease.
Psychosis and hallucinations Psychosis:
Thoughts and beliefs that are out of touch with reality — may occur in 20% to 40% of people because of the disease itself and medication side effects.
Visual hallucinations:
Seeing things that aren't real — are the most common psychotic symptom of Parkinson Disease.
Hallucinations:
Often become more frequent and severe as the disease progresses.
Delusions:
Some people with Parkinson Disease also have delusions, including false beliefs that they're in danger, being stolen from, or being cheated on by a spouse.
Mood disorders:
Some people with Parkinson Disease become depressed, anxious, or apathetic — lacking the motivation to walk, talk, or express emotion.
Sleep disorders:
Difficulties falling asleep and staying asleep are common with Parkinson disease. These problems may be caused or worsened by difficulty turning over in bed, muscle cramps or pain, a frequent need to urinate, or vivid dreams and nightmares.
Daytime sleepiness:
Excessive daytime sleepiness affects up to 75% of people with Parkinson Disease. It may be worsened by medication for the disease. Some people with Parkinson may fall asleep suddenly, which can be very dangerous if they drive a car.
Autonomic dysfunction:
The autonomic nervous system controls automatic functions of the body, including heart rate, blood pressure, breathing, digestion, sweating, urination, and sexual arousal. Any of these body functions can become abnormal in Parkinson disease, leading to issues like low blood pressure upon standing up (causing dizziness), constipation, urinary difficulties, abnormal sweating, and a decreased interest in sex.
Loss of sense of smell:
This is common with Parkinson Disease, and losing your sense of smell — or your ability to distinguish one odor from another — can be one of the earliest symptoms of the disease.
Pain:
This is reported in more than 40% of people with Parkinson Disease, often in the same areas of the body as motor symptoms. This pain is often described as burning, tingling, or stabbing.
REM sleep behavior disorder (RBD):
RBD is a condition in which a person physically acts out their dreams while sleeping, affects up to half of Parkinson's disease patients. RBD dreams are frequently terrifying, and the individual may respond by kicking, punching, or shouting. This could endanger both the dreamer and their bed partner. Many people with RBD and Parkinson's disease have RBD first. A high proportion of RBD patients develop Parkinson's disease or another neurodegenerative disease, such as Lewy body dementia or multiple system atrophy, both of which cause parkinsonian symptoms, according to several studies.
Causes and theories about Young Onset Parkinson Disease
Genetics vs. Environmental
Most cases of Parkinson's disease are caused by a combination of genetics and environmental exposures. However, genetics is more important in YOPD. Researchers have identified genes that can cause or increase the risk of developing Parkinson's disease at a younger age.
Some people with these genes, however, may never develop Parkinson's disease. The Parkinson's Foundation genetics initiative, PD GENEration: Mapping the Future of Parkinson's Disease, is the first national Parkinson's study to offer free genetic testing plus counselling for Parkinson's-related genes through medical professionals. This flagship study will eventually provide genetic information that will lead to better care, expanded research, and faster clinical trial enrollment.
Genetic mutation
Genes responsible for YOPD
People with both early-onset Parkinson's disease and a strong family history of the disease are more likely to carry PD-related genes such as SNCA, PARK2, PINK1, and LRRK2. A recent study discovered that 65 percent of people with PD onset under the age of 20 and 32 percent of people with PD onset between the ages of 20 and 30 had a genetic mutation thought to increase PD risk.
In theory, genes may play a larger role in young-onset Parkinson's disease, whereas environmental factors may play a larger role in sporadic Parkinson's disease. However, researchers have found it difficult to prove this to date because we are still learning about the disease's biological mechanisms.
YODP still largely undiscovered!
Young Onset Parkinson disease in numbers
Because most people know that the risk of developing Parkinson’s disease increases with age, especially over 50 years, the shock is significant when a young person is diagnosed with Young Onset Parkinson Disease (YOPD).
Young Onset Parkinson is not so rare as we think
It is estimated that 1 in 20 people first experience some Parkinson symptoms when they're under 40.
With a population of around 145,000 Parkinson disease patients in the UK, we can estimate roughly 7,250 of those to be under the age 40.
Symptom differences between Young & Late Onset of Parkinson's
Young Onset Parkinson symptoms are similar to late onset ones. However, it is important to be aware about the challenges that face young people diagnosed with the disease, especially at the financial, family and employment levels.
Parkinson with kids and teens
It remains extremely rare that Parkinson's-like symptoms appear in children and teenagers. This form of the disease is called Juvenile Parkinsonism and is often associated with specific, high-Parkinson Disease risk genetic mutations.