Parkinsonism

Parkinsonism is a clinical syndrome characterized by the four motor symptoms found in Parkinson's disease: tremor, bradykinesia (slowed movements), rigidity, and postural instability.

Parkinsonism gait problems can lead to falls and serious physical injuries. Other common symptoms include:

• Tremors, as rest tremor (when resting, mostly in the hands) and/or postular tremor
• Short, shuffling gait
• Slow movements (bradykinesia)
• Loss of sound perception leading to soft speech, hypophonia{{cite journal |last1=Kwan |first1=Lorinda C. |last2=Whitehill |first2=Tara L. |date=2011 |title=Perception of Speech by Individuals with Parkinson's Disease: A Review |journal=Parkinson's Disease |volume=2011 |pages=389767 |doi=10.4061/2011/389767 |issn=2090-8083 |pmc=3179876 |pmid=21961077 |doi-access=free }}
• Difficulty sleeping
• Dry skin
• Apathy
• Lack of facial expressions
• Balance problems
• Frequent falls
• Very small handwriting
• Rigid, stiff muscles
• Cogwheeling (jerky feeling in arm or leg)
• Upgaze impairment
• Plastic, dead feeling resistance known as "lead-pipe rigidity".{{cite book |last1=Barrett |first1=Kim E. |last2=Barman |first2=Susan M. |last3=Brooks |first3=Heddwen L. |last4=Yuan |first4=Jason |title=Ganong's Review of Medical Physiology |date=21 January 2019 |publisher=McGraw Hill |isbn=978-1-260-12241-1 |edition=26 |url=https://books.google.com/books?id=JuN8DwAAQBAJ |access-date=1 April 2024}}

Parkinsonism occurs in many conditions.

Neurodegenerative conditions and Parkinson-plus syndromes that can cause parkinsonism include:{{cite book|title= Neurology in Clinical Practice: Principles of diagnosis and management |volume= 1 |editor= Bradley, Walter George |publisher= Taylor & Francis |year= 2004 |chapter= Diagnosis and Assessment |vauthors= Jankovic J, Lang AE |pages= [https://books.google.com/books?id=vOQqyNhTDl0C&q=parkinsonism&pg=PA294 295–96] | isbn= 978-99976-25-88-5}}

• Corticobasal degeneration
• Dementia with Lewy bodies
• The relationship (if any) with essential tremor is not clear.{{cite journal | vauthors = Algarni M, Fasano A | title = The overlap between Essential tremor and Parkinson disease | journal = Parkinsonism & Related Disorders | volume = 46 | pages = S101–S104 | date = January 2018 | issue = Suppl 1 | pmid = 28729090 | doi = 10.1016/j.parkreldis.2017.07.006 | url = https://www.prd-journal.com/article/S1353-8020(17)30239-0/abstract?code=prd-site }}
• Frontotemporal dementia (Pick's disease){{cite journal | vauthors = Finger EC | title = Frontotemporal Dementias | journal = Continuum | volume = 22 | issue = 2 Dementia | pages = 464–89 | date = April 2016 | pmid = 27042904 | pmc = 5390934 | doi = 10.1212/CON.0000000000000300 | type = Review }}
• 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 causing hereditary juvenile dystonia
• Parkinson's disease
• Parkinson's disease dementia{{cite journal | vauthors = McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor JP, Weintraub D, Aarsland D, Galvin J, Attems J, Ballard CG, Bayston A, Beach TG, Blanc F, Bohnen N, Bonanni L, Bras J, Brundin P, Burn D, Chen-Plotkin A, Duda JE, El-Agnaf O, Feldman H, Ferman TJ, Ffytche D, Fujishiro H, Galasko D, Goldman JG, Gomperts SN, Graff-Radford NR, Honig LS, Iranzo A, Kantarci K, Kaufer D, Kukull W, Lee VM, Leverenz JB, Lewis S, Lippa C, Lunde A, Masellis M, Masliah E, McLean P, Mollenhauer B, Montine TJ, Moreno E, Mori E, Murray M, O'Brien JT, Orimo S, Postuma RB, Ramaswamy S, Ross OA, Salmon DP, Singleton A, Taylor A, Thomas A, Tiraboschi P, Toledo JB, Trojanowski JQ, Tsuang D, Walker Z, Yamada M, Kosaka K | title = Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium | journal = Neurology | volume = 89 | issue = 1 | pages = 88–100 | date = July 2017 | pmid = 28592453 | pmc = 5496518 | doi = 10.1212/WNL.0000000000004058 | type = Review }}
• Progressive supranuclear palsy
• Wilson's disease
• X-linked dystonia parkinsonism (Lubag syndrome)

• Creutzfeldt–Jakob disease{{cite journal | vauthors = Maltête D, Guyant-Maréchal L, Mihout B, Hannequin D | title = Movement disorders and Creutzfeldt-Jakob disease: a review | journal = Parkinsonism & Related Disorders | volume = 12 | issue = 2 | pages = 65–71 | date = March 2006 | pmid = 16364674 | doi = 10.1016/j.parkreldis.2005.10.004 }}
• Encephalitis lethargica
• HIV infection and AIDS{{cite journal | vauthors = Tse W, Cersosimo MG, Gracies JM, Morgello S, Olanow CW, Koller W | title = Movement disorders and AIDS: a review | journal = Parkinsonism & Related Disorders | volume = 10 | issue = 6 | pages = 323–34 | date = August 2004 | pmid = 15261874 | doi = 10.1016/j.parkreldis.2004.03.001 }}
• Japanese encephalitis{{cite book |first=Johnie A.|last=Yates|editor1-last=Jong |editor1-first=Elaine C. |editor2-last=Stevens |editor2-first=Dennis L. |title=Netter's Infectious Diseases |date=2022 |publisher=Elsevier |location=Philadelphia |isbn=978-0-323-71159-3 |page=419|edition=2nd |chapter-url=https://books.google.com/books?id=l8skEAAAQBAJ&pg=PA419|language=en |chapter=70. Arboviruses of medical importance}}

Evidence exists to show a link between exposure to pesticides and herbicides and PD; a two-fold increase in risk was seen with paraquat or maneb/mancozeb exposure.{{cite journal | vauthors = Pezzoli G, Cereda E | title = Exposure to pesticides or solvents and risk of Parkinson disease | journal = Neurology | volume = 80 | issue = 22 | pages = 2035–41 | date = May 2013 | pmid = 23713084 | doi = 10.1212/WNL.0b013e318294b3c8 | s2cid = 13628268 | type = Meta-analysis }}

Chronic manganese (Mn) exposure has been shown to produce a parkinsonism-like illness characterized by movement abnormalities.{{cite journal | vauthors = Guilarte TR, Gonzales KK | title = Manganese-Induced Parkinsonism Is Not Idiopathic Parkinson's Disease: Environmental and Genetic Evidence | journal = Toxicological Sciences | volume = 146 | issue = 2 | pages = 204–12 | date = August 2015 | pmid = 26220508 | pmc = 4607750 | doi = 10.1093/toxsci/kfv099 | type = Review }} This condition is not responsive to typical therapies used in the treatment of PD, suggesting an alternative pathway than the typical dopaminergic loss within the substantia nigra. Manganese may accumulate in the basal ganglia, leading to the abnormal movements that characterize parkinsonism.{{cite journal | vauthors = Kwakye GF, Paoliello MM, Mukhopadhyay S, Bowman AB, Aschner M | title = Manganese-Induced Parkinsonism and Parkinson's Disease: Shared and Distinguishable Features | journal = International Journal of Environmental Research and Public Health | volume = 12 | issue = 7 | pages = 7519–40 | date = July 2015 | pmid = 26154659 | pmc = 4515672 | doi = 10.3390/ijerph120707519 | type = Review | doi-access = free }} A mutation of the SLC30A10 gene, a manganese efflux transporter necessary for decreasing intracellular Mn, has been linked with the development of this parkinsonism-like disease.{{cite journal | vauthors = Peres TV, Schettinger MR, Chen P, Carvalho F, Avila DS, Bowman AB, Aschner M | title = Manganese-induced neurotoxicity: a review of its behavioral consequences and neuroprotective strategies | journal = BMC Pharmacology & Toxicology | volume = 17 | issue = 1 | pages = 57 | date = November 2016 | pmid = 27814772 | pmc = 5097420 | doi = 10.1186/s40360-016-0099-0 | type = Review | doi-access = free }} The Lewy bodies typical to PD are not seen in Mn-induced parkinsonism.

Agent Orange may be a cause of parkinsonism, although evidence is inconclusive and further research is needed.{{cite journal |vauthors=McKnight S, Hack N |title=Toxin-Induced Parkinsonism |journal=Neurol Clin |volume=38 |issue=4 |pages=853–865 |date=November 2020 |pmid=33040865 |doi=10.1016/j.ncl.2020.08.003 |s2cid=222299758 |type= Review|doi-access=free }}

Other toxins that have been associated with parkinsonism are:

• Annonaceae{{cite journal | vauthors = Carod-Artal FJ | title = [Neurological syndromes linked with the intake of plants and fungi containing a toxic component (I). Neurotoxic syndromes caused by the ingestion of plants, seeds and fruits] | language = es | journal = Revista de Neurología | volume = 36 | issue = 9 | pages = 860–71 | date = 2003 | pmid = 12717675 | type = Review }}
• Carbon monoxide
• Carbon disulfide
• Cyanide
• Ethanol
• Hexane{{cite journal | vauthors = Kim EA, Kang SK | title = Occupational neurological disorders in Korea | journal = Journal of Korean Medical Science | volume = 25 | issue = Suppl | pages = S26-35 | date = December 2010 | pmid = 21258587 | pmc = 3023358 | doi = 10.3346/jkms.2010.25.S.S26 | type = Review }}
• Mercury
• Methanol
• MPTP{{cite journal | vauthors = Watanabe Y, Himeda T, Araki T | title = Mechanisms of MPTP toxicity and their implications for therapy of Parkinson's disease | journal = Medical Science Monitor | volume = 11 | issue = 1 | pages = RA17-23 | date = January 2005 | pmid = 15614202 | url = http://www.medscimonit.com/pub/vol_11/no_1/5333.pdf }}
• Rotenone{{cite journal | vauthors = Nandipati S, Litvan I | title = Environmental Exposures and Parkinson's Disease | journal = International Journal of Environmental Research and Public Health | volume = 13 | issue = 9 | pages = 881 | date = September 2016 | pmid = 27598189 | pmc = 5036714 | doi = 10.3390/ijerph13090881 | type = Review | doi-access = free }}
• TolueneWeiss J. Chapter 151. Toluene and Xylene. In: Olson KR, ed. Poisoning & Drug Overdose. 6th ed. New York: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aID=55982958. Accessed April 21, 2013. (inhalant abuse: "huffing"){{cite journal | vauthors = Uitti RJ, Snow BJ, Shinotoh H, Vingerhoets FJ, Hayward M, Hashimoto S, Richmond J, Markey SP, Markey CJ, Calne DB | title = Parkinsonism induced by solvent abuse | journal = Annals of Neurology | volume = 35 | issue = 5 | pages = 616–9 | date = May 1994 | pmid = 8179306 | doi = 10.1002/ana.410350516 | s2cid = 23657208 }}

• Binswanger's disease (subcortical leukoencephalopathy)
• Vascular dementia (multi-infarct)
• Dural arteriovenous fistula / dAVF (reversible parkinsonism through fistula treatment){{cite journal |last1=Lai |first1=Joshua |last2=Heran |first2=Manraj K.S. |last3=Stoessl |first3=A. Jon |last4=Gooderham |first4=Peter A. |date=2017-03-27 |title=Reversible Parkinsonism and Rapidly Progressive Dementia Due to Dural Arteriovenous Fistula: Case Series and Literature Review |journal=Movement Disorders Clinical Practice |volume=4 |issue=4 |pages=607–611 |doi=10.1002/mdc3.12480 |issn=2330-1619 |pmc=6174482 |pmid=30363443}}{{cite journal |last1=Matsuda |first1=S. |last2=Waragai |first2=M. |last3=Shinotoh |first3=H. |last4=Takahashi |first4=N. |last5=Takagi |first5=K. |last6=Hattori |first6=T. |date=1999-05-01 |title=Intracranial dural arteriovenous fistula (DAVF) presenting progressive dementia and parkinsonism |url=https://pubmed.ncbi.nlm.nih.gov/10426146/ |journal=Journal of the Neurological Sciences |volume=165 |issue=1 |pages=43–47 |doi=10.1016/s0022-510x(99)00075-1 |issn=0022-510X |pmid=10426146|s2cid=31594108 }}{{cite journal |last1=Kim |first1=Hang Rai |last2=Lee |first2=Jee-Young |last3=Kim |first3=Yu Kyeong |last4=Park |first4=Hyeyoung |last5=Kim |first5=Han-Joon |last6=Son |first6=Young-Je |last7=Jeon |first7=Beom Seok |date=September 2015 |title=Dural Arteriovenous Fistula-Associated Reversible Parkinsonism with Presynaptic Dopaminergic Loss |journal=Journal of Movement Disorders |volume=8 |issue=3 |pages=141–143 |doi=10.14802/jmd.15021 |issn=2005-940X |pmc=4572665 |pmid=26413242}}
• Dural arteriovenous malformation / dAVM (reversible through dAVM treatment) {{cite journal |last1=Goldstein |first1=S. |last2=Friedman |first2=J. H. |last3=Innis |first3=R. |last4=Seibyl |first4=J. |last5=Marek |first5=K. |date=March 2001 |title=Hemi-parkinsonism due to a midbrain arteriovenous malformation: dopamine transporter imaging |url=https://pubmed.ncbi.nlm.nih.gov/11295793/ |journal=Movement Disorders|volume=16 |issue=2 |pages=350–353 |doi=10.1002/mds.1047 |issn=0885-3185 |pmid=11295793|s2cid=22701874 }}{{cite journal |last1=Armenteros |first1=Patricia Rodrigo |last2=Kapetanovic |first2=Solange |last3=Lopez |first3=Sonia Gonzalez |last4=Vazquez-Lorenzo |first4=Enrique |last5=Mendez |first5=Lander Anton |last6=Muga |first6=Juan Jose Gomez |last7=Deza |first7=Edison Santos Morales |last8=Iriarte |first8=Markel Erburu |last9=Garcia-Monco |first9=Juan Carlos |date=2022-03-29 |title=Pearls & Oy-sters: Arteriovenous Malformation With Sinus Thrombosis and Thalamic Hemorrhage: Unusual Cause of Parkinsonism and Dementia |url=https://n.neurology.org/content/98/13/550 |journal=Neurology |language=en |volume=98 |issue=13 |pages=550–553 |doi=10.1212/WNL.0000000000200016 |issn=0028-3878 |pmid=35121672|s2cid=246556634 |doi-access=free }}

• Chronic traumatic encephalopathy (boxer's dementia or pugilistic encephalopathy)
• Damage to the brain stem (especially dopaminergic nuclei of the substantia nigra),{{cite journal | vauthors = Jubault T, Brambati SM, Degroot C, Kullmann B, Strafella AP, Lafontaine AL, Chouinard S, Monchi O | title = Regional brain stem atrophy in idiopathic Parkinson's disease detected by anatomical MRI | journal = PLOS ONE | volume = 4 | issue = 12 | pages = e8247 | date = December 2009 | pmid = 20011063 | pmc = 2784293 | doi = 10.1371/journal.pone.0008247|editor1-link=Howard E. Gendelman | editor-first = Howard E. | editor-last = Gendelman | bibcode = 2009PLoSO...4.8247J | doi-access = free }} basal ganglia (especially globus pallidus){{cite journal | vauthors = Kuoppamäki M, Rothwell JC, Brown RG, Quinn N, Bhatia KP, Jahanshahi M | title = Parkinsonism following bilateral lesions of the globus pallidus: performance on a variety of motor tasks shows similarities with Parkinson's disease | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 76 | issue = 4 | pages = 482–90 | date = April 2005 | pmid = 15774432 | pmc = 1739601 | doi = 10.1136/jnnp.2003.020800 }} and the thalamus.{{cite journal|last=Halliday|first=Glenda M.|date=2009-12-15|title=Thalamic changes in Parkinson's disease|journal=Parkinsonism & Related Disorders|language=en|volume=15|pages=S152–S155|doi=10.1016/S1353-8020(09)70804-1|pmid=20082979}}
• Hypothyroidism
• Orthostatic tremor{{cite journal | vauthors = Apartis E, Tison F, Arné P, Jedynak CP, Vidailhet M | title = Fast orthostatic tremor in Parkinson's disease mimicking primary orthostatic tremor | journal = Movement Disorders | volume = 16 | issue = 6 | pages = 1133–6 | date = November 2001 | pmid = 11748748 | doi = 10.1002/mds.1218 | s2cid = 36301428 }}
• Paraneoplastic syndrome: neurological symptoms caused by antibodies associated with cancers{{cite journal | vauthors = Panzer J, Dalmau J | title = Movement disorders in paraneoplastic and autoimmune disease | journal = Current Opinion in Neurology | volume = 24 | issue = 4 | pages = 346–53 | date = August 2011 | pmid = 21577108 | pmc = 3705177 | doi = 10.1097/WCO.0b013e328347b307 }}
• Rapid onset dystonia parkinsonism{{cite journal | vauthors = Liu Y, Lu Y, Zhang X, Xie S, Wang T, Wu T, Wang C | title = A case of rapid-onset dystonia-parkinsonism accompanied by pyramidal tract impairment | journal = BMC Neurology | volume = 16 | issue = 1 | pages = 218 | date = November 2016 | pmid = 27835968 | pmc = 5105251 | doi = 10.1186/s12883-016-0743-8 | doi-access = free }}
• Autosomal recessive juvenile parkinsonism{{cite journal | vauthors = Saito M, Maruyama M, Ikeuchi K, Kondo H, Ishikawa A, Yuasa T, Tsuji S | title = Autosomal recessive juvenile parkinsonism | journal = Brain & Development | volume = 22 | pages = S115-7 | date = September 2000 | issue = Suppl 1 | doi = 10.1016/s0387-7604(00)00137-6 | pmid = 10984671 | s2cid = 22733500 }}

Secondary parkinsonism, including vascular parkinsonism and drug-induced parkinsonism.{{cite journal |vauthors=Del Toro-Pérez C, Guevara-Sánchez E, Martínez-Sánchez P |title=Treatment of Vascular Parkinsonism: A Systematic Review |journal=Brain Sci |volume=13 |issue=3 |date=March 2023 |page=489 |pmid=36979299 |pmc=10046744 |doi=10.3390/brainsci13030489 |url= |doi-access=free }}{{cite journal |vauthors=Shin HW, Hong SW, Youn YC |title=Clinical Aspects of the Differential Diagnosis of Parkinson's Disease and Parkinsonism |journal=J Clin Neurol |volume=18 |issue=3 |pages=259–270 |date=May 2022 |pmid=35589315 |pmc=9163948 |doi=10.3988/jcn.2022.18.3.259 |url=}}

About 7% of people with parkinsonism developed symptoms as a result of side effects of medication, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupentixol and zuclopenthixol) and butyrophenones (such as haloperidol), and rarely, antidepressants. Yet another drug that can induce parkinsonism is the antihistaminic medication cinnarizine, usually prescribed for motion sickness; this is because besides antagonizing histamine receptors this drug antagonizes the dopamine D2 receptors. The incidence of drug-induced parkinsonism increases with age. Drug-induced parkinsonism tends to remain at its presenting level and does not worsen like Parkinson's disease.{{cite web | url = http://www.parkinsons.org.uk/PDF/FS38_druginducedparkinsonism.pdf | title = Information Sheet: Drug-induced Parkinsonism | publisher = Parkinson's Disease and Society |access-date = 2013-04-15 | url-status = dead | archive-url = https://web.archive.org/web/20130626024034/http://www.parkinsons.org.uk/PDF/FS38_druginducedparkinsonism.pdf | archive-date = 2013-06-26 }}

Implicated medications include:

• Antipsychotics
• Lithium
• Metoclopramide{{cite journal | vauthors = Shuaib UA, Rajput AH, Robinson CA, Rajput A | title = Neuroleptic-induced Parkinsonism: Clinicopathological study | journal = Movement Disorders | volume = 31 | issue = 3 | pages = 360–5 | date = March 2016 | pmid = 26660063 | pmc = 5064745 | doi = 10.1002/mds.26467 }}
• MDMA (addiction and frequent use){{cite journal | vauthors = Louis ED, Ottman R | title = Is there a one-way street from essential tremor to Parkinson's disease? Possible biological ramifications | journal = European Journal of Neurology | volume = 20 | issue = 11 | pages = 1440–4 | date = November 2013 | pmid = 24033795 | pmc = 3801177 | doi = 10.1111/ene.12256 | type = Review }}{{cite journal |author=Fabrizi, Monaco, Dalla Libera |title=Parkinsonian syndrome following MDMA (Ecstasy) addiction |journal=Movement Disorders |volume=19 |pages=S73–S74 |year=2004}}
• Tetrabenazine
• Cinnarizine{{cite journal |first1=José F. |first2=Juan J. |url=https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.870130313 |journal=Movement Disorders |publisher=International Parkinson and Movement Disorder Society/Wiley |issn=1531-8257 |editor1-first=A. Jon |editor1-last=Stoessl |editor2-first=Christine |editor2-last=Klein |editor3-first=David G. |editor3-last=Standaert |publication-place=Vancouver, British Columbia, Canada |title=Cinnarizine-induced parkinsonism: ten years later |last1=Martí-Massó |last2=Poza |doi=10.1002/mds.870130313 |pmid=9613736 |date=1 May 1998 |volume=13 |issue=3 |pages=453–456

|s2cid=31516105 }}

In the United States, the 2021 National Defense Authorization Act (NDAA) added parkinsonism to the list of presumptive conditions associated with Agent Orange exposure, enabling affected service members to receive Veterans Affairs disability benefits.{{cite web |url= https://www.publichealth.va.gov/exposures/publications/agent-orange/agent-orange-2021/presumptions.asp |title= VA adds three new Agent Orange presumptions |publisher= U. S. Department of Veteran Affairs |date= September 10, 2021 |access-date= March 2, 2022}} 

{{Reflist|32em}}

• [https://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=perry GeneReviews/NIH/NCBI/UW entry on Perry syndrome]
• [https://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=gene&part=xdp GeneReviews/NCBI/NIH/UW entry on X-Linked Dystonia-Parkinsonism]

{{CNS diseases of the nervous system}}

{{Antiparkinson agents}}

{{Medical resources

| DiseasesDB = 24212

| ICD11 = {{ICD11|8A00}}

| ICD10 = {{ICD10|G20}}, {{ICD10|G21}}, {{ICD10|G22}}

| ICD9 = {{ICD9|332}}

| ICDO =

| OMIM =

| MedlinePlus = 000759

| eMedicineSubj =

| eMedicineTopic =

| MeshID = D020734

}}

{{Authority control}}

Category:Extrapyramidal and movement disorders

Category:Geriatrics

Category:Parkinson's disease