When her right hand started trembling uncontrollably, 68-year-old Sherri Fowler (not her real name) began to fear that she was developing Parkinson’s Disease, the progressive disorder of the nervous system that plagued Mohammed Ali and led actor Michael J. Fox to create a foundation that is working toward a cure for the degenerative disease.
But Fowler may have gotten ahead of herself. “There are many causes of tremor and Parkinson’s disease is only one,” explains Nikolaus McFarland, M.D., Ph.D., assistant professor of neurology and chief of the Movement Disorders Division of the University of Florida College of Medicine. “Indeed one of the first symptoms of Parkinson’s disease may be tremor, but there are many other key features to look out for. To diagnose Parkinson’s disease we typically look for a constellation of symptoms including rest tremor, rigidity (or stiffness), slowed movement, and postural instability. Patients may have some or all of these features, making the diagnosis tricky at times.”
The disease affects about one million Americans and usually strikes people who are older than 60. It develops gradually and is a breakdown of vital brain nerve cells that produce the neurotransmitter dopamine, which is important for normal brain function, including movement, learning, and emotion. Disruption of signals in the brain are what leads to involuntary tremors.
While your doctor should definitely check out a tremor, you may not be facing Parkinson’s Disease unless you also have some of the following:
Common Symptoms of Parkinson’s Disease
Postural Instability: People with Parkinson’s Disease have trouble standing up straight or maintaining their balance. A small push can send them tumbling. A stooped posture is common along with a slow, shuffling gait.
Change in Speech: Commonly people with Parkinson’s Disease experience a change in the tone of their voice. It typically gets softer and becomes more monotone, McFarland says. You may not notice it yourself, but if your family members are saying, “Speak up!” or your friends ask you to repeat yourself, that may be an indicator that you’re voice’s timbre has changed.
Change in Handwriting: Is your handwriting becoming small and illegible? You may be developing what is called micrographia. Dr. McFarland says that movements in general slow and become small, including handwriting. You may notice your handwriting trailing off the page, getting smaller and smaller, and harder to read.
A Shuffling Gait: If you have trouble walking, or your steps have become more of a shuffle than a walk, that’s could be a symptom of Parkinson’s Disease. Some patients experience what doctors call “freezing.” “These are rigid spells where a person gets frozen in place,” McFarland says. “You turn or get to a threshold and get frozen in place, feeling like you can’t possibly take another step. You need some cue, be it a sound, tactile, or visual (like a laser line to step over), to get moving again.”
A Lack of Facial Expression: “Friends and family tend to notice this first,” says McFarland, who says that patients often tell him, “I’ve been told I look like I’m depressed all the time.” This “mask” expression is often the result of small facial muscles being unable to move. In fact, says McFarland, some Parkinson’s patients get treated for depression because of this lack of expression and the overall slowness of their movements. “It can be misconstrued,” he says, but notes that depression and anxiety often go hand in hand with Parkinson’s. “It absolutely needs to be treated and taken seriously,” he adds. But some patients who are treated solely for depression may not be getting all the help they need if they are also dealing with Parkinson’s.
Loss of a Sense of Smell: If you find that your nose doesn’t pick up scents as well as it once did, mention it to your doctor. “This is something that has to be carefully interpreted,” Dr. McFarland. “It doesn’t mean if you lose your sense of smell, that you’ll receive a diagnosis of Parkinson’s, but it is a risk factor.”
Trouble Sleeping: Many Parkinson’s patients experience sleep disturbance. “Restless leg is not uncommon and is characterized by a nondescript discomfort, or restless feeling, in the legs causing you to want to move. The feeling occurs at rest, when lying down to sleep, and can make it very difficult to fall asleep,” says Dr. McFarland. “Some patients suffer from active dreams, yelling, punching, or kicking. Normally when we dream only our eyes are moving and our body is flaccid. This state is called REM sleep for Rapid Eye Movement. In Parkinson’s, active dreams, or what is called REM sleep behavior disorder, can result in arousals, potential injury, and overall poor sleep quality.” These symptoms can occur years before a Parkinson’s diagnosis, or they can crop up later.
This is a likely explanation for why Parkinson’s patients also report a deep fatigue as part of their symptoms. They may be in bed for eight hours, but they may not be experiencing enough restorative sleep.
Getting a Diagnosis
There is no blood test for Parkinson’s. Currently the only available test for Parkinson’s is a type of brain scan called DaTscan. In contrast to CT or MRI imaging which show detailed brain structures, the DaTscan specifically looks at the dopamine system. While it can be useful to diagnosis Parkinson’s, it is not specific to Parkinson’s disease. A normal scan, however, can help rule out PD. The diagnosis of PD, however, remains primarily clinical, based on symptoms and signs. In most cases, your neurologist will not need to order a DaTscan unless there is something unusual or unexpected about your case. If there is any question about whether you have Parkinson’s or not, you should consider seeing a movement disorders specialist. To find one near you, visit Partnersinparkinsons.org.
Parkinson’s Disease is not curable but medication can ease its symptoms and give patients good quality of life for a long time, says Dr. McFarland. “For decades we’ve treated the disease by replacing the dopamine that is lost. These are very effective treatments.”
To learn more about Parkinson’s Disease, visit The Parkinson’s Disease Foundation or The Michael J. Fox Foundation.
Sherri Fowler discovered that her tremor was related to a medication she was taking. Tremors can be caused by many different factors, Dr. McFarland says, including endocrine issues, thyroid issues, vascular disease, inflammation, diabetes, anxiety, or even some psychiatric issues. Consult your doctor to get a diagnosis.
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