Parkinsonism

What is parkinsonism?

Parkinsonism is an umbrella term that refers to brain conditions that cause slowed movements, rigidity (stiffness) and tremors. These conditions can happen for many reasons, including genetic mutations, reactions to medications and infections.

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

Parkinsonism refers to several conditions — including Parkinson’s disease — that have similar symptoms and features. However, Parkinson’s disease makes up about 80% of all cases of parkinsonism, making it the most common form by far. Other conditions that fall under the term parkinsonism include multiple system atrophy or corticobasal degeneration.

Another key difference is that parkinsonism can happen for reasons that are treatable or even curable. Some of the causes of parkinsonism can also go away on their own and only need treatment for some of their symptoms.

Who does it affect?

Parkinsonism overall is usually an age-related disease. It’s slightly more common in people assigned male at birth than in those assigned female at birth. The most common forms of parkinsonism are more likely to happen after age 60.

But some forms can happen at a much earlier age. The average age when juvenile parkinsonism starts is 17. That form of parkinsonism is also four times more common in assigned males than assigned females.

How common is parkinsonism?

The most common form of parkinsonism, Parkinson’s disease, ranks second among the most common age-related degenerative brain diseases (behind Alzheimer’s disease). It’s also the most common motor (movement-related) brain disease. Experts estimate that it affects at least 1% of people over age 60 worldwide.

How does this condition affect my body?

The effects of parkinsonism depend on why it happens. Most parkinsonian conditions affect parts of your brain responsible for movement. That means you move more slowly. You also may have muscle tremors, causing you to shake.

What are the symptoms of parkinsonism?

The key symptoms of parkinsonism are:

• Slowed movements (bradykinesia)*.
• Tremors.
• Stiffness or rigidity.

*This symptom always happens with parkinsonism.

Other possible symptoms include:

• Unstable posture or walking gait.
• Flexed, hunched or stooped posture.
• Freezing (being unable to move when trying to walk).

Condition-specific parkinsonian symptoms

Certain symptoms are more likely with a few conditions involving parkinsonism. Those conditions and the symptoms include:

• Parkinson’s disease: In addition to motor (movement-related) symptoms, this condition tends to involve several non-motor symptoms also. Many of these affect the unconscious processes of your body. Examples of this include constipation, loss of sense of smell and sleep problems.
• Vascular parkinsonism: This condition tends to cause early balance and walking problems. It can also cause trouble speaking (dysarthria) and swallowing (dysphagia). People with this also tend to have an unusual reflex when the bottom of their foot is touched a certain way (known as Babinski’s sign, this causes their toes to extend and fan out rather than curl).
• Drug-induced parkinsonism: People with this tend to have parkinsonism-type symptoms equally on both sides of their body. With Parkinson’s disease, the effects usually are worse on one side.
• Toxin-induced parkinsonism: People with this have more severe "cogwheel rigidity," which is a jerky pattern to their movements (similar to the second hand of a clock). Their muscles also are tense, causing slowed movements and trouble walking backward.
• Juvenile parkinsonism: Experts usually suspect this type of parkinsonism once they rule out other causes because it is rare for this condition to happen to those under age 45.

What causes the condition?

The causes of parkinsonism depend on the specific subtype of the condition.

Parkinson’s disease

Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells (neurons) communicate with each other. When you have Parkinson’s disease, you don’t have enough dopamine, one of the most important neurotransmitters.

When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements. The neurons that fine-tune your movements need dopamine. Without it, they can't do their job correctly. That’s why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson's disease.

With lack of dopamine, the basal ganglia (a key area of your brain) start to deteriorate. As they do, you lose the abilities they once controlled. As Parkinson's disease gets worse, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.

Genetic Parkinson’s disease

The only confirmed causes of Parkinson's disease are genetic mutations that you inherit from your parents. Genetic Parkinson's disease accounts for about 10% of all cases.

Idiopathic Parkinson’s disease

When Parkinson’s disease isn’t genetic, experts classify it as “idiopathic” (this term comes from Greek and means “a disease of its own”). That means they don’t know exactly why it happens.

Experts suspect Parkinson’s disease happens because of a problem with how your body uses a certain protein, α-synuclein (alpha sy-nu-clee-in). Proteins are chemical molecules that have a very specific shape. When some proteins don’t have the correct shape — a problem known as protein misfolding — your body can’t use them and can't break them down.

With nowhere to go, the proteins build up in various places or in certain cells, like the dopamine-using cells that control movement. Tangles of these proteins are visible when looking at these cells under a microscope.

Secondary parkinsonism

Secondary parkinsonism means this condition is happening because of another medical condition. Examples of secondary parkinsonism include:

• Vascular parkinsonism: This form of parkinsonism happens when you don’t have enough blood flow to certain areas of the brain. That causes damage to the affected parts of your brain, leading to parkinsonian symptoms.
• Post-traumatic parkinsonism: This kind of parkinsonism happens because of brain damage from repeated head injuries. It’s especially common in high-contact sports like boxing, football and hockey.
• Drug-induced parkinsonism: These kinds of parkinsonism can happen when a drug (either prescription or recreational) interferes with how your body creates or uses dopamine.
• Toxin-induced parkinsonism: This happens because toxic substances can destroy very specific types of brain cells. When those specific brain cells are dopamine-sensitive neurons in the basal ganglia, it can lead to parkinsonism symptoms.
• Normal-pressure hydrocephalus: Normal-pressure hydrocephalus (NPH) is when you have too much cerebrospinal fluid (CSF) inside your skull, which puts pressure on parts of your brain areas responsible for walking and controlling your bladder. It can happen because of injuries, bleeding in your brain, tumors, and many other reasons. The condition is named NPH because when you have this, a spinal tap (lumbar puncture) will show normal pressure levels even though imaging tests may show large pockets of spinal fluid in your brain.
• Postencephalitic parkinsonism: Encephalitis is an inflammation of your brain that can happen when you have an infection. It can happen after you have an infection that causes encephalitis. This kind of parkinsonism is less common in developed countries.

Atypical parkinsonism

These are unusual or rare conditions that cause parkinsonism. These include:

• Progressive supranuclear palsy.
• Corticobasal degeneration.
• Multiple system atrophy.

Other types of dementia or inherited conditions

Other kinds of degenerative brain diseases and genetic conditions can also cause parkinsonism. Some examples include:

• Alzheimer’s disease.
• Huntington’s disease.
• Wilson’s disease.

Is it contagious?

Parkinsonism isn't contagious. Some of the things that cause it are genetic, so you can inherit them from your parents or pass them to your children.

How is parkinsonism diagnosed?

Diagnosing parkinsonism relies heavily on a healthcare provider examining your symptoms, asking you questions and reviewing your medical history.

If providers can’t find a specific cause of parkinsonism, they’ll likely try to start treatment soon. If you don’t respond to treatment, providers will likely want to run lab tests. Not responding to Parkinson’s disease treatments may indicate that you have another form of parkinsonism.

What tests will be done to diagnose this condition?

When healthcare providers suspect a condition that falls under parkinsonism, various imaging and diagnostic tests are possible. These include:

• Blood tests (these can help look for other forms of parkinsonism).
• Computerized tomography (CT) scan.
• Genetic testing.
• Magnetic resonance imaging (MRI).
• Positron emission tomography (PET) scan.

New lab tests forthcoming

There are also new lab tests that, while still experimental or waiting for approval, might be able to help with diagnosing Parkinson's disease or other conditions like it. These tests look for misfolded or malfunctioning alpha-synuclein proteins in your cerebrospinal fluid or nerves. But more research and testing are necessary before these tests are widely available.

How is parkinsonism treated?

The treatments for parkinsonism depend on the condition itself and what caused it. Most forms of parkinsonism are treatable, and some can stop entirely (though this might not be a cure so much as it is the condition going into remission).

Some examples of treatable conditions include:

• Drug-induced parkinsonism. This is usually the easiest type of parkinsonism to treat. It happens when other medications interfere with how your body uses dopamine. Stopping the medication that caused your parkinsonism — often by switching to another medication — is often all it takes to stop this condition. However, it can sometimes take weeks or even months for the symptoms to disappear fully. In rare cases, it may be permanent.
• Normal pressure-hydrocephalus. Treating NPH involves relieving the pressure inside your skull. Placing a shunt can help, as the shunt acts as a pressure relief valve so excess CSF can drain out of your skull. This usually reduces or completely stops parkinsonism-type symptoms as long as the shunt works as it should.
• Parkinson’s disease. This condition isn't curable but is usually very treatable thanks to the medication levodopa and the medications often combined with it. However, the downside to levodopa is that it loses effectiveness over time and increasing the dose past a certain point increases the chance of having side effects. However, many medications help delay this problem when used instead of or combined with levodopa.
• Wilson’s disease. This inherited condition causes too much copper to build up in your body. Treatments that remove excess copper from your body can help prevent this condition from causing permanent damage.

In general, your healthcare provider is the best person to provide more information about whether or not your condition is treatable or curable. That's because so many different conditions fall under parkinsonism, many of which are very different from person to person. Your provider can tell you more about if your condition is treatable and what your treatment options are with your specific case and circumstances.

How to take care of myself or manage symptoms?

Parkinsonism refers to a wide range of conditions and diseases with similar effects and symptoms. Most of these diseases and conditions are severe and have a high risk of complications when there’s a delay in diagnosing and treating them.

Because many of these conditions are so severe and need diagnosing and treating sooner rather than later, you shouldn't try to self-diagnose or treat parkinsonism. If you think you have a form of parkinsonism, it's important to talk to a healthcare provider as soon as possible. They can help you by determining if you have one of these conditions, or they can refer you to a specialist for diagnosis and treatment.

How soon after treatment will I feel better?

The time it takes you to feel better and recover after treatment depends on multiple factors, including your condition and the treatments you receive. Your healthcare provider is the best person to tell you what to expect regarding your recovery time and when you should start to feel better.

How can I prevent this condition or reduce my risk of developing it?

Parkinsonism happens unpredictably in most cases, so it's usually impossible to prevent it or reduce your risk of developing it. However, there are specific types of secondary parkinsonism that you can reduce the risk of developing. These are:

• Toxin-induced parkinsonism. It’s possible to reduce your risk of developing this type of parkinsonism by avoiding toxins or substances that can cause it or by using safety equipment to reduce your exposure to these substances when you can’t avoid them.
• Post-traumatic parkinsonism. You can reduce your risk of developing this by using safety equipment to protect yourself from head injuries.
• Vascular parkinsonism. Reducing your risk of developing this involves taking care of your circulatory health, especially the circulation in your brain. Managing this involves maintaining a weight that's healthy for you, eating a balanced diet and staying physically active.

What can I expect if I have this condition?

All cases of parkinsonism — regardless of the specific condition — involved slowed movements plus other related symptoms. What you can expect depends on the specific condition you have and what treatments — if any — that you receive. Your healthcare provider is the best person to tell you more about what you can expect if you have parkinsonism.

How long does parkinsonism last?

How long parkinsonism lasts depends on the specific condition. Nearly all conditions that fall under parkinsonism are life-long conditions. One condition that isn't always a life-long problem is drug-induced parkinsonism.

Because parkinsonism includes so many different conditions, it's best to talk to your healthcare provider about how long your condition will last. They can best explain what you can expect, including the likely timeline for how this condition will affect you.

What’s the outlook for this condition?

The outlook for parkinsonism depends on your condition, how severe it is, and whether or not it's treatable. Many forms of parkinsonism aren't deadly on their own but can contribute to deadly complications. An example of this is trouble swallowing, a common symptom of Parkinson’s disease and other forms of parkinsonism, and how this increases your risk of developing pneumonia.

How do I take care of myself?

If you have parkinsonism, it's important to follow your healthcare provider's guidance on caring for yourself and managing this condition. They are the best source of information about how your specific condition will affect you and what you can do to help yourself.

In general, you should do the following:

• Take your medication as prescribed. Taking your medications — if your provider prescribes any — can make a huge difference in the symptoms of parkinsonism. You should also talk to your provider if you notice side effects or start to feel like your medications aren't as effective.
• See your provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help manage your conditions, find the right medications and dosages, and minimize any side effects.
• Don’t ignore or avoid symptoms. Parkinsonism can cause a wide range of symptoms, many of which are treatable by treating the condition or the symptoms themselves. It's also important to tell your provider about symptoms, even minor ones. Many parkinsonism conditions are easily mistaken for others, so telling your provider about all your symptoms can sometimes help avoid an incorrect diagnosis.

When should I see my healthcare provider?

You should see your healthcare provider as recommended or if you notice changes in your symptoms, especially if the symptoms start to interfere with your life and routine. You should also see your provider if you notice any changes in the effectiveness of your medication.

When should I go to ER?

Your healthcare provider can give you guidance and information on signs or symptoms that mean you need to go to the hospital or get medical attention. In general, you should get medical attention if you fall, especially when you lose consciousness or might have an injury to your head, neck, chest, back or abdomen.

A note from Cleveland Clinic

Parkinsonism is a term that covers a wide range of conditions that affect your ability to move and live independently. While these conditions all share certain similarities, they also can have major differences from each other. If you’re diagnosed with parkinsonism, it’s important to talk to your healthcare provider about what condition you have (or that they suspect), and what that diagnosis means for you. Not all parkinsonism conditions are the same, so understanding your specific case can make a big difference in managing it and how it affects your life.