Learn how what is Parkinson’s disease is diagnosed through clinical exams and imaging. Understand the role of DaTscan and MRI in the evaluation process.
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Diagnosis and Imaging
There is no specific test to diagnose Parkinson’s disease. A doctor trained in nervous system conditions (neurologist) will diagnose Parkinson’s disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination. The diagnosis is often a process of ruling out other conditions.
The diagnostic criteria usually require the presence of two of the three primary motor symptoms. These are tremor, slowing of motion, and muscle rigidity. The doctor will also look for a sustained positive response to levodopa medication. If symptoms improve significantly with this medication, it confirms the diagnosis.
A neurological examination is a series of tests that assess the function of your nervous system. For Parkinson’s disease, the doctor focuses heavily on the motor system. This is an interactive exam where the patient follows instructions to move, walk, and speak.
The exam evaluates:
During the exam, the doctor will ask you to perform specific tasks. To check for rigidity, the doctor will move your arms and legs to feel for resistance. To check for bradykinesia, they may ask you to tap your finger and thumb together rapidly or tap your foot.
Specific exam maneuvers:
An MRI (Magnetic Resonance Imaging) uses a magnetic field and radio waves to create detailed images of your brain. In Parkinson’s disease, an MRI of the brain usually appears normal. The primary purpose of ordering an MRI is to rule out other causes of your symptoms.
Conditions ruled out by MRI:
A DaTscan is a specialized imaging test that captures detailed pictures of the dopamine system in your brain. It involves the injection of a small amount of a radioactive drug. A special camera then measures the amount of dopamine transporters in the brain.
Patients with Parkinson’s disease will show a significant reduction in dopamine transporters in the striatum area of the brain. This test can help distinguish Parkinson’s from essential tremor, which does not involve dopamine loss. It is not always necessary for diagnosis but is helpful in unclear cases.
One of the most effective diagnostic tools is a therapeutic trial of medication. The doctor may prescribe carbidopa levodopa, which is the gold standard treatment. If the patient has Parkinson’s disease, they should see a significant improvement in their movement symptoms.
This is often called a challenge test. If there is no improvement after reaching a therapeutic dose, the doctor may reconsider the diagnosis and look for atypical parkinsonism disorders which usually do not respond well to dopamine replacement.
Genetic testing is generally not used for diagnosing Parkinson’s disease in the typical patient because most cases are not hereditary. However, it may be recommended for people who develop the disease at a very young age or who have a strong family history of the condition.
Genetic testing can identify mutations in genes such as LRRK2, PARK7, PINK1, or PRKN. Knowing the genetic status can help in understanding the progression and may qualify patients for specific clinical trials targeting these mutations.
Loss of smell, or hyposmia, is one of the earliest signs of Parkinson’s disease, often appearing years before motor symptoms. Doctors may use “scratch and sniff” smell tests to evaluate olfactory function.
While loss of smell can be caused by many things including viruses and sinus issues, a profound loss of smell combined with other risk factors can support a Parkinson’s diagnosis. It is a supportive piece of evidence rather than a standalone diagnostic tool.
Essential tremor is the most common movement disorder and is often confused with Parkinson’s. The key difference lies in when the tremor occurs. An essential tremor happens during action, such as lifting a cup or writing. A Parkinson’s tremor happens at rest.
Differences include:
To get an accurate diagnosis, preparation is helpful. Patients should write down all their symptoms, even those that seem unrelated like constipation or sleep issues. Making a list of all medications and supplements is crucial.
Preparation tips:
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Currently, there is no commercially available blood test to diagnose it, though research into alpha-synuclein biomarkers in blood and skin is ongoing.
A DaTscan is a specialized imaging test that captures detailed pictures of the dopamine system in your brain to help distinguish Parkinson’s disease from other causes of tremors.
Small, cramped handwriting (micrographia) is a common and specific early sign of the disease, reflecting the loss of fine motor control.
While a GP can suspect it, a diagnosis is best confirmed by a neurologist or a movement disorder specialist who can rule out mimics.
It can take time, sometimes years, because early symptoms are subtle and must be distinguished from normal aging or other neurological conditions.
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