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Tuesday, September 16, 2014
Is tremors alone indicative of Parkinson`s disease in an 83 year old woman?
Diagnosis of Parkinson's disease (PD) is based on findings present on clinical exam supported by typical historical features. Currently, there are no reliable biomarkers such as blood tests or X-rays that can make that diagnosis. Clinical exam provides a possible or probable diagnosis because of the:
1. variability in presentation of PD itself and
2. other conditions that may share some of the same features as PD.
Therefore, at the present time, the only "definite" diagnosis of PD is through autopsy (pathological diagnosis).
Clinically, there are many symptoms and signs that may be caused by this disease. However, there are four signs (objective findings on exam) that are considered the "Cardinal Feature" of PD. Two of these cardinal features must be present on exam to make the diagnosis. These include Bradykinesia (slowness of movement) and at least one of the following: Rigidity, Tremor (usually at rest), and Postural Instability.
Tremor is the most common feature that brings the patient into the doctor to be evaluated because it is the most noticeable. Note that tremor alone does not make the diagnosis, however. Other features may be very subtle and easily overlooked; therefore, it is important to have a thorough evaluation by a neurologist well-experienced in PD or a PD specialist if there is uncertainty about the diagnosis.
Karen M Thomas, DO
College of Medicine
The Ohio State University