Be Vigilant for Signs of Parkinson Disease

Below, Anwar Ahmed, MD, a neurologist in Cleveland Clinic’s Center for Neurological Restoration, addresses key factors in the diagnosis of Parkinson disease.

Q: What is most important to keep in mind about diagnosing this common neurological condition?

A: Some of the early signs of Parkinson disease (PD) are often missed or wrongly attributed to aging. It is important to be vigilant about PD’s early signs because the risk of developing PD is five times higher in people older than 65.

Signs and symptoms of early PD include:

• Bradykinesia. The patient’s spouse may note that the patient is moving more slowly.
• Smaller handwriting.
• Muscle rigidity. This may involve the upper extremities.
• Tremor. This is present in only 60 percent of PD patients, is usually asymmetric and occurs at rest.
• Depression and anxiety.
• A reduced sense of smell. This may occur years before other symptoms.
• Talking, yelling or physical activity during sleep. This may also occur years before other symptoms.
• Chronic constipation.

Q: How can early diagnosis impact a patient’s care?

A: Early diagnosis allows the patient to begin implementing lifestyle changes, such as an exercise regimen, that may help control PD symptoms and improve the disease’s long-term progression.

We try not to prescribe medication until symptoms interfere with quality of life. For early PD, we start with MAO-B inhibitors, dopamine agonists and other non-levodopa drugs. Levodopa, a dopamine replacement therapy, is a potent drug and should be reserved for more advanced symptoms.

Q: Where should patients be referred?

A: Movement disorders centers have special expertise in PD. However, if such a center isn’t convenient, well-trained local neurologists also can perform evaluations and recommend appropriate treatment.

An expert neurologist can diagnose PD with high accuracy based on a detailed history and good neurological examination. Imaging with dopamine transporter brain SPECT (single-photon emission computerized tomography) can provide slightly greater accuracy.

Patients with more advanced PD or with complications from standard treatment should be referred to a movement disorders center. There, they can access the latest clinical trials as well as experts in the surgical management of PD.

To refer a patient to the Center for Neurological Restoration, call 855.REFER.123.