Diagnosis “Parkinson’s disease ” (БП).
How to put it correctly?

This is the prerogative of a neurologist, a specialist in movement disorders (Parkinsonologist)

The diagnosis of “PD” is made clinically, meaning the diagnosis can be made based solely on the presence of certain symptoms. This is a triad of movement symptoms –

The first and main symptom (consists of three types of movement disorders)
– Bradykinesia (slowness)
– hypokinesia (reduction of movement amplitude)
– oligokinesia (slowing of movements)

May manifest as reduced facial expressions (“mask-like face”), a quiet voice, changes in handwriting (small, bead-like handwriting), decreased arm movement activity while walking, in rhythm with steps.

Second important symptom – resting tremor. This is the classic “parkinsonian” tremor that occurs in a relaxed position (or while walking) and resembles “pill rolling” or “coin counting” “.

Third symptom – muscle rigidity, manifested by increased muscle tone and increased stiffness

These symptoms form the syndrome of parkinsonism.

Each syndrome has its own CAUSE, and there can be many causes for the development of parkinsonism syndrome (as well as conditions that mimic parkinsonism) – tumor, stroke, hypothyroidism, depression, rheumatic and joint diseases, normal pressure hydrocephalus

Therefore, in the diagnosis of Parkinson’s disease, a thorough neurological examination, medical history collection, and identification of comorbidities and medications are necessary, along with neuropsychological testing (clock drawing test, depression and anxiety questionnaires), laboratory tests (complete and biochemical blood tests, thyroid hormones, ceruloplasmin, and others), neuroimaging (CT and MRI); consultations with other specialists (cardiologist, endocrinologist, etc.)

Currently, there is no specific diagnostic test or examination capable of confirming the diagnosis. Neuroimaging methods – single-photon emission computed tomography (SPECT or SPECT, DaTscan) and positron emission tomography (PET) with fluorodopa have maximum specificity and sensitivity, close to 100%, and are practically unavailable here in the Russian Federation

More accessible are ultrasound examination of the substantia nigra and MRI of the brain with nigrosome 1 study. The result of the studies may depend on the quality of the equipment and the specialist’s experience.

It is becoming less necessary to conduct a diagnostic levodopa test – a single dose of Nakom (taking 1 tablet of standard levodopa), or an extended levodopa test (taking levodopa for 2-3 weeks), with an assessment of the drug’s effect – IMPROVEMENT in motor condition (reduction of tremor, reduction of stiffness and slowness) while taking the drug.

Sometimes, for diagnosis, dynamic observation over several months or years is necessary—often cases of atypical parkinsonism (diseases from the parkinsonism-plus group) in the early stages can be very similar to the onset of Parkinson’s disease.

Overall, it can be concluded: if there are complaints of tremor, stiffness, impaired fine motor skills, or uncooperative hand movements, it is always better to consult a neurologist and determine the cause of the ailment, as early diagnosis and early treatment prolong life and improve quality of life.

In our Extrapyramidal Center, it is possible to conduct a comprehensive examination – consultation with a Parkinson’s specialist, laboratory tests (if necessary), MRI with nigrosome assessment, ultrasound of the substantia nigra. We will be happy to help. Health to you and your loved ones!

Akhmadeeva Gulnara Nailevna, PhD, neurologist specializing in Parkinson’s disease
V.S. Buzaev International Medical Centre