Osiyo Vicki. This is a complicated question. I have had the punch skin biopsy done which came back positive showing buildup of alpha synnucleosin protein which my original neurologist told me was confirmatory to diagnose PD. So he changed my dx from Essential Tremors to PD. He retired Jan this year. I just established with a new neurologist with specialization in movement disorders. After reviewing office notes of prior Neuro, notes from Dr prior referred me to for second opinion who after examining me diagnosed me with PD 5 years ago, and notes from UT Southwestern Neurology (where I had a DaTScan which came back normal) and her doing a physical exam she changed my dx from PD to Parkinsonism.

Now an article from the Parkinson’s Foundation noted “All the parkinsonisms have a loss of Dopamine so a DaTScan cannot be used to differentiate between them and idiopathic Parkinson’s Disease.”

A paper published by the National Institute of Neurological Disorders and Stroke when researching about Multiple System Atrophy MSA ( a type of Parkinsonism) states “Research findings indicate that abnormal alpha-synnucleosin accumulation in nerve cells and their supporting cells, including glia, leads to cellular dysfunction and progressive loss of nerve cell function (known as neurodegeneration) . Studies suggest that the diverse forms and structures of alpha-synnuclein might explain why the protein accumulates in glial cells in MSA and nerve cells in Parkinson’s Disease.”

Further from the Parkinson’s Foundation paper cited earlier, “Parkinsonisms, also known as atypical Parkinson’s or Parkinson’s plus, represent about 10-15% of all diagnosed cases of Parkinsonism.

Bottom line: There is NO definitive test to detect Parkinson’s disease or Parkinsonism!

Now if you are as confused as I am Vicki, I say “Welcome to my world” 🙂. We all shall keep searching for answers together…

I have had both DaTScan and P-SYN skin biopsy. Markwebb previously described it well - there is simply not perfect test, to diagnosis PD right now. Nonetheless, I'm glad I did it. It required three tiny skin punches (neck, back and knee) that were not very painful and healed quickly. In my case, it helped validate my PD diagnosis and bring closure to me as I was in denial.

Do you have a reference stating “the skin biopsy will confirm dx of PD, Lewy Body or a couple of otherparkinsoniam presentations”? I have become a bit more skeptical when a Neuro tells me something unless I can see it in print from a respected medical reference 😖🙂

Thanks. We have been down the neuro mystery path. Two years ago after a Pet scan my husband was definitively diagnosed with Alzheimer's. He was experiencing cognitive issues but I later figured amount it was just effects from anesthesia that lasted a very long time. Finally got a good neuro that specialized in AZ and she said no. By then he was experiencing tremors and found PD or parkinsonian also explained his way of walking that had been going on for several years. So now seeing a movement specialist and she suspects lewy body...I don't agree but then I'm not a Dr. I think he looks like PD...has all the symptoms. Anyway the skin biopsy will only confirm that he has PD, LB or a couple of other parkinsonian diseases but at least it will narrow down the choices. Very frustrating.

I understand that too much meds is just as bad as too little. It takes fine tuning.