Parkinsonism: Difference between revisions

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{{Infobox_Disease
{{Redirect-distinguish|Parkinson's syndrome|Parkinson's disease}}
| Name = {{PAGENAME}}
{{Infobox medical condition (new)
| Image =
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| name = Parkinsonism
| DiseasesDB = 24212
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| image = Person with Parkinson disease.jpg
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| MedlinePlus = 000759
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| onset =
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| causes = * [[Parkinson's disease]]
* [[Dementia with Lewy bodies]]
* [[Parkinson's disease dementia]]
* [[Neurodegenerative|Other neurodegenerative disorders]], including [[multiple system atrophy]], [[progressive supranuclear palsy]], and [[corticobasal degeneration]]
* [[Drugs]]
* [[Toxins]]
* [[Metabolic disease]]
* [[Dural arteriovenous fistula]]
* Dural [[arteriovenous malformation]]
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'''Parkinsonism''' (also known as '''Parkinson's syndrome''', '''atypical Parkinson's''', or '''secondary Parkinson's''') is a [[syndrome]] characterized by [[tremor]], [[hypokinesia]], [[spasticity|rigidity]], and [[balance disorder|postural instability]].<ref name=Aminoff_2005>{{cite book | author = Aminoff MJ, Greenberg DA, Simon RP | title = Clinical Neurology | publisher = Lange: McGraw-Hill Medical | edition = 6th ed. | year = 2005 | isbn = 0071423605 }}</ref> While [[Parkinson's disease]] (PD) — a [[neurodegenerative]] condition — is the most common cause of parkinsonism, a number of other etiologies can lead to similar symptoms.<ref name=Christine_2004>{{cite journal | author = Christine CW, Aminoff MJ | title = Clinical differentiation of parkinsonian syndromes: prognostic and therapeutic relevance | journal = Am. J. Med. | volume = 117 | issue = 6 | pages = 412-9 | year = 2004 | pmid = 15380498 | doi = 10.1016/j.amjmed.2004.03.032}}</ref>
'''Parkinsonism''' is a clinical [[syndrome]] characterized by [[tremor]], [[bradykinesia]] (slowed movements), [[Rigidity (neurology)|rigidity]], and [[balance disorder|postural instability]].<ref name="Aminoff_2005">{{cite book |vauthors=Aminoff MJ, Greenberg DA, Simon RP | title = Clinical Neurology | publisher = Lange: McGraw-Hill Medical | edition = 6th | pages = 241–45 |year = 2005 | isbn = 978-0-07-142360-1 |chapter= Chapter 7: Movement disorders}}</ref><ref name="Role of neuroimaging on differentia">{{cite journal |vauthors=Ogawa T, Fujii S, Kuya K, Kitao SI, Shinohara Y, Ishibashi M, Tanabe Y |title=Role of neuroimaging on differentiation of Parkinson's disease and its related diseases |journal=Yonago Acta Med |volume=61 |issue=3 |pages=145–55 |date=September 2018 |pmid=30275744 |pmc=6158357 |doi=10.33160/yam.2018.09.001|type= Review|quote= Parkinsonian syndromes are a group of movement disorders characterized by classical motor symptoms such as tremors, bradykinesia, and rigidity. They are most frequently due to primary neurodegenerative disease, resulting in the loss of dopaminergic nerve terminals along the nigrostriatal pathway, similar to idiopathic PD, MSA, PSP, CBD, and DLB.}}</ref> Both hypokinetic (bradykinesia and akinesia) as well as hyperkinetic (cogwheel rigidity and tremors at rest) features are displayed by Parkinsonism.<ref name=Ganog/>These are the four [[Parkinson's disease#Motor|motor symptoms]] found in [[Parkinson's disease]] (PD){{snd}}after which it is named{{snd}}[[dementia with Lewy bodies]] (DLB), [[Parkinson's disease dementia]] (PDD), and many other conditions. This set of symptoms occurs in a wide range of conditions and may have many causes, including [[neurodegenerative]] conditions, drugs, [[toxin]]s, [[metabolic disease]]s, and neurological conditions other than PD.<ref>{{cite journal | vauthors = Christine CW, Aminoff MJ | title = Clinical differentiation of parkinsonian syndromes: prognostic and therapeutic relevance | journal = The American Journal of Medicine | volume = 117 | issue = 6 | pages = 412–9 | date = September 2004 | pmid = 15380498 | doi = 10.1016/j.amjmed.2004.03.032 }}</ref>


== Signs and symptoms ==
The underlying causes of parkinsonism are numerous and diagnosis can be complex.<ref name=Tuite_2007>{{cite journal | author = Tuite PJ, Krawczewski K | title = Parkinsonism: a review-of-systems approach to diagnosis | journal = Seminars in neurology | volume = 27 | issue = 2 | pages = 113-22 | year = 2007 | pmid = 17390256 | doi = 10.1055/s-2007-971174}}</ref> If PD has been excluded, the [[differential diagnosis]] or list of potential causes for this disease includes:
Parkinsonism is a clinical [[syndrome]] characterized by the four [[Parkinson's disease#Motor|motor symptoms]] found in [[Parkinson's disease]]: [[tremor]], [[bradykinesia]] (slowed movements), [[Rigidity (neurology)|rigidity]], and [[balance disorder|postural instability]].<ref name="Aminoff_2005"/><ref name="Role of neuroimaging on differentia"/>
* [[AIDS]] can sometimes lead to the symptoms of Parkinson's disease, due to commonly causing dopaminergic dysfunction.<ref name=Tse_2004>{{cite journal | author = Tse W, Cersosimo MG, Gracies JM, Morgello S, Olanow CW, Koller W | title = Movement disorders and AIDS: a review | journal = Parkinsonism Relat. Disord. | volume = 10 | issue = 6 | pages = 323-34 | year = 2004 | pmid = 15261874 | doi = 10.1016/j.parkreldis.2004.03.001}}</ref>
* [[Corticobasal degeneration]]
* [[Creutzfeldt-Jakob disease]]<ref name=Maltête_2006>{{cite journal | author = Maltête D, Guyant-Maréchal L, Mihout B, Hannequin D | title = Movement disorders and Creutzfeldt-Jakob disease: a review | journal = Parkinsonism Relat. Disord. | volume = 12 | issue = 2 | pages = 65-71 | year = 2006 | pmid = 16364674 | doi = 10.1016/j.parkreldis.2005.10.004}}</ref>
* [[Diffuse Lewy body disease]]
* Drug-induced parkinsonism (due to drugs such as [[antipsychotics]], [[metoclopramide]], [[MPTP]]<ref name=Watanabe_2005>{{cite journal | author = Watanabe Y, Himeda T, Araki T | title = Mechanisms of MPTP toxicity and their implications for therapy of Parkinson's disease | journal = Med. Sci. Monit. | volume = 11 | issue = 1 | pages = RA17-23 | year = 2005 | pmid = 15614202 | doi = }}</ref>)<ref name=Aminoff_2005/>
* [[Encephalitis]] lethargica<ref name=Aminoff_2005/>
* [[Hallervorden-Spatz syndrome]]
* [[Multiple system atrophy]]
* [[Progressive supranuclear palsy]]
* Toxicity (due to substances such as [[Manganism|manganese]], [[toluene]], [[paraquat]], [[rotenone]], [[hexane]], [[carbon monoxide]], and [[carbon disulfide]]){{cn}}
* Vascular parkinsonism<ref name=Thanvi_2005>{{cite journal | author = Thanvi B, Lo N, Robinson T | title = Vascular parkinsonism--an important cause of parkinsonism in older people | journal = Age and ageing | volume = 34 | issue = 2 | pages = 114-9 | year = 2005 | pmid = 15713855 | doi = 10.1093/ageing/afi025}}</ref>
* [[Wilson's disease]]. Wilson's disease is a genetic disorder in which there is an abnormal accumulation of copper. The excess copper can lead to the formation of a copper-dopamine complex, which leads to the oxidation of dopamine to aminochrome.


Parkinsonism [[gait]] problems can lead to falls and serious physical injuries. Other common symptoms include:
==References==
* [[Tremor]]s, as rest tremor (when resting, mostly in the hands) and/or postular tremor
<!-- ---------------------------------------------------------------
* Short, [[shuffling gait]]
See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a
* Slow movements ([[bradykinesia]])
discussion of different citation methods and how to generate
* Loss of [[perception#Sound|sound perception]] leading to soft speech, [[hypophonia]]<ref>{{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 }}</ref>
footnotes using the <ref> & </ref> tags and the {{Reflist}} template
* [[Difficulty sleeping]]
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* [[Dry skin]]
{{Reflist|2}}
* [[Apathy]]
* [[Hypomimia|Lack of facial expressions]]
* [[Balance problems]]
* Frequent [[Falling (accident)|falls]]
* [[Micrographia (handwriting)|Very small handwriting]]
* [[Hypertonia|Rigid, stiff muscles]]
* [[Cogwheeling]] (jerky feeling in arm or leg)
* Upgaze impairment
* Plastic, dead feeling resistance known as "[[lead-pipe rigidity]]".<ref name="Ganog">{{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}}</ref>


== Conditions==
[[Category:Neurology]]
Parkinsonism occurs in many conditions.

=== Neurological ===
[[Neurodegenerative]] conditions and [[Parkinson plus syndrome|Parkinson-plus syndrome]]s that can cause parkinsonism include:<ref name="Bradley2004">{{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}}</ref>
* [[Corticobasal degeneration]]<ref name="Bradley2004" />
* [[Dementia with Lewy bodies]]<ref name="Bradley2004" />
* The relationship (if any) with [[essential tremor]] is not clear.<ref>{{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 }}</ref>
* [[Frontotemporal dementia]] ([[Pick's disease]])<ref name="Finger2016">{{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 }}</ref>
* [[Gerstmann–Sträussler–Scheinker syndrome]]<ref name="Bradley2004" />
* [[Huntington's disease]]<ref name="Bradley2004" />
* [[Lytico-bodig disease]] ([[ALS]] complex of Guam)<ref name="Bradley2004" />
* [[Multiple system atrophy]] ([[Shy–Drager syndrome]])<ref name="Bradley2004" />
* [[Neuroacanthocytosis]]<ref name="Bradley2004" />
* [[Neuronal ceroid lipofuscinosis]]<ref name="Bradley2004" />
* [[Olivopontocerebellar atrophy]]<ref name="Bradley2004" />
* [[Pantothenate kinase-associated neurodegeneration]], also known as [[neurodegeneration with brain iron accumulation]]<ref name="Bradley2004" />
* [[Parkin mutation]] causing [[hereditary juvenile dystonia]]<ref name="Bradley2004" />
* [[Parkinson's disease]]<ref name="Bradley2004" />
* [[Parkinson's disease dementia]]<ref name="McKeithConsensus2017">{{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 }}</ref>
* [[Progressive supranuclear palsy]]<ref name="Bradley2004" />
* [[Wilson's disease]]<ref name="Bradley2004" />
* [[X-linked dystonia parkinsonism]] ([[Lubag Syndrome|Lubag syndrome]])<ref name="Bradley2004" />

=== Infectious ===
* [[Creutzfeldt–Jakob disease]]<ref name="Bradley2004" /><ref>{{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 }}</ref>
* [[Encephalitis lethargica]]<ref name="Aminoff_2005" />
* [[HIV]] infection<ref name="Bradley2004" /> and [[AIDS]]<ref name="Bradley2004" /><ref>{{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 }}</ref>

=== Toxins ===
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.<ref name="Pezzoli2013">{{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 }}</ref>

Chronic [[manganese]] (Mn) exposure has been shown to produce a parkinsonism-like illness characterized by movement abnormalities.<ref name="Guilarte2015">{{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 }}</ref> This condition is not responsive to [[Management of Parkinson's disease|typical therapies used in the treatment of PD]], suggesting an alternative pathway than the typical [[dopamine]]rgic loss within the [[substantia nigra]].<ref name="Guilarte2015" /> Manganese may accumulate in the [[basal ganglia]], leading to the abnormal movements that characterize parkinsonism.<ref name="Kwakye2015">{{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 }}</ref> 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.<ref name="Peres2016">{{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 }}</ref> The [[Lewy body|Lewy bodies]] typical to PD are not seen in Mn-induced parkinsonism.<ref name="Kwakye2015" />

[[Agent Orange]] may be a cause of parkinsonism, although evidence is inconclusive and further research is needed.<ref name=McKnight2020>{{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 }}</ref>

Other toxins that have been associated with parkinsonism are:
* [[Annonaceae]]<ref>{{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 }}</ref>
* [[Carbon monoxide]]<ref name="Bradley2004" />
* [[Carbon disulfide]]<ref name="Bradley2004" />
* [[Cyanide]]<ref name="Bradley2004" />
* [[Ethanol]]<ref name="Bradley2004" />
* [[Hexane]]<ref name="Kim2010">{{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 }}</ref>
* [[Mercury (element)|Mercury]]<ref name="Bradley2004" />
* [[Methanol]]<ref name="Bradley2004" />
* [[MPTP]]<ref name="Bradley2004" /><ref name="Watanabe_2005">{{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 }}</ref>
* [[Rotenone]]<ref name="Nandipati">{{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 }}</ref>
* [[Toluene]]<ref>Weiss 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.</ref> ([[inhalant abuse]]: "huffing")<ref>{{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 }}</ref>

=== Vascular ===
* [[Binswanger's disease]] (subcortical [[leukoencephalopathy]])<ref name="Bradley2004" />
* [[Vascular dementia]] (multi-infarct)<ref name="Bradley2004" />
* [[Dural arteriovenous fistula]] / dAVF (reversible parkinsonism through fistula treatment) <ref>{{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}}</ref><ref>{{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 }}</ref><ref>{{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}}</ref>
* Dural arteriovenous malformation / dAVM (reversible through dAVM treatment) <ref>{{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 }}</ref><ref>{{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 }}</ref>

=== Other ===
* [[Chronic traumatic encephalopathy]] (boxer's dementia or pugilistic encephalopathy)<ref name="Bradley2004" />
* Damage to the [[brain stem]] (especially dopaminergic nuclei of the [[substantia nigra]]),<ref>{{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 }}</ref>[[basal ganglia]] (especially [[globus pallidus]])<ref>{{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 }}</ref> and the [[thalamus]].<ref>{{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}}</ref>
* [[Hypothyroidism]]<ref name="Bradley2004" />
* [[Orthostatic tremor]]<ref>{{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 }}</ref>
* [[Paraneoplastic syndrome]]: neurological symptoms caused by antibodies associated with cancers<ref>{{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 }}</ref>
* Rapid onset dystonia parkinsonism<ref>{{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 }}</ref>
* Autosomal recessive juvenile parkinsonism<ref>{{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 }}</ref>

==Differential diagnosis ==
Secondary parkinsonism, including vascular parkinsonism and drug-induced parkinsonism.<ref>{{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 }}</ref><ref>{{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=}}</ref>

=== Drug-induced ("pseudoparkinsonism") ===
About 7% of people with parkinsonism developed symptoms as a result of side effects of medications, mainly neuroleptic [[antipsychotic]]s especially the [[phenothiazine]]s (such as [[perphenazine]] and [[chlorpromazine]]), [[thioxanthene]]s (such as [[Flupentixol|flupenthixol]] and [[zuclopenthixol]]) and [[butyrophenone]]s (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 receptor]]s.<ref name="Marti-Masso" /> 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.<ref>{{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 }}</ref>

Implicated medications include:
* [[Antipsychotics]]<ref name="Bradley2004" />
* [[Lithium (medication)|Lithium]]<ref name="Bradley2004" />
* [[Metoclopramide]]<ref>{{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 }}</ref>
* [[MDMA]] (addiction and frequent use)<ref>{{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 }}</ref><ref>{{cite journal |author=Fabrizi, Monaco, Dalla Libera |title=Parkinsonian syndrome following MDMA (Ecstasy) addiction |journal=Movement Disorders |volume=19 |pages=S73–S74 |year=2004}}</ref>
* [[Tetrabenazine]]<ref name="Bradley2004" />
* [[Cinnarizine]]<ref name="Marti-Masso">{{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 }}</ref>

== Society and culture ==
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 [[United States Department of Veterans Affairs|Veterans Affairs]] disability benefits.<ref name= VAParkinsonism>{{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}}</ref> 

== References ==
{{Reflist|32em}}

== External links ==
* [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:Geriatrics]]
[[Category:Parkinson's disease]]

Latest revision as of 12:24, 17 April 2024

"Parkinson's syndrome" redirects here. Not to be confused with Parkinson's disease.
Parkinsonism
SpecialtyNeurology Edit this on Wikidata
Causes

Parkinsonism is a clinical syndrome characterized by tremor, bradykinesia (slowed movements), rigidity, and postural instability.[1][2] Both hypokinetic (bradykinesia and akinesia) as well as hyperkinetic (cogwheel rigidity and tremors at rest) features are displayed by Parkinsonism.[3]These are the four motor symptoms 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. This set of symptoms occurs in a wide range of conditions and may have many causes, including neurodegenerative conditions, drugs, toxins, metabolic diseases, and neurological conditions other than PD.[4]

Signs and symptoms[edit]

Parkinsonism is a clinical syndrome characterized by the four motor symptoms found in Parkinson's disease: tremor, bradykinesia (slowed movements), rigidity, and postural instability.[1][2]

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

Conditions[edit]

Parkinsonism occurs in many conditions.

Neurological[edit]

Neurodegenerative conditions and Parkinson-plus syndromes that can cause parkinsonism include:[6]

Infectious[edit]

Toxins[edit]

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.[12]

Chronic manganese (Mn) exposure has been shown to produce a parkinsonism-like illness characterized by movement abnormalities.[13] 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.[13] Manganese may accumulate in the basal ganglia, leading to the abnormal movements that characterize parkinsonism.[14] 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.[15] The Lewy bodies typical to PD are not seen in Mn-induced parkinsonism.[14]

Agent Orange may be a cause of parkinsonism, although evidence is inconclusive and further research is needed.[16]

Other toxins that have been associated with parkinsonism are:

Vascular[edit]

Other[edit]

Differential diagnosis[edit]

Secondary parkinsonism, including vascular parkinsonism and drug-induced parkinsonism.[35][36]

Drug-induced ("pseudoparkinsonism")[edit]

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. 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.[37] 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.[38]

Implicated medications include:

Society and culture[edit]

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.[42] 

References[edit]

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External links[edit]

Retrieved from "https://en.wikipedia.org/w/index.php?title=Parkinsonism&oldid=1219381284"