Misdiagnosis of Parkinson's Disease

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It is an irrefutable fact that diagnosis is vital to medical care. It creates pathways for the creation and implementation of treatment plans. Conversely, we have all heard stories of people suffering due to misdiagnosis of their condition. Misdiagnosis can lead to no treatment, the wrong treatment, confusion, or even a worsening of the condition, and has become common in all medical settings; big and small.

This has been observed many times with patients having Parkinson’s Disease. In a survey of 2000 people in the UK with Parkinson's Disease, it was found that more than a quarter (26%) reported they were misdiagnosed with a different condition before receiving the correct Parkinson's Disease diagnosis.

There can be either of the following types of misdiagnosis of Parkinson’s Disease:

1. Initially, a Parkinson’s diagnosis is given, but later it turns out that it was not Parkinson’s Disease but some other condition.

2. A person is diagnosed with another condition, but later it's found that it is actually a case of Parkinson’s Disease.

There are a few reasons cited for the misdiagnosis of Parkinson’s Disease:

1. Parkinson’s Disease is a complex condition with more than 40 known symptoms. Everyone’s symptoms are different; the order in which they appear and the way and pace at which these symptoms progress would also be different.

2. As of now, there is no single definitive test for Parkinson’s Disease. No lab test or brain scan can confirm the diagnosis with complete certainty. Diagnosis is done primarily based on symptoms and their history, and that is considered a 'clinical' diagnosis. Sometimes, brain scans like Trodat and F-DOPA are prescribed, but they are also not 100% accurate. However, if these scans are normal, one can safely say that Parkinson’s is not present, but if these are abnormal, one cannot safely say it is Parkinson’s Disease or a Parkinson's mimic.

3. There are other conditions that mimic Parkinson’s. We shall describe those in more detail below.

Parkinson’s Mimics

Conditions that have symptoms similar to PD and can contribute to misdiagnosis are collectively called ‘Parkinson’s mimics’.

These can be classified into:

1. Drug induced Parkinsonism - Some psychiatric, anti-vertigo or blood pressure medication can give symptoms like that of PD

2. PD Plus syndromes - where the condition has more symptoms than just PD-like which could be a tell-tale sign to make the correct diagnosis

3. Mimics caused by brain destruction - Excessive copper, iron or calcium in the brain, brain damage due to cardiac arrest, infections like HIV

4. Completely unrelated mimics.

Named conditions that are mistaken for Parkinson's Disease

1. Essential Tremor - This is usually a tremor in the hands or arms and on both sides, while the limbs are active. This is similar to PD but different too, as PD tremor usually starts on one side and is present when the limb is at rest, not active.

2. Normal Pressure Hydrocephalus (NPH) - In this condition, the cerebrospinal fluid does not drain properly. This can result in symptoms similar to PD such as slow movements or impaired thinking.

3. Dementia with Lewy bodies - This is a type of dementia where memory and thinking issues come up first, due to the buildup of a certain protein in the brain. This happens to some PD patients too, but in later stages.

4. Multiple system atrophy - Here, symptoms resemble PD, but can have more signs like urinary symptoms, a decrease in sweating, and so on.

5. Progressive supranuclear palsy (PSP) - Here, too, there can be more symptoms like falls in the early stage, difficulty with speech, limited eye movements, etc.