Parkinson’s Disease

Diagnosis

A diagnosis of Parkinson’s disease is based on your medical history, a review of symptoms, and a neurological and physical exam. There is no single test that confirms Parkinson’s disease. A neurologist trained in movement disorders evaluates how symptoms change over time, which may require several follow-up visits before a clear diagnosis is made.

Your healthcare team may recommend one or more of the following tests:

Physical and neurological exam
This includes a review of your medical history and an exam that evaluates thinking and memory, sensory function, coordination, and reflexes.

Blood and lab tests
These tests help rule out other medical conditions that may be causing symptoms similar to those seen in Parkinson’s disease.

Imaging tests
MRI, brain ultrasound, and PET scans are typically used to rule out other conditions. These tests are not very helpful in confirming Parkinson’s disease but support a broader evaluation.

Dopamine transporter (DAT) scan
A DAT SPECT scan may support the suspicion of Parkinson’s disease and help distinguish between different types of tremor. However, the diagnosis relies mainly on symptoms and neurological exam findings, and most people do not need this scan.

Genetic testing
Testing may be recommended if there is a known family history of Parkinson’s disease or if symptoms begin at an early age.

Short medication trial
You may be given a short course of Parkinson’s medicines to see if symptoms improve. A sufficient dose must be used, as low doses for a day or two are not reliable.

Follow-up appointments
Neurologists may monitor your symptoms over time to confirm a diagnosis, especially when early signs are unclear.

Alpha-synuclein test
Also known as an alpha-synuclein seed amplification assay, this test measures clumped alpha-synuclein in spinal fluid or skin samples. Clumps of this protein are a key feature of Parkinson’s disease. Research shows promise for detecting the disease even before symptoms begin, although larger studies and future blood-based tests are still needed.

Treatment

Parkinson’s disease has no cure, but treatments can help manage symptoms. Medicines are often the first line of treatment, and they typically work well for many years. When symptoms become difficult to control with medicines alone, surgery or advanced therapies may be considered. Exercise, physical therapy focused on balance and stretching, and speech therapy also play a valuable role.

Medicines
These treatments help improve movement, walking, and tremor by increasing or replacing dopamine in the brain. Dopamine levels are low in people with Parkinson’s disease, but dopamine itself cannot be taken as a medicine because it does not enter the brain.

Common medicines include:

• Carbidopa-levodopa (Rytary, Sinemet, others), the most effective treatment, which converts to dopamine in the brain
• Inhaled levodopa (Inbrija) for sudden symptom return during the day
• Carbidopa-levodopa infusion (Duopa), delivered directly into the small intestine through a tube placed during minor surgery
• Dopamine agonists such as pramipexole, rotigotine patches, and apomorphine injections
• MAO B inhibitors, including selegiline, rasagiline, and safinamide
• COMT inhibitors, such as entacapone and opicapone
• Anticholinergics for severe tremor in select cases
• Amantadine for short-term early symptoms or for controlling involuntary movements in advanced stages
• A2A receptor antagonists such as istradefylline
• Pimavanserin for hallucinations and delusions related to Parkinson’s disease

Each medicine has specific benefits and possible side effects, which your healthcare team monitors over time.

Surgery
Deep brain stimulation, or DBS, is the most common surgical treatment. It involves placing electrodes in specific brain areas and connecting them to a generator implanted beneath the skin near the collarbone. Electrical pulses are sent to the brain to help reduce symptoms such as severe tremor or involuntary movements.

Settings can be adjusted during follow-up visits. While DBS helps control symptoms, it does not stop the disease from progressing.

Possible side effects include bleeding, infection, muscle twitching, mood changes, and speech or vision problems.

Advanced treatments
MRI-guided focused ultrasound (MRgFUS) is a minimally invasive procedure used for tremor control. Using MRI to guide high-intensity ultrasound waves, this treatment targets and destroys specific areas of the brain involved in tremor.

Possible side effects may include walking difficulties, speech issues, or new involuntary movements.