An Overview of Parkinsonism

Parkinsonism, also known as atypical or secondary Parkinsonism, is a condition that impacts movement and causes symptoms similar to those seen in Parkinson’s disease. These include muscle stiffness, slow movement, speech impairment, tremors at rest, and more.

The most common type of Parkinsonism is drug-induced Parkinsonism, which can be caused by prescription medications taken to treat another condition.

Potential Causes

There are several possible causes of Parkinsonism, but most people with Parkinson’s symptoms will be diagnosed with Parkinson’s disease, which is called idiopathic Parkinson’s (idiopathic means “unknown cause”).

Parkinson’s Disease

Parkinson’s disease is likely caused by a combination of genetic and environmental factors that damage the cells that produce dopamine. Without dopamine—a neurotransmitter that regulates movement—a person experiences neurodegeneration and the classic symptoms of Parkinson’s disease.

However, about 15% of people who have these symptoms will be diagnosed with secondary Parkinsonism instead of Parkinson’s disease.

Medications

The most common type of Parkinsonism is drug-induced Parkinsonism. Some antipsychotic and antidepressant medications that alter dopamine production in the brain have Parkinsonism as a side effect.

Viruses

Emerging research also shows that there could be an infectious origin of Parkinsonism in some people that is related to neuroinflammation caused by viruses such as influenza A, Epstein-Barr, hepatitis C, varicella-zoster, and others.

Other Causes

There are also other possible causes of Parkinsonism, including:

• Vascular Parkinsonism
• Lewy body dementia
• Frontotemporal dementia
• Viral encephalitis
• Traumatic brain injuries
• Acquired brain injuries (including strokes)
• Corticobasal degeneration
• Multiple system atrophy
• Progressive supranuclear palsy
• Wilson’s disease
• Toxin exposures—especially carbon monoxide or manganese (people in certain professions, such as welders, are at an increased risk)

Symptoms of Parkinsonism

The symptoms of Parkinsonism are the same as the symptoms of Parkinson’s disease. The three defining symptoms of Parkinsonism are bradykinesia, rigidity, and tremors.

Bradykinesia is a term that health professionals use to describe the slow movement that is characteristic of Parkinsonism (“brady” means slow, and “kinesia” means movement).

Someone with bradykinesia moves very slowly. For example, it might take them a long time to bring a fork to their mouth or put on a shirt.

They also will have a slower reaction time. If you ask them to perform an action, such as pass you a napkin, they will only do so after a delay—it might appear that they have not heard you or are ignoring you. They may also speak very slowly and softly.

Bradykinesia

Bradykinesia also affects how a person walks. It produces a very recognizable slow, shuffling gait with very short steps. A person’s feet may get “stuck” during steps—they may freeze, or find it hard to initiate each step.

Tremors

Tremors are one of the earlier symptoms of Parkinsonism and Parkinson’s disease. There are many types of tremors, but the tremors that occur in Parkinsonism are called resting tremors, meaning that they happen when a person is at rest and not performing a voluntary action.

These tremors typically occur in the hands and arms, but sometimes occur in the chin or legs. The resting hand tremors are sometimes referred to as “pill-rolling” because it looks like the person is repeatedly rolling a pill between their thumb and fingers.

Rigidity

The third defining symptom of Parkinsonism is postural rigidity, which causes a person to have very stiff, rigid movements. They also can experience pain and soreness in their muscles.

Symptoms of Secondary Parkinsonism

The symptoms of secondary Parkinsonism are caused by another condition and not Parkinson’s disease; therefore, other symptoms can also be present. The additional symptoms will depend on the type of Parkinsonism that a person has.

Types of Parkinsonism

Parkinsonism refers to a collection of symptoms, but there are multiple conditions that can cause these symptoms. It may help you to think of these causes as different “types” of Parkinsonism. The diagnosis, treatment, and outcomes depend on the type.

The most common types of atypical Parkinsonism include drug-induced Parkinsonism, neurodegenerative disorders, heredodegenerative conditions, and vascular Parkinsonism.

Drug-Induced Parkinsonism

Parkinsonism caused by medication is the most common type of secondary Parkinsonism. It was first described in the 1950s and is becoming more common.

The reasons why it is more common are probably related to the increase of polypharmacy (the use of multiple medications at a time) among older populations, as well as an increased life expectancy.

Compared to Parkinson’s disease, drug-induced Parkinsonism is less likely to cause tremors and more likely to cause symmetrical symptoms (the same symptoms on both sides of the body).

Drugs that affect the brain’s dopamine levels or production (dopamine receptor antagonists) are known to have Parkinsonism as a side effect. However, other drugs—including those that are used to treat schizophrenia, high blood pressure, migraines, depression, or another condition—can also cause Parkinsonism, for unknown reasons.

Several drugs have Parkinsonism as a possible side effect. These include:

• Antipsychotics
• Certain antidepressants
• Reserpine
• Tetrabenazine
• Certain calcium channel blockers
• Some antiemetics (anti-nausea drugs)

Stopping these medications may not immediately make Parkinsonism symptoms go away. It can take weeks—sometimes up to a year—for the symptoms of Parkinsonism to remit after a person stops taking the medication that caused it.

Neurodegenerative Disorders

Neurodegenerative disorders can also lead to Parkinsonism symptoms. Neurodegeneration is the progressive loss of neurons (nerve cells).

Conditions associated with Parkinsonism symptoms include:

• Progressive supranuclear palsy (PSP)
• Dementia with Lewy bodies (LBD)
• Multiple system atrophy (MSA)
• Corticobasal degeneration (CBD)

Heredodegenerative Conditions

Heredodegenerative conditions also cause the loss of neurological functioning but are genetically inherited conditions rather than acquired conditions. Several heredodegenerative conditions have been found to cause Parkinsonism.

Heredodegenerative conditions associated with Parkinsonism include:

• Frontotemporal dementia (FTD)
• Alzheimer’s disease
• Perry syndrome

Vascular Parkinsonism

Vascular changes (changes in the vessels that carry blood) in the brain can also lead to Parkinsonism. These changes are usually caused by ischemic cerebrovascular disease or disease in which blood flow in the brain was stopped or reduced. When this happens, it can lead to a stroke, transient ischemic attack, aneurysm, or another cerebrovascular event.

People with VP display more lower-body symptoms, primarily a wide stance and gait impairment. As their symptoms progress, they may experience urinary incontinence and a decline in cognition.

Studies have found that people with VP develop white matter lesions and lacunes in the brain that are distinct from the brain changes in Parkinson’s disease.

Diagnosis

Differential diagnosis (the process of testing and ruling out all possible conditions) is important when someone presents with Parkinsonism to help prevent misdiagnosis.

Your doctor needs to find the correct underlying cause of a patient’s Parkinsonism, because the treatments for drug-induced Parkinsonism, vascular Parkinsonism, Parkinson’s disease, dementia with Lewy bodies, and other causes differ.

If you see your doctor for Parkinsonism, they might refer you to a general neurologist or a movement disorder specialist.

During the diagnosis process, your doctor will evaluate your symptoms and medical history. They may use brain imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT).

In some cases, your doctor may also want you to try taking levodopa—a drug that is used to treat Parkinson’s disease—to see if it helps your symptoms.

Treatment

The treatment of Parkinsonism varies by patient and the type of Parkinsonism that they have. For example, people with drug-induced Parkinsonism may be able to wean off the medications causing the symptoms, while people with vascular Parkinsonism may benefit from taking levodopa.

Parkinsonism symptoms can lead to falls and impair your ability to function in everyday life. To address these issues, your doctor might suggest occupational, physical, and speech therapy. While these rehabilitation professionals won’t cure your Parkinsonism symptoms, they can help increase your independence and safety.

For example, a physical therapist can help you increase lost strength and improve your gait. Your occupational therapist will help you do things at home like take a shower by yourself or play with your grandkids. They might also recommend environmental modifications and assistive devices to help you stay engaged in your daily activities safely.

A speech therapist can help you improve your communication and speech, develop nonverbal strategies to communicate, and learn techniques to help your memory.

Frequently Asked Questions

What is Parkinsonism characterized by?

Parkinsonism is characterized by the loss of dopamine, a neurotransmitter that helps regulate movement.

Without dopamine, a person will experience the symptoms of bradykinesia, rigidity, and tremors that are characteristic of Parkinsonism.

The exact cause of the damage to dopamine-producing cells is unknown and likely differs from person to person.

What is the difference between Parkinson’s disease and Parkinsonism?

Parkinson’s disease is a neurodegenerative disorder that leads to movement symptoms and non-movement symptoms. It is sometimes called idiopathic (unknown cause), but the cause is believed to be a combination of genetic and environmental factors.

Parkinsonism is a more general term that encompasses the symptoms of Parkinson’s disease. A variety of disorders or syndromes can lead to Parkinsonism, and these syndromes can lead to faster progression of symptoms, increased falling, presence of hallucinations, and can be non-responsive to levodopa (the drug that is used to treat Parkinson’s disease).

The majority of people with the symptoms of Parkinson’s disease will be diagnosed with idiopathic Parkinson’s disease. Between 10% to 15% of these people will be diagnosed with Parkinsonism that is caused by something else.

Which age group is Parkinsonism more prevalent in?

There is more data on the incidence of Parkinson’s disease than there is for Parkinsonism. The incidence of Parkinson’s disease increases with age, and the diagnosis is more likely in older populations.

About 4% of people with Parkinson’s disease will be diagnosed before they turn 50 years old.

Summary

Parkinsonism is when someone has the same symptoms as Parkinson’s disease, but the symptoms are being caused by another condition. There are many causes of Parkinsonism, ranging from drug-induced, to vascular changes, toxin exposure, infectious disease, neurodegenerative diseases, and more.

Older adults who are taking multiple medications (particularly antipsychotic medications that affect dopamine levels) need to be screened for drug-induced Parkinsonism, which is the most common cause of the symptoms.

Research has suggested that Parkinsonism is under-diagnosed and Parkinson’s disease is over-diagnosed by general neurologists. If you believe that you could have Parkinsonism but have been diagnosed with Parkinson’s disease, you might want to get another doctor’s input.

Receiving an accurate diagnosis is essential to forming a helpful treatment plan. Parkinsonism is typically seen as “harder” to treat than Parkinson’s disease, which might be because it is initially misdiagnosed as Parkinson’s disease and does not respond to levodopa treatment.

Your treatment may include stopping, changing, or adding medications, such as levodopa. You may also receive outpatient or in-home therapy from rehabilitation professionals, such as occupational, physical, and speech therapists, to help you regain your independence and stay safe.