Parkinsonism: Causes, diagnosis, coping strategies

Over-view of Parkinsonism

Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia, rigidity, and postural instability. It is found in Parkinson’s disease (PD), after which it is named, dementia with Lewy bodies (DLB), Parkinson’s disease dementia (PDD), and many other conditions. A wide range of causes may lead to this set of symptoms, including neuro-degenerative conditions, drugs, toxins, metabolic diseases, and neurological conditions other than PD.

Parkinsonism is any condition that causes a combination of the movement abnormalities seen in Parkinson’s disease — such as tremor, slow movement, impaired speech or muscle stiffness — especially resulting from the loss of dopamine-containing nerve cells (neurons).

Symptoms of parkinsonism

A person with Parkinsonism usually starts developing symptoms at anywhere from age 50 to 80, according to the University of Texas Southwestern Medical Center.

Parkinson’s disease can cause varying and progressive symptoms throughout its course. Some of the most common symptoms associated with the disease include:

  • difficulty showing facial expressions
  • muscle stiffness
  • slowed, affected movements
  • speech changes
  • tremor, especially of one hand

A person with Parkinsonism may have some, but not all, of the symptoms listed above. This is because they also have an additional disorder that affects the brain’s functioning.
For example, people with Parkinsonism often do not have the hand tremor that affects many people with Parkinson’s disease.

Other symptoms associated with Parkinsonism include:

  • dementia
  • issues with the autonomic nervous system, such as problems with controlled movements or spasms
  • early problems with balance
  • rapid onset and progression of symptoms
Each underlying cause of Parkinsonism, such as dementia with Lewy bodies, also has its own unique set of symptoms.

Causes of parkinsonism

Drug-induced: About 7% of people with parkinsonism developed symptoms as a result of side effects of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol and zuclopenthixol) and butyrophenones (such as haloperidol), and rarely, antidepressants. The incidence of drug-induced parkinsonism increases with age. Drug-induced tends to remain at its presenting level, not progress like Parkinson’s disease.

Other causes associated with Parkinsonism include:

  • Corticobasal degeneration: This condition causes dementia as well as affected movements, usually on one side. A person may also be unable to make controlled muscle movements.
  • Dementia with Lewy bodies: This condition causes changes in overall alertness as well as visual hallucinations. This condition is the second most common cause of dementia after Alzheimer’s disease, according to Johns Hopkins Medicine.
  • Multiple system atrophy: This condition affects coordination and autonomic dysfunction, including bowel and bladder incontinence.
  • Progressive supranuclear palsy: This condition causes dementia, frequent backward falls, and problems moving the eyes up and down in addition to Parkinson’s disease symptoms.

The conditions above are the four most common causes of Parkinsonism, according to University of Texas Southwestern Medical Center. The number of people with these conditions is about one-fourth of the amount of people who have Parkinson’s disease itself.

Another, less common condition called vascular Parkinsonism also exists. This condition causes multiple, small strokes that can affect a person’s balance, walking, and memory.

Parkinsonism is also sometimes the result of taking certain medications. Doctors call this condition drug-induced Parkinsonism. Examples of drugs that could cause it include:

  • aripiprazole (Abilify)
  • haloperidol (Haldol)
  • metoclopramide (Reglan).

Ideally, if a person has drug-induced Parkinsonism, they can slowly reduce the dosages of these medicines. However, that may not always be possible, and a person should not stop taking a medication without their doctor’s approval.

summary of parkinsonism conditions: Parkinsonism occurs in many conditions.

Neurodegenerative conditions and Parkinson plus syndrome
  • Corticobasal degeneration
  • Dementia with Lewy bodies
  • Frontotemporal dementia (Pick’s disease)
  • Gerstmann–Sträussler–Scheinker syndrome
  • Huntington’s disease
  • Lytico-bodig disease (ALS complex of Guam)
  • Multiple system atrophy (Shy–Drager syndrome)
  • Neuroacanthocytosis
  • Neuronal ceroid lipofuscinosis
  • Olivopontocerebellar atrophy
  • Pantothenate kinase-associated neurodegeneration, also known as neurodegeneration with brain iron accumulation
  • Parkin mutation (hereditary juvenile dystonia)
  • Parkinson’s disease
  • Parkinson’s disease dementia
  • Progressive supranuclear palsy
  • Wilson’s disease
  • X-linked dystonia parkinsonism (Lubag syndrome)
Drug-induced (“pseudoparkinsonism”)
  • Antipsychotics
  • Lithium
  • Metoclopramide
  • MDMA addiction and frequent use
  • Tetrabenazine

How do doctors diagnosed it?

No single test exists for doctors to diagnose Parkinsonism. A doctor will start by taking a person’s health history and review their current symptoms. They will ask for a medication list to determine if any medicines could be causing the symptoms.

A doctor will likely also order blood testing to check for underlying potential causes, such as thyroid or liver problems. A doctor will also order imaging scans to examine the brain and body for other causes, such as a brain tumor.

Doctors can perform a test that tracks the movement of dopamine in the brain. This is known as the DaT-SPECT test.

The test uses radioactive markers designed to track dopamine in the brain. This allows a doctor to watch the release of dopamine in a person’s brain and identify the areas of the brain that do or do not receive it.

Because Parkinsonism does not respond to typical treatments and can have a variety of symptoms, doctors can have difficulty coming to a quick diagnosis. It may take time for doctors to rule out other conditions and begin to make treatment recommendations.

Secondary parkinsonism

Secondary parkinsonism is when symptoms similar to Parkinson disease are caused by certain medicines, a different nervous system disorder, or another illness.

Parkinsonism refers to any condition that involves the types of movement problems seen in Parkinson disease. These problems include tremors, slow movement, and stiffness of the arms and legs.


Secondary parkinsonism may be caused by health problems, including:

Other causes of secondary parkinsonism include:

  • Brain damage caused by anesthesia drugs (such as during surgery)
  • Carbon monoxide poisoning
  • Certain medicines used to treat mental disorders or nausea
  • Mercury poisoning and other chemical poisonings
  • Overdoses of narcotics
  • MPTP (a contaminant in some street drugs)

There have been rare cases of secondary parkinsonism among IV drug users who injected a substance called MPTP, which can be produced when making a form of heroin.


One of the most commonly prescribed medications to treat Parkinson’s disease is levodopa. This medication is related to dopamine and can increase the amount of dopamine available in the brain.

However, people with Parkinsonism not only have problems producing dopamine, but they also have damaged or destroyed cells that cannot respond to dopamine. As a result, levodopa may not work as well to reduce their symptoms.

Doctors can find Parkinsonism challenging to treat because the symptoms of the condition do not always respond as well or at all to medications that boost dopamine.

As a result, treatments for Parkinsonism depend upon the “plus” disease that a person has. For example, if a person has corticobasal degeneration and related muscle spasms, a doctor may prescribe antidepressants and botulinum toxin A (BOTOX) injections.

Treatments for Parkinsonism usually aim to help reduce a person’s symptoms whenever possible to help them maintain independence. Doctors often recommend physical and occupational therapy because they can help a person keep their muscles strong and improve balance.



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