If you're seeing this message, it means we're having trouble loading external resources on our website.

If you're behind a web filter, please make sure that the domains *.kastatic.org and *.kasandbox.org are unblocked.

Main content
Current time:0:00Total duration:9:42

Video transcript

so here we have our friend Vivek and the back is a little concerned because he's having a few problems with his movements lately so for example he says he's noticed a little bit of a tremor in his hand and he's also having some problems just kind of moving around he's having a tough time walking around like normal and and just doing things around the house you know like day to day things now this set of symptoms you know it sounds like it could be a few different things right but we do notice that vivec is about 65 years old now and we have to at least in the back of our minds consider that maybe this is him presenting with previously undiagnosed Parkinson's disease right because the the older you are in general the higher your risk of developing Parkinson's disease and some of the things that he's telling us about they do kind of sound like the the early signs of the disease so what do we want to do here how should we try to figure out if the Veck does indeed have Parkinson's disease well let's take a look at vivec let's ask him some questions and do some physical exams on him to try to diagnose Parkinson's disease and you might have noticed that I didn't mention anything about any lab tests any blood work or or brain scans or anything like that and that's because we actually don't have any lab or imaging tests that actually tell us hey this is Parkinson's disease I mean we have a few things that we can do to rule other things out but we don't really have anything that that confirms Parkinson's disease so instead we're going to have to rely on taking a clinical history and doing some neurological exams to try to diagnose this possible Parkinson's disease in vivec here so let's let's go through these together and let's try to diagnose Parkinson's disease so our clinical history it's basically like an interview we want to ask our patient here a series of questions about the symptoms that are characteristic of Parkinson's disease so for example we would definitely want to make sure that we asked him about the cardinal signs of Parkinson's disease so he might tell us that he's been experiencing a resting tremor right and he might also tell us how it's been really difficult to kind of initiate movements to start movements so for example maybe getting out of a chair seems to be a bit tougher these days and he also tells us that he's been feeling like his muscles are just kind of stiff they're just kind of hard to move so this does sound an awful lot like the major signs of Parkinson's disease the tremor the brady kinesia the rigidity those things that are actually part of the symptom complex parkinsonism so you know it could be Parkinson's disease but we do know that there are a few different diseases and other things that can cause the syndrome of parkinsonism not just Parkinson's disease so we need to ask a few more questions here to try to really get at what might be causing parkinsonism here in vivec so maybe he goes on to tell us that his tremor actually started in one of his hands and it's not really affecting the other hand at least not yet so we're thinking okay this fits even more with Parkinson's disease because remember that the tremor often not always but often is asymmetric so just on one side of the body so the fact that vivec here has an asymmetric tremor it rules out a couple of the other causes that we know of of parkinsonism but it still keeps Parkinson's disease at the top of our list of differentials because we know that in Parkinson's disease the the tremor often starts on just one side of the body but we want to be a bit more sure about our suspected Parkinson's disease diagnosis here so we're gonna keep digging a little what else would be useful to ask in a history well we might ask Rebecca how long he's been having these problems for right we want to find out did they start suddenly or have they been developing slowly and worsening over time if that could just kind of suddenly you know woken up one day and started experiencing these problems we might consider something else other than Parkinson's disease as the underlying cause right because remember that Parkinson's disease is a progressive disease so the signs and the symptoms they develop and worsen over time rather than coming on suddenly so we would expect vivec to tell us that that the problems that he's been having the movement problems have been developing over time and getting a bit worse now we should also check to see if the VEX been having any other problems right because remember that Parkinson's disease it doesn't just cause problems with movements so maybe we should ask him we should ask him about his sense of smell right because we know that in the majority of people with Parkinson's disease eventually they end up having some trouble with or lose their sense of smell so we should ask him about that and we might also ask him how his mood has been if he's been feeling anxious or maybe depressed because we know that Parkinson's disease can often cause anxiety and depression and let's also ask him about his memory and his concentration let's ask him how those have been has he been feeling forgetful maybe he's been having trouble focusing on his everyday tasks because we know that this can also be a problem in Parkinson's disease so the last few things that we might do here in our history taking is well check to see if avec has a family history of Parkinson's disease because we know that having a positive family history for the disease could increase his risk of developing the disease himself and that's because the cause could be a genetic cause a problem with with one of the genes that when mutated can cause Parkinson's disease so we'll also check to see if the vecas on any medications that would maybe explain these issues that he's having because remember that Parkinson's disease is just one cause of parkinsonism and there are some medications out there that we might take for other conditions that can actually cause parkinsonism and we might confuse that for Parkinson's disease so some psychiatric drugs out there and some drugs that we take the stop us from vomiting so we'd want to make sure that vivec isn't on any of these that might be causing parkinsonism as a side effect we need to rule this out so that we don't accidentally think that it's Parkinson's disease all right so now we've taken a pretty good history from vivec right and we're thinking that Parkinson's disease might be the cause of his symptoms so the next thing that we want to do here remember that we can't rely on on any blood tests or scans to diagnose Parkinson's disease so the next thing that we'll do is a neurological exam which is just a physical exam and we're doing it because we want to see for ourselves those signs of parkinsonism that vivec talked about in his history so really important part of a neurological exam when when looking for Parkinson's disease is asking the patient to walk just to see how they walk and move around now you might remember that people with this sort of later stages of Parkinson's disease can develop a kind of stooped posture and problems with their balance and they might start to shuffle their feet a little bit now the vak here he if he has Parkinson's disease it's probably pretty early on but we just want to double-check we still want to get them to walk around just to see how his movements are being affected and we might also try to bring these symptoms the brady kinesia and the rigidity that are so synonymous with Parkinson's disease we might try to bring them out in other ways too so maybe we'll get him to stand up from a sitting position to see how long it takes them and we might push or pull on his arms a little bit to see if we can feel that rigidity which would feel like resistance right and we definitely want to look at that tremor so we want to see for ourselves if it is indeed a resting tremor because remember that there are lots of different types of tremors but in Parkinson's disease we normally see a resting tremor so we might get vivec to let his hand rest on the table and see if the tremor starts while it's just resting and then we might get him to maybe use his head let's get him to grab his keys and see if the tremor goes away so this would suggest to us if it did that it was indeed a resting tremor so at this point we've decided that vivec is definitely displaying signs of parkinsonism and we think that maybe it's Parkinson's disease that's causing the parkinsonism but we're not a hundred percent sure we're not a hundred percent sure if Parkinson's disease is indeed the cause so what could we do if this was the case well one thing that we might do is we might consider giving the VEX some of the medication that we would give to someone with Parkinson's disease and this medication what it what it does is it's able to restore those levels of dopamine in the brain because remember that we lose a lot of dopamine neurons in Parkinson's disease and when we lose dopamine neurons we lose dopamine and this is actually what causes a lot of the movement problems that we see in a disease so when we give people with with diagnose Parkinson's disease these medications it often really helps with the movement problems that they're having by replacing some of that lost dopamine but on the other hand if someone has these signs of parkinsonism but parkinsonism that's not caused by Parkinson's disease then the medication tends to not really help right because the other cause is the parkinsonism they don't really work in the same way the Parkinson's disease does it's not necessarily by a loss of dopamine neurons in the substantia [ __ ] so just pumping them full of dopamine it won't really do much good and helping with their movement problems so this is one way that we might consider to try to figure out if the VEX cause of parkinsonism here is indeed Parkinson's disease because of his brady kinesia and his rigidity are improved with dopamine replacement medications then we might be a little bit more confident that the underlying cause of his signs is indeed Parkinson's disease so the last thing that we might do is we might get vivec to come back after a little bit of time and we might do that so that we can keep track of how vivexx signs and symptoms that he's experiencing how they worsen over time because often it can be really hard to diagnose Parkinson's disease in the early stages and so we might need to check up on vivec 2 to see how he progresses before we can definitely decide that this is Parkinson's disease