Parkinsonism is a group of neurological conditions that manifest as movement problems such as tremors, slowness of movement and rigidity. It is particularly identified by the presence of bradykinesia, both a slowness of and decrease in movement resulting in fatigue. Parkinsonisms result in part because of a loss of dopamine in the brain.1 A complex disease process, it can be difficult to differentiate because of idiopathic, unknown, origins. Often there is not enough information about the hallmark symptoms to accurately diagnose a specific disorder.1
Often confused as one and the same, Parkinson’s disease (PD) is actually the most common kind of Parkinsonism, accounting for nearly 80% of all cases.2 PD is a progressive neurodegenerative disorder characterized by the same motor conditions as Parkinsonisms including tremor, rigidity, bradykinesia, and impaired balance. Other contributing causes of Parkinsonism include multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration. PD has no directly attributable cause or cure.
Parkinsonisms look like Parkinson’s disease. Sometimes called atypical Parkinsonism or Parkinson-plus syndromes, it is hard to definitively distinguish between them. A neurologist would need to conduct a thorough medical history and may request several kinds of physical tests to identify and rule out the specific conditions. Definitive diagnoses for both Parkinsonisms and Parkinson’s disease can only be done via an autopsy.1
Drug-induced Parkinsonism is the most common secondary cause, followed by vascular Parkinsonism (arteriosclerotic pseudoparkinsonism) which generally affects the lower body and involves gait disturbance and cognitive impairment.2
Atypical Parkinsonisms are generally more difficult to treat than PD. Syndromes include:4,5
Drug-Induced Parkinsonism (DIP)
Sometimes called secondary Parksinsonism, DIP can be caused by drugs, especially those affecting dopamine levels including antipsychotics or anti-depressive and antiemetic medications. Once the contributory medications have been stopped, Parkinsonism symptoms should gradually disappear over time.
Progressive Supranuclear Palsy (PSP)
PSP generally progresses more rapidly than PD. Falling is a hallmark of PSP and as the condition progresses people may experience limitations in eye movements, swallowing (dysphagia), speech (dysarthria), sleep, memory and other cognitive functions including dementia.
Multiple System Atrophy (MSA)
MSA typically develops in people in their 50s. It is characterized by slowness, stiffness, imbalance and the deterioration of one or more body systems. There is no specific treatment for MSA and people tend to respond poorly to PD medications. Treatment is focused on alleviating symptoms. Sometimes increased doses of medication are prescribed, often however with limited benefits.
Corticobasal Syndrome (CBS)
The least common form of Parkinsonism, it also develops after age 60 and progresses more rapidly than PD. Symptoms generally start in one extremity and can progress to include dystonia, myoclonus and apraxia. Some people have found Botox® to be an effective treatment for dystonia. Others find antidepressants, as well as speech and physical therapy to be useful. Dopamine medications tend not to be effective.
A progressive, neurodegenerative disorder, LBD is close behind Alzheimer’s as a cause for degenerative dementia. Like Parkinson’s, it is associated with clumping deposits of alpha-synuclein proteins in the substantia nigra area of the brain. Along with cognitive change, LBD can cause slowness, stiffness and other symptoms similar to PD. People with LBD often experience memory issues, cognitive problems, and visual hallucinations.
Vascular Parkinsonism (VP)
Small strokes in specific areas of the brain may contribute to the development of Parkinsonisms. There are no distinct clinical features or diagnostic tests which can differentiate PD and vascular Parkinsonism. VP may be more likely if symptoms occur after having had a stroke. The presence of vascular disease in the brain combined with other hallmark Parkinsonisms like early cognitive change, lower body, gait, and balance problems are other indicators. Treatment with medications has shown some improvement.
PD is generally thought of as a condition characterized by a loss of motor control including resting tremors, stiffness, balance issues and slowness of movements.1,2 There is also a wide range of non-motor symptoms including mood disorders like depression, a change in basic body functions like digestion and sleep patterns, as well as cognitive change.1Motor symptoms most frequently appear in people in their 60s, although young onset Parkinson’s can develop in people in their 30s or 40s.
Underlying pathological changes in Parkinson’s may appear up to 30 years before the appearance or recognition of clinical signs of disease. Factors contributing to Parkinson’s include a hereditary predisposition, environmental toxins, and aging.2
The most effective approach to Parkinson’s is to treat the symptoms that most affect a person’s quality of life. Levodopa is the most efficacious drug available for treating Parkinson’s symptoms. It has resulted in significant improvement since its debut on the market in the 1960s.2 Dopaminergic medications are less effective in treating Parkinsonisms. Common treatments for both Parkinson’s and Parkinsonisms include physical, occupational, and speech therapy, antidepressants, and botulinum toxin (Botox) for dystonia.
Parkinson’s and Parkinsonisms can be confusing to differentiate. Physicians may need to revise diagnoses over time as additional clarity of symptoms emerges. Parkinsonisms typically don’t include a tremor and affect both sides of the body, whereas PD generally affects one side more than the other.4 Disease progression, response to medications, and other factors can help distinguish PD from Parkinsonisms.1 Parkinsonisms typically do not respond as well to pharmacological dopaminergic treatments as PD and generally have a worse prognosis compared to typical Parkinson’s disease.
Questions to ask your doctor
Upon a new diagnosis, how are you sure I have PD and not another Parkinsonism?
What symptoms should I be aware of?
What treatments are available
Are there other specialists I should see?
How can you be sure which condition I have? What should I know about its progression and treatment(s)?
Parkinson’s Disease vs. Parkinsonism. Available at: https://parkinson.org/pd-library/fact-sheets/parkinsonism-vs-parkinsons-disease. Accessed 1.18.19
Merello, M., Burn, D. Parkinson's Disease & Parkinsonism. Available at: https://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Parkinsons-Disease--Parkinsonism.htm. Accessed 1.18.19.
Postuma, R., Berg, D., Stern, M. et al.. MDS clinical diagnostic criteria for Parkinson's disease. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/mds.26424. Accessed 1.18.19.
Understanding the differences between Parkinsonism and Parkinson Plus Syndromes. Available at: https://www.apdaparkinson.org/article/atypical-parkinsonism-parkinson-plus-syndromes/. Accessed 1.18.19.
Types of Parkinsonisms. Available at: https://www.parkinson.org/Understanding-Parkinsons/What-is-Parkinsons/Types-of Parkinsonisms?gclid=EAIaIQobChMIsr_2pMH63wIVQrbACh3w7wS_EAAYASABEgLQ2_D_BwE. Accessed 1.17.19