Parkinsonism: What It Is and How It Differs from Parkinson's Disease

A hand that recently buttoned a button with ease suddenly does it more slowly, as if against resistance. At rest the fingers begin to tremble finely, and the gait becomes shorter. Behind such a sensation may lie parkinsonism — a syndrome that does not always mean Parkinson's disease.

What parkinsonism is

Parkinsonism is a neurological syndrome, that is, a set of signs with various causes. It is characterized by tremor, muscle rigidity (a sustained increase in tone, uniform resistance of the muscles in all phases of passive movement), postural instability — difficulty with balance and walking, falls — and bradykinesia: a slowed pace of movements, difficulty with initiating movements and turning. The core of the clinical picture is the akinetic-rigid syndrome.

Parkinson's disease and parkinsonian syndrome: what the difference is

Parkinson's disease is a specific illness: parts of the brain are damaged gradually, over years, and because of the death of cells in the substantia nigra the level of dopamine, which regulates movement, falls. Parkinsonism is a broader concept. Its most common cause is precisely Parkinson's disease, which is called primary, idiopathic parkinsonism. Everything else is secondary, symptomatic parkinsonism.

• drug-induced — most often associated with neuroleptics, accounts for 4 to 10% of all cases of parkinsonian symptoms;
• vascular — acute in strokes in the region of the putamen and substantia nigra, chronic in subcortical atherosclerotic encephalopathy;
• toxic, hypoxic, metabolic, postencephalitic;
• tumoral and paraneoplastic;
• traumatic — in severe traumatic brain injuries or frequent trauma, such as boxer's encephalopathy.

Main manifestations of parkinsonism

Symptoms begin gradually, often on one side of the body, and later affect both. Trembling of the hands, arms, legs, jaw, face; stiffness of the arms, legs and trunk; slowness of movements; poor balance and coordination. Further — difficulty with walking, speaking, simple everyday tasks, depression and anxiety, problems with sleep and memory, loss of smell, difficulty with chewing, swallowing and speech. If movements have slowed, muscles have become stiff, and the gait has changed — this is a reason to see a neurologist.

Atypical parkinsonism: which forms exist

A common feature of atypical parkinsonism is a rapid course, an incomplete or short-lived effect of antiparkinsonian therapy, and symptoms atypical for Parkinson's disease at least at an early stage: postural disturbances, autonomic dysfunctions, predominance of the hypokinetic-rigid syndrome in the trunk rather than in the limbs, pyramidal signs, myoclonus, cerebellar symptoms, disorders of eye movements and frontal functions. Forms: progressive supranuclear gaze palsy, Shy-Drager syndrome with striatonigral degeneration, corticobasal degeneration, dementia with Lewy bodies, familial calcification of the basal ganglia, pallidal degeneration, juvenile form of Huntington's chorea, Wilson-Konovalov disease. Some of these forms do not respond to deep brain stimulation.

Diseases resembling Parkinson's disease

Drug-induced parkinsonism is one of the most common forms of secondary parkinsonism, from 4 to 10% of all cases. It is precisely this that the physician rules out first in recently appeared hypokinesia, rigidity or tremor. Non-modifiable risk factors — age over 60 years, female sex, heredity; modifiable — a high dose and long-term use of a neuroleptic, polytherapy, a prior traumatic brain injury, stroke, pronounced cognitive disorders. In approximately half of cases drug-induced parkinsonism is caused by drugs not belonging to antipsychotics. A similar picture is produced by vascular and toxic lesions.

How it is diagnosed and when a neurologist is needed

There is no specific test for Parkinson's disease: the diagnosis is built on the medical history and neurological examination. PET with fluorodopa and SPECT (DaTSCAN) with ioflupane are used. Most people with Parkinson's disease notice symptoms after age 50, some — before 40, with onset on average at about 60 years; men are affected somewhat more often. If resting tremor, slowness, muscle stiffness, instability when walking, problems with speech or swallowing have appeared — this is a reason to consult a neurologist.

Parkinsonism in itself is not a reason to call an ambulance; 103/112 — if a stroke or another life-threatening condition is suspected.

This text is for reference: it helps to understand the terms but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer