-- Norman Ichiyen wrote: > A fellow support group member is trying to appeal a decision in Canada for getting a disability pension for her husband who has PD. She needs referenceable material that relates to the length of time that symptoms can be present before a formal diagnosis is made. Norm, I found this. I don't know if it will be helpful or not... http://neuro-chief-e.mgh.harvard.edu/parkinsonsweb/Main/YOPD_Handbook/CHAPTER_8.html Young Parkinson's Handbook Chapter 8: Psychological Issues J. Thomas Hutton, M.D., Ph.D., F.A.C.P. Trudy Hutton, J.D. Introduction The patient with Parkinson's disease may be affected by psychological changes which can be as important as the physical changes in understanding and living with the disease. In general, the psychological factors which affect the patient may be thought of as both internal and external, and determine how well the patient copes with PD. Some changes which may occur can be directly attributed to alterations in the brain's chemical messengers and selective loss of brain cells. Others can be seen as reflections of external factors and the individuals' reactions to them. How the patient responds to the pressures of his or her world with this chronic neurological condition is an example of these external factors. PD can also have a significant impact on family and friends which, in turn, can affect the patient's outlook. Some patients see PD as a "challenge", while others see it as a "problem". For the Young Onset Parkinson Disease (YOPD) patient in particular, the external issues can create tremendous challenges. {{PD usually has an insidious onset with the patient experiencing nothing more than a feeling of being uneasy, out of sorts, unusually fatigued or suffering vague aches and pains. Besides being nebulous and difficult to define, these vague symptoms tend to come and go. Small physical disabilities which may appear are more of a nuisance than recognizable as a symptom. Complaints of not being able to perform fine motor tasks such as buttoning a child's shirt or braiding a child's hair may not seem connected to muscle aches or an occasional loss of balance. These subtle symptoms and minor physical impairments may go unnoticed and certainly unlinked for quite some time. One may attribute the uneasy feeling to some family or work related events. Depression may not be recognized as a symptom of a movement disorder. PD tends to sneak up on its victims, coming on imperceptibly in small degees. The apprehension and distress caused by being "not quite one's self" but not recognizing any obvious physical peculiarity is a common symptom described by Parkinson's patients. Because of PD's insidious onset and the often slow progression for many months or years, it is not uncommon for one to ignore its symptoms and fail to seek medical care. Many times the patient denies any serious problems. This is understandable because denial is a form of self-protection. However, as the symptoms progress and the patient experiences increased physical limitations, the troubles become psychologically harassing as well as physically frustrating. The sufferer finds himself caught between denial of any problem and fear and worry about what the problem might be. It is at about this point that the opinion of a physician is sought.}} The diagnosis of Parkinson's may come simultaneously as a relief and a shock. One feels some relief in finally being able to put a diagnosis with the vague symptoms, and at the same time shock or distress at having a chronic, progressive neurological illness. The future may seem jeopardized by uncertainty. What will one be able to do? Is it possible to continue to work? Can one still function as a nurturing parent and spouse? What kind of medical bills may occur? Will insurance be available? The patient may experience a roller coaster of emotions as both patient and family come to terms with the diagnosis. Judith -- Judith Richards, London, Ontario, Canada [log in to unmask]