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New Guidelines for Parkinson's Disease

April 2006 the American Academy of Neurology issued new guidelines about diagnosis and treatment of individuals with Parkinson’s Disease (PD). Since the disease is often misdiagnosed, the guidelines were aimed at giving more options to physicians concerning diagnosis, as well as providing patients and caregivers with insights into treatment options. Estimates are that 5 – 10 percent of individuals are diagnosed incorrectly, while 20 percent who are diagnosed with Parkinson’s are diagnosed with another disease post mortem.

Not only do the new guidelines address diagnosis and prognosis, there are guidelines for treatment strategies; evaluation and screening for co-morbid (coexisting) disorders, like depression; as well as hints to patients and caregivers for sustaining quality of life as long as possible.

Diagnosis:

After careful review of existing literature, the researchers issued the guidelines in hopes of making the diagnosis and treatment process easier for physicians and patients to manage. Since there is no one definitive test that pinpoints PD, doctors have to interpret a battery tests that can identify a series of symptoms that either points to PD or points another cause for the symptoms. The guidelines offer several testing mechanisms for physicians that make diagnosis an easier process.

If patients present with symptoms such as lack of tremor, the doctor should be concerned that PD is not the ultimate cause of the symptoms. In addition, patients falling early in the disease progression can generally indicate that something else is to blame for the symptoms. Since the disease is progressive, it generally takes a number of years to progress from the beginning stages to the more severe ones. If a patient begins to move too rapidly through the stages, this could be another clue that PD is not the disease in question.

In developing the guidelines, researchers combed through all existing research to decide the tests that most accurately predicted PD. When they reviewed the research, some noticeable trends developed. One of these included evidence that the drug levodopa, a medication that increases dopamine levels, is an effective treatment and does not speed up the appearance of PD symptoms as some people had once suspected. The new guidelines indicate that levodopa should be considered as a “challenge” to whether or not the symptoms respond to the medication. If symptoms respond, PD should be considered a correct diagnosis.

Evaluation of Coexisting Disorders:

Patients with PD are more likely to have bouts of depression. Dopamine, the neurotransmitter involved in the onset of PD symptoms like rigidity and trembling, is also involved in regulating mood. Many of today’s antidepressant medications also increase the amount of dopamine produced in the brain in order to elevate mood and alleviate depression.

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