Navigating Diagnostic Challenges: A Case Report on Early Parkinson's Disease Identification

Abstract

In late life stages, symptoms of neurodegenerative diseases can be masked by depression, apathy, and stress. This case study explores the challenges of early Parkinson's Disease (PD) diagnosis. A 58-year-old man with initial symptoms of depression, anxiety, insomnia, and increased gambling behavior after age 50 was treated for assumed bipolar disorder using olanzapine, with minimal response. Further history and examination revealed motor symptoms, including tremors and asymmetric bilateral rigidity, which raised the suspicion for an underlying neurodegenerative disorder. We further expanded the differential diagnosis to include causes of Parkinsonism, e.g., idiopathic Parkinson's, atypical parkinsonian disorders, drug induced Parkinsonism. Based on Postuma et al.’s MDS Clinical Diagnostic Criteria for Parkinson's Disease, the patient's physical examination confirmed a diagnosis of clinically established PD. The patient underwent medication adjustments, incorporating carbidopa-levodopa, quetiapine, and buspirone, resulting in significant improvements in PD symptoms and anxiety. Ongoing medication management and follow-ups contributed to restoring mood and appetite, reducing impulsivity, and overall enhancing functioning. This case navigates through the complexities of PD diagnosis, emphasizing the role of early identification of nonmotor symptoms and their treatments, adding to the patient's quality life trajectory through early recognition and treatment of non-motor symptoms associated with Parkinson's disease.