® KeySense is a registered trademark of Parkinson’s Foundation (Australia)
© Copyright 2023 Parkinson’s Foundation (Australia)
Parkinson’s FOUNDATION
(AUSTRALIA)
Problems With Diagnosis
Diagnosis
is
difficult
at
every
stage
of
the
disease,
but
particularly
in
the
early
stages.
No
single
test
can
provide
a
diagnosis.
A
diagnosis
will
likely
involve
physical
and
neurological
examinations,
conducted
over
time
to
assess
changes
in
reflexes,
coordi
-
nation,
muscle
strength,
and
mental
function.
Your
doctor
might
also
see
how
you respond to medicine.
•
Parkinson's
disease
symptoms
are
different
for
different
people.
Some
are
hard
for
even
doctors
to
detect.
Others
are
obvious
even
to
an
untrained eye.
•
No
blood
test,
brain
scan
or
other
test
can
be
used
to
make
a
definitive
diag
-
nosis
of
Parkinson’s
disease.
At
present
the
diagnosis
of
PD
relies
on
observation
of
a
patient’s
movement
by
a
trained
specialist
(typically
a
neurologist)
as
the
patient
executes
movement
tasks
such
as
walking
to
and
fro,
tapping
their
fingers
or
performing
rapidly
alternating
hand
movements
–
there
is
no
objective,
precise,
definitive
test in use today.
You
may
be
familiar
with
the
visible
signs
of
someone
with
PD.
The
three
‘cardinal’
motor symptoms are:
•
Stiffness
(rigidity):
muscle
stiffness
detected by a doctor on examination
•
Slowness
(bradykinesia):
decrease
in
spontaneous
and
voluntary
movement;
may
include
slower
walking,
less
arm
swinging
while
walking,
or
decreased
blinking or facial expression
•
Resting
tremor:
a
rhythmic,
involuntary
shaking
that
occurs
in
a
finger,
hand
or
limb
when
it's
relaxed
and
disappears
during voluntary movement
Not
everyone
with
Parkinson's
experiences
all
three
motor
symptoms,
but
slowness
always
is
present.
And
although
tremor
is
the
most
common
symptom
at
diagnosis,
only
70%
or
so
of
all
people
with
Parkinson's have tremor (Figure 1)
Other
motor
symptoms
-
walking
problems
or
difficulty
with
balance
and
coordination
-
may
also
occur.
These
can
happen
any
time
in
the
course
of
Parkinson's,
but
are
more likely as the disease advances.
Assessment
of
PD
symptoms
is
usually
done
by
a
neurologist
employing
rating
scales
such
as
the
Unified
Parkinson’s
Disease
Rating
Scale
or
‘UPDRS’,
which
is
based
on
observations
and
judgments
by
them of the presenting patient.
However,
the
use
of
this
and
similar
clinical
scales
are
inherently
subjective
and
require
considerable
clinical
experience.
With
regard
to
PD,
many
symptoms
are
imprecise,
particu
-
larly
in
its
early
stages,
and
also
common
to
other
diseases,
both
n
e
u
r
o
d
e
g
e
n
e
r
a
t
i
v
e
and
non-neurode
-
generative
in
nature,
with
the
result
that
PD
is
commonly
either
misdiag
-
nosed
or
the
diagnosis
is
missed
completely.
A
UK
study
back
in
2012
found
that
diagnoses
by
primary
care
doctors
had
a
correct
diagnosis
of
just
53%
and
special
-
ists
who
were
not
movement
disorder
experts
had
a
correct
diagnosis
rate
of
only
75%.
In
contrast,
movement
disorder
specialists
were
mistaken
by
only
6%
to
8%,
which
raises
an
obvious
issue
–
in
order
to
be
referred
on
to
a
movement
specialist,
the
patient’s
general
practitioner
(GP)
must
first
recognize
and
diagnose
the
symp
-
toms.
A
more
recent
review
looked
at
the
PD
diagnostic
accuracy
over
the
last
25
years,
and
found
that
it
is
still
not
satisfactory
and
has
not
improved
over
that
period,
particu
-
larly
for
patients
in
the
early
stages
of
the disease.
By
the
time
that
PD
is
diagnosed
currently,
the
disease
is
already
well
advanced,
significant
dopaminergic
neuron
loss
and
damage
has
already
occurred,
and
any
possibility
of
delaying
further
disease
progression
and
neuro
-
protection
is
unlikely.
In
the
coming
years,
it
is
likely
that
drugs
will
become
available
to
slow,
or
even
halt,
the
disease
progression,
so
the
goal
must
be
to
diagnose
and
treat
PD
well
before
the
irreversible
destructive
changes
have
taken
place,
ideally
at
least
5
years
earlier
than
is
currently
the
case
(Figure
2).
Figure1. The early motor symptoms are often subtle
and variable (e.g. only 70% have tremor)
Figure 2. There needs to be earlier detection
of PD, ideally 5 years before currently