Approximately 200,000 people in Germany are affected by the nerve disease Parkinson’s disease. On average, the disease is detected one year after the first signs appear. The reason is that the symptoms in the early stages are very unspecific and do not directly suggest Parkinson’s disease. However, the earlier therapy can be started, the more favorable the long-term course of the disease.
Skin test holds out hope for early detection
In February 2017, researchers proved for the first time that an examination of the skin‘s nerve cells can detect Parkinson’s disease. Parkinson’s is known to cause deposits of proteins in certain regions of the brain. The protein “alpha-synuclein” is deposited not only in the brain, but also in the skin nerve cells. And this happens years before the onset of obvious motor symptoms. When this Parkinson’s test can be used routinely is still unclear.
Transcranial ultrasound – certainty at an early stage?
Another method researchers are working on is ultrasound of the brain, transcranial sonography. Through a natural bone window at the temple, doctors can determine the reflection of sound waves from the brain’s substantia nigra region. An amplified signal is indicative of cell breakdown in this area, which is typical of Parkinson’s disease. The test could help diagnose early-stage Parkinson’s disease, but it also shows abnormalities in nine percent of healthy subjects.
A first sign: the sense of smell disappears
The decline and eventual disappearance of the sense of smell (hyposmia and anosmia, respectively) is a common symptom in the early stages of Parkinson’s disease. The affected persons themselves first notice a loss of the sense of taste, which is closely linked to the sense of smell. The basic tastes of sweet, sour, salty, umami and bitter can often still be perceived. This is caused by degradation processes in the olfactory center of the brain. These occur approximately four to six years before the motor symptoms. An olfactory test by a neurologist can provide information. In the process, the test person is presented with different olfactory samples.
Nonspecific pain as an early symptom
Pain can be an early sign of Parkinson’s disease. It often affects the shoulders and arms or other parts of the musculoskeletal system. Burning, pulling, or tingling pain is also reported. They resemble rheumatic symptoms and are rarely directly associated with Parkinson’s disease. In the late stages, orthopedic problems occur as a result of poor posture. Since many diseases are accompanied by pain, the diagnosis is very difficult to make without other Parkinson’s symptoms. Most patients are initially evaluated orthopedically or rheumatologically before being referred to a neurologist.
Sleep disturbances in the early stages
In a more advanced early stage of the disease, the so-called Schenck syndrome may occur. This is a behavioral disorder during sleep, which is characterized by jerky, often violent movements. The cause is the loss of the flaccid paralysis that normally occurs during REM sleep. The affected person virtually lives out the dream physically. In addition to a neurological examination, the diagnosis is usually made in a sleep laboratory.
Depression in Parkinson’s disease
Sometimes a depressed mood to the point of depression is an early symptom in Parkinson’s disease. Listlessness, lack of interest and joylessness are manifestations of this. If there are no motor abnormalities, Parkinson’s is rarely suspected. In later stages of the disease, the depressive mood is intensified by the progression of the disease and the accompanying everyday restrictions.
Dementia and Parkinson’s disease
Parkinson’s disease patients often develop additional dementia in the late stages, i.e., a slowing of memory performance to the point of memory loss. The personality also changes. Affected persons are disoriented, confused and often in need of care. This dementia, which is caused by the degradation of dopaminergic cells, must be distinguished from other dementia diseases, such as Alzheimer’s dementia.
Tremor, rigor, akinesia – the typical Parkinson’s triad.
A classic symptom of Parkinson’s disease is trembling of body parts, most commonly the hands. Medical professionals refer to this as tremor. Typical of Parkinson’s patients, tremor is present when the patient is at rest and disappears when the patient concentrates on a movement. Any new onset of tremor should be thought of as Parkinson’s disease. However, it is usually observed only in the advanced stages of the disease. The generally reduced mobility of the affected person is also noticeable. Parkinson’s patients move slowly and need more time for many everyday things. This is referred to as akinesia. As the disease progresses, “dyskinesias” may also occur. These are jerky, involuntary movements. Another classic phenomenon is so-called rigor, a muscle stiffness that makes movements even more difficult.
The role of the eyes in early detection of Parkinson’s disease
Only in recent years have researchers found that the eyes also begin to tremble, that is, develop a “tremor.” This can go unnoticed by those around them. Sufferers themselves rarely notice this eye tremor. If Parkinson’s disease is suspected, an examination of the eyes by an ophthalmologist can provide information about a possible eye tremor.
Late-stage symptoms
The gait pattern of a person with Parkinson’s disease is always similar: small steps without swinging of the arms, often initially affecting only one side of the body in early stages. A clear change in the gait pattern does not occur until later stages of the disease.
Disorders of muscle function
In Parkinson’s patients, fine motor skills are impaired as the disease progresses. Reaching for things, opening bottles, combing hair, or buttoning pants become increasingly difficult for those affected. In addition, the declining ability to control the muscles of the hands and fingers alters the handwriting of those affected. Many people with Parkinson’s write very small and spidery letters. Since the facial muscles can also move less, the face appears stiff and expressionless, the facial expressions are frozen (“mask face”). Speech may also be affected, sounding monotonous and washed out.
How else does Parkinson’s disease announce itself?
In addition to motor symptoms, there are also changes in the autonomic nervous system. This controls numerous involuntary processes of the body. For example, blood pressure. Many Parkinson’s patients suffer from low blood pressure – dizziness and fainting spells can be the result. Due to a dysfunction of the sweat glands, they produce too much secretion and increased sweating is the result. Another organ affected is the intestines, which can become sluggish and thus cause blockages. Likewise, the bladder muscles may be weakened and result in urinary incontinence.
Who can get Parkinson’s disease?
Anyone can develop Parkinson’s disease. The cause is a deficiency of a neurotransmitter in the brain called dopamine. The result is a disturbance of motor control and thus malfunction of voluntary and involuntary muscle cells. The first signs usually appear from the age of 55 to 65, but an earlier or later onset is possible. Symptoms are not apparent until about 50 percent of dopaminergic neurons have died.
Different forms of Parkinson’s disease
There are different forms of Parkinson’s disease, the most common being no identifiable cause (idiopathic Parkinson’s syndrome). However, there are also hereditary forms that are caused by a mutation in the genes of one parent. However, these forms are much rarer than idiopathic Parkinson’s and usually occur at a younger age. A genetic test can provide certainty. Other forms of Parkinson’s include secondary and atypical Parkinson’s disease.
How do I recognize Parkinson’s disease?
The problem with each of the early symptoms of the disease is that they are very nonspecific. Many signs are first noticed by those around them, for example, the altered writing pattern, the slackening of facial expressions or the one-sided swinging along of the arms. If pain or depression leads to a visit to the doctor, Parkinson’s disease is rarely suspected first. In contrast, in advanced stages with motor symptoms such as rigor, tremor, and akinesia, a visual diagnosis is often possible.
13 possible early warning signs of Parkinson’s disease at a glance.
- Protein deposits in the skin (alpha-synuclein).
- Cell degradation in the brain region substantia nigra.
- Loss of the sense of smell
- Nonspecific pain, especially of the musculoskeletal system.
- Sleep disorders (“Schenck syndrome”)
- Depression
- Dementia
- Tremor, rigor and akinesia
- Tremor of the eyes
- Classic gait pattern
- Changed typeface
- Rigid facial expression (mask face)
- Low blood pressure, increased sweating, constipation, urinary incontinence due to disturbances of the autonomic nervous system.
Our Parkinson’s early detection test can help identify potential symptoms early.
