Definition

Many of us are familiar with Parkinson's disease, but the term Parkinsonism may be less well-known. Parkinsonism refers to a group of symptoms involving motor movement disorders. Typical symptoms of parkinsonism include rigidity or stiffness, tremors (shaking in the limbs), bradykinesia (slowness of movement), and unstable posture.

Parkinson's disease is the most common type of parkinsonism, accounting for 80 per cent of all parkinsonism cases. Other types of parkinsonism include atypical parkinsonian disorders or Parkinson-plus syndromes. Many types of Parkinsonism are very similar to the symptoms of Parkinson's disease, making diagnosis sometimes difficult.

Causes

The exact cause of most forms of Parkinsonism is not well understood. Both genetic and environmental factors play a role in the occurrence of parkinsonism. According to existing research, Parkinson's disease is linked to exposure to pesticides and herbicides. Several genes are also associated with an increased risk of Parkinson's disease. Conditions that cause brain damage, such as traumatic injuries, tumors, brain infections, certain medications, or toxin exposure, also contribute to the development of Parkinsonism.

The most common type of parkinsonism, Parkinson's disease, occurs due to damage to specific nerve cells (neurons) in the brain. Symptoms appear due to the loss of neurons that produce the hormone dopamine, which plays a role in transmitting signals throughout the body. When dopamine levels decrease, brain activity becomes abnormal, leading to movement disorders and other symptoms of Parkinson's disease.

The exact cause of decreased dopamine levels is not known. However, several factors may contribute, including:

• Genetic Factors: Researchers have identified certain genetic mutations that can cause Parkinson's disease. This is rare unless many family members are affected by Parkinson's disease. However, specific genetic variations have been shown to increase the risk of Parkinson's disease, although the risk is relatively small.
• Environmental Factors: Exposure to certain toxins or other environmental factors can increase the risk of developing Parkinson's disease later in life, but the risk is relatively small.

Risk factor

People with a family history of Parkinsonism have a higher risk compared to those without such a family history. Individuals whose jobs involve significant exposure to chemicals and patients with certain illnesses who use antipsychotic medications are more at risk of experiencing Parkinsonism symptoms.

A specific form of parkinsonism, Parkinson's disease, has several risk factors, including:

• Age: Young adults rarely experience Parkinson's disease. It usually begins in middle age or older, with risk increasing with age. Most people develop the disease around age 60 or older.
• Heredity: Having a family member with Parkinson's disease increases the likelihood of developing the disease, and the risk is higher if multiple family members are affected.
• Gender: Men are more likely to develop Parkinson's disease than women.
• Toxin Exposure: Long-term exposure to herbicides and pesticides can slightly increase the risk of Parkinson's disease.

Symptoms

Symptoms of Parkinsonism include:

• Slowness of movement
• Tremors or shaking in certain body parts
• Muscle stiffness
• Difficulty walking
• Disrupted or unstable posture

Diagnosis

Parkinson's disease is one of many types of parkinsonism caused by the loss of cells in the brain that produce the neurotransmitter dopamine. Parkinson's disease and various other types of Parkinsonism develop differently. Some types may progress faster than Parkinson's disease, while others, like secondary parkinsonism, can recover.

Each type of parkinsonism also responds differently to treatment. For instance, someone with a particular type of Parkinsonism may not respond to levodopa, a drug typically used for Parkinson's disease. Generally, distinguishing between types of Parkinsonism can be challenging.

There is no single test to diagnose Parkinsonism. Doctors use a combination of tests to rule out other conditions and diagnose based on the patient's symptoms and medical history.

Parkinsonism is sometimes difficult to diagnose due to its similarity to Parkinson's disease. Here are some methods for diagnosing Parkinsonism:

• Genetic Testing: Genetic tests can help identify genes associated with Parkinsonism in people with a family history of the condition.
• DaTscan: This type of imaging allows doctors to see dopamine levels in the brain. Low dopamine levels may indicate Parkinson's disease.
• Other Imaging: CT or MRI scans can show blood vessel damage causing vascular parkinsonism. MRI can also rule out brain tumors or hydrocephalus.
• Blood Tests: Blood tests can identify proteins indicating specific types of parkinsonism, such as corticobasal degeneration.

Management

Anti-parkinsonism medications vary in responsiveness and duration depending on the cause of parkinsonism. The most responsive cause to medications is Parkinson's disease. Anti-parkinsonism drugs include Levodopa-Carbidopa (effective for Parkinson's disease), dopamine agonists, COMT inhibitors, MAO inhibitors, amantadine, and anticholinergics.

For other causes of parkinsonism, treatments include:

• Hydrocephalus: Treated with surgery and shunt placement to reduce brain pressure from excess fluid, improving Parkinsonism symptoms.
• Vascular Parkinsonism: Levodopa can be administered, and antiplatelet medications can be added if MRI shows brain tissue death from blood flow disturbances.
• Drug-Induced Parkinsonism: Stopping the causative medication is the best approach. Consult with a doctor to adjust the type or dosage of medication. Antipsychotic drugs typically trigger parkinsonism, but atypical antipsychotics with lower risks can be prescribed. Anticholinergics like benztropine and trihexyphenidyl can treat the condition. If ineffective, amantadine at 100 mg twice or thrice daily can be used. Electroconvulsive therapy is an option when other treatments fail.
• Brain Tumors: Most patients achieve full remission after tumor removal surgery.

Complications

Severe parkinsonism can cause complications such as:

• Dementia
• Autonomic dysfunction like constipation, urinary incontinence, sexual dysfunction, or excessive sweating
• Mood disorders including depression
• Hallucinations and psychosis
• Sleep disorders like insomnia and restless leg syndrome
• High-dose levodopa treatment can cause dyskinesia, such as involuntary twitching or head shaking

Prevention

Parkinsonism, of any type, leads to weakness and daily activity disruptions. Preventive measures should be taken to reduce future deterioration, including:

• Installing safety features like handrails to prevent falls in patients with increased fall risk.
• Ensuring driving safety; patients with worsening symptoms should not drive.
• Patients and families can receive support through groups for individuals with similar conditions.
• Regular check-ups and therapy can prevent symptom deterioration.

When to see a doctor?

Consult a doctor if you or someone around you experiences symptoms of Parkinsonism as described above. Early diagnosis and treatment can slow the progression of symptoms and prevent complications.

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