Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton  

Introduction[edit | edit source]

Man-walker dementia.jpg

Parkinsonism is a constellation of signs and symptoms that are characteristically observed in Parkinson’s disease (PD), but that are not necessarily due to PD[1]. Parkinsonism is the primary type of hypokinetic movement disorder, manifesting as rigidity, tremors, and bradykinesia.

Parkinsonism can be categorized into four different types. These are:

  1. Primary parkinsonism (idiopathic Parkinson's disease see link)
  2. Parkinsons Plus Syndrome
  3. Secondary parkinsonism
  4. Familial neurodegenerative conditions causing parkinsonism[2]

Early in the disease process, it is often hard to know whether a person has idiopathic Parkinson’s disease or a syndrome that mimics it. These syndromes tend to progress more rapidly than Parkinson’s, present with additional symptoms such as early falling, dementia or hallucinations, and do not respond or respond only for a short time to levodopa therapy[3].[4][5]

Below are descriptions of some of the most common Parkinsonism disorders. Remember many people will not exhibit the cardinal symptoms necessary for a diagnosis of a specific disorder and will simply be labeled “parkinsonism”. For these people a definite diagnosis will only come if the family requests a brain autopsy at time of death[3].

Parkinsonism Symptoms

Parkinson Plus Syndrome[edit | edit source]

Basal ganglia

Parkinson-plus syndromes are a loose group of neurodegenerative disorders that are characterised by features of Parkinson disease but with other neurological symptoms/signs (atypical parkinsonian disorders are also known as Parkinson-plus syndromes). They have a poor response to levodopa. Conditions include:

Approximately 25% of patients diagnosed with Parkinson disease end up being diagnosed with a Parkinson-plus syndrome instead . Early recognition of features of Parkinson-plus on imaging may help determine an earlier diagnosis and more appropriate treatment[6].

Secondary Parkinsonism[edit | edit source]

Secondary causes of parkinsonism typically do not respond to levodopa therapy. They include:

  1. Vascular Parkinsonism (VP): usually occurs due to an underlying vascular disorder (most commonly hypertension) that leads to lacuna infarcts, white matter ischemia, and also large vessel infarcts. Diffuse white matter ischemic lesions present bilaterally can lead to the destruction of thalamocortical functioning reducing the impulses sent to the higher centers via the basal ganglia, resulting in disruption of motor movements[4].
  2. Drug-induced Parkinsonism: medications that block the dopamine receptors and interrupt the transmission of dopamine are known to cause secondary parkinsonism.
  3. Toxin-induced Parkinsonism: prolonged exposure to heavy metals and industrial toxins can result in parkinsonian features. Toxins result in vast neurological damage resulting in parkinsonism as compared to that seen in PD.
  4. Chronic Traumatic Encephalopathy: repeated head injury can often present with parkinsonian features.

Familial Neurodegenerative Parkinsonism[edit | edit source]

Familial Parkinson disease was once considered to be exquisitely rare however now researchers are reevaluating its true incidence. A growing number of genes responsible for familial Parkinson disease have been discovered since 1997. To date, at least eight genes have been linked with familial disease.[7]

References[edit | edit source]

  1. Singer HS, Mink J, Gilbert DL, Jankovic J. Movement disorders in childhood. Academic Press; 2015 Oct 27. Available: (accessed 17.3.2022)
  2. PD program Different types of Parkinsonism Available: (accessed 16.3.2022)
  3. 3.0 3.1 Parkinson org PD vs parkinsonism Available: (accessed 17.3.2022)
  4. 4.0 4.1 Shrimanker I, Tadi P, Sánchez-Manso JC Sept 2021. Parkinsonism.Available: 17.3.2022)
  5. Williams DR, Litvan I. Parkinsonian syndromes. Continuum: lifelong learning in neurology. 2013 Oct;19(5 Movement Disorders):1189.Available: (accessed 17.3.2022)
  6. Radiopedia Parkinson Plus Available: 16.3.2022)
  7. Ma MJ. Biopsy pathology of neurodegenerative disorders in adults. InPractical Surgical Neuropathology: A Diagnostic Approach 2018 Jan 1 (pp. 659-680). Elsevier. Available: 16.3.2022)