Diagnosing Parkinson’s Disease
THE CHALLENGE OF EVALUATING SYMPTOMSBy: NEAL HERMANOWICZ, MD, MEDICAL DIRECTOR, PHILLIP AND CAROL TRAUB PARKINSON’S CENTER, EISENHOWER MEDICAL CENTER
Although I spend a great deal of my time evaluating people with Parkinson’s disease (PD), there are patients for whom a diagnosis is not simple. The initial symptoms for PD, such as fatigue or generally not feeling well, are often nonspecific and do not clearly indicate that PD is the cause, or even that the patient has a neurological problem. An examination may show only the slightest of findings, perhaps some subtle stiffness or slowness, which does not lend itself to a reasonably certain diagnosis of PD.
It is becoming increasingly evident that the earliest symptoms of PD may not be neurological at all, or at least not what is conventionally regarded as neurological. An impaired sense of smell may be the earliest manifestation of the disease; however, this condition is not specific to PD and can be caused by anything from allergies to sinusitis to head trauma. Some PD studies have used a scratch and smell test called the University of Pennsylvania Smell Identification Test, or UPSIT, to assess a patient’s ability to smell since people with PD often cannot identify simple odors.
Among other early symptoms of PD are constipation and an interesting and potentially dangerous phenomenon called Rapid Eye Movement Sleep Behavior Disorder, or REMBD. Normally when we dream, our brain is disconnected from our muscles, except those that allow us to breathe and move our eyes. This disconnection prevents people from shouting, screaming or flailing their limbs in response to a dream. In REMBD this disconnect switch does not work, and people do, in fact, shout and move during their dreams. People with this disorder have been known to strike their spouses or even leave their beds while they are dreaming. For some people, REMBD may be one of the earliest signs of PD, and it may occur years before the more conventional symptoms, like tremor and stiffness.
A goal of PD research is to identify the presence of the disease as early as possible and then intervene with a medication to slow the progression of PD and lessen its symptoms. Selegiline, or Eldepryl®, was the first medication to be studied in this regard, and although the results were controversial, this medication remains of interest as a possible way to slow PD progression. CoQ10 has had some positive results and is still being examined. Most recently, a not yet published study of rasagiline, or Azilect®, a medication designed to have a disease modifying effect, has been found to have positive results. Identifying Parkinson’s disease at its very earliest appearance and intervening to interrupt or slow the progression could possibly change PD from a disease largely of management to mostly prevention, which, for many people with PD in years to come, could constitute a cure.
Meanwhile, it remains the mission of the Phillip and Carol Traub Parkinson’s Center to provide comprehensive care of the highest quality to people suffering with PD. Unique in the Coachella Valley in the care we can provide, the Phillip and Carol Traub Parkinson’s Center is dedicated to our mission and the opportunity to serve our patients.
The Phillip and Carol Traub Parkinson’s Center has moved to a new, larger location in the Rancho Mirage Medical Center, located at the northwest corner of Country Club Drive and Monterey Avenue.