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Påvisning av Parkinsons sykdom

Parkinsons sykdom er en klinisk diagnose som kan stilles på grunnlag av sykehistorien og funn ved legeundersøkelsen. Men ofte er det hensiktsmessig med både tilleggsundersøkelser og bildediagnostikk for å utrede alternative årsaker til parkinsonisme.

Eldre
Diagnosen Parkinsons sykdom baseres på internasjonale diagnosekriterier og parkinsonisme med minst to av følgende symptomer: skjelving i hvile, stivhet i kroppen, vansker med å starte og gjennomføre aktiviteter.

Sist oppdatert:

17. mars 2020

Tidlig i sykdomsforløpet kan det ofte være vanskelig å påvise Parkinsons sykdom. Symptomene er gjerne vage, og de kommer og går på en uforutsigbar måte. Ofte blir de tolket som aldersrelaterte problemer i begynnelsen.

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Det er heller ingen blodprøver eller bildeundersøkelser, for eksempel CT eller MR, som kan påvise sykdommen. 

På grunn av dette kan symptomene tidlig i forløpet mistolkes, og pasienten kan få stilt feil diagnose. Etter hvert som sykdommen skrider frem og symptomene blir mer karakteristiske, blir det lettere for legen å stille diagnosen Parkinsons sykdom.

Kriteriene for å stille diagnosen er for det første symptomer på symptomsettet (syndromet) parkinsonisme med to eller flere av følgende tre symptomer:

  1. Hviletremor (skjelving). Typisk er skjelvinger i hånden med 4-6 rykninger per minutt, mest uttalt i hvile.
  2. Rigiditet (stivhet) i kroppen. Dette er ofte mest tydelig i armer og hender.
  3. Brady-/akinesi - som betyr vansker med å starte og gjennomføre aktiviteter.
Mr-maskin

I begynnelsen av sykdommen ser man at symptomene ofte har litt forskjellige preg på høyre eller venstre side (asymmetri). Ved en undersøkelse på legekontoret gjør legen gjerne forskjellige tester for å vurdere nervesystemet ditt. 

I Norge er det anbefalt at pasienter med mulig Parkinsons sykdom skal henvises til nevrolog for å få stilt diagnosen. Etter at parkinsonisme er påvist bør det vurderes alternative årsaker til symptomene. 

En del av tilleggsundersøkelsene vil allmennlegen kunne utføre. Det dreier seg om forskjellige blodprøver, eventuelt stående/sittende blodtrykksmåling. Allmennlegen kan også henvise til CT- eller MR-undersøkelse av hjernen. Noen undersøkelser vil bestilles av eller utføres hos spesialist. 

Når undersøkelsene for å utrede alternative årsaker er gjort, bør det anvendes standardiserte kliniske diagnosekriterier. Det finnes støttende kriterier og en rekke kriterier som gjør diagnosen Parkinsons sykdom mindre sannsynlig. 

Ofte vil legen be deg forsøke en medisin kalt levodopa, som brukes i behandlingen av Parkinsons sykdom. God effekt av denne behandlingen er for eksempel et støttende diagnosekriterium.

Diagnosen Parkinsons sykdom stilles av legen etter en helhetsvurdering der både sykehistorien, kliniske funn, resultater av eventuelle undersøkelser, samt diagnosekriteriene er tatt i betraktning. 

Animasjon om Parkinsons sykdom

Vil du vite mer

Dette dokumentet er basert på det profesjonelle dokumentet Parkinsons sykdom (PS) . Referanselisten for dette dokumentet vises nedenfor

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