From the Guidelines
A Parkinson's disease specific questionnaire or a water swallow test with the measurement of the average volume per swallow is recommended for testing Parkinson's disease. When evaluating a patient for Parkinson's disease, it is crucial to consider the most recent and highest quality evidence available. According to the ESPEN guideline on clinical nutrition in neurology 1, a strong consensus (91% agreement) supports the use of a Parkinson's disease specific questionnaire or a water swallow test. This approach prioritizes the patient's morbidity, mortality, and quality of life by utilizing a recommended method with a high level of agreement among experts. Key points to consider when testing for Parkinson's disease include:
- Utilizing a Parkinson's disease specific questionnaire to assess symptoms and their impact on daily life
- Conducting a water swallow test to measure the average volume per swallow, which can help identify dysphagia and other swallowing difficulties commonly associated with Parkinson's disease
- Considering the results of these tests in conjunction with clinical evaluation and other diagnostic tools to confirm the diagnosis and develop an effective treatment plan. The ESPEN guideline provides a valuable framework for healthcare professionals to follow when testing for Parkinson's disease, emphasizing the importance of a comprehensive and multidisciplinary approach to diagnosis and management 1.
From the Research
Diagnosis of Parkinson's Disease
- Parkinson's disease (PD) is a progressive neurological disorder characterized by a large number of motor and non-motor features that can impact on function to a variable degree 2.
- There is no definitive test for the diagnosis of PD, and the disease must be diagnosed based on clinical criteria 2.
- The cardinal signs of PD are rest tremor, bradykinesia, rigidity, and loss of postural reflexes 2, 3.
Clinical Features of Parkinson's Disease
- Secondary motor symptoms of PD include hypomimia, dysarthria, dysphagia, sialorrhoea, micrographia, shuffling gait, festination, freezing, dystonia, and glabellar reflexes 2.
- Non-motor symptoms of PD include autonomic dysfunction, cognitive/neurobehavioral abnormalities, sleep disorders, and sensory abnormalities such as anosmia, paresthesias, and pain 2, 4.
- The presence and specific presentation of these features are used to differentiate PD from related parkinsonian disorders 2, 3.
Diagnostic Challenges
- The absence of rest tremor, early occurrence of gait difficulty, postural instability, dementia, hallucinations, and the presence of dysautonomia, ophthalmoparesis, ataxia, and other atypical features, coupled with poor or no response to levodopa, suggest diagnoses other than PD 2.
- A thorough understanding of the broad spectrum of clinical manifestations of PD is essential to the proper diagnosis of the disease 2.
- Genetic mutations or variants, neuroimaging abnormalities, and other tests are potential biomarkers that may improve diagnosis and allow the identification of persons at risk 2.