Parkinsonism: Understanding Its Causes, Types, and Symptoms

Parkinsonism is a group of neurological conditions that cause movement-related difficulties in individuals. These neurological conditions are often characterised by tremors, stiffness, slowness of movement, and balance problems. It is usually a chronic condition that requires attention and care throughout the person's life and can impact the individual and their loved ones.

Knowing the kind of post encephalitic parkinsonism, idiopathic parkinsonism, or juvenile parkinsonism through tests can help individuals and medical professionals in planning treatment and provide insights into the condition. This clarity can help identify causes that vary, such as genetic predisposition, medication side effects, or underlying health conditions. This can help in long term management of the conditions and identify the right care strategy.

What is Parkinsonism?

Parkinsonism is a broad term used to describe neurological conditions that cause movement-related issues in individuals. It includes Parkinson’s Disease, along with other conditions. It's often used to describe conditions that cause tremors, balance issues, and movement difficulties. It is often a chronic condition that can be managed with care and physiotherapy.

Difference Between Parkinsonism and Parkinson's Disease

Parkinsonism is a broad term for conditions causing movement symptoms like tremors, stiffness, and slow movement, often linked to dopamine deficiency. Parkinson’s disease is a specific, progressive neurodegenerative disorder and the most common form of Parkinsonism. Unlike Parkinsonism caused by drugs or strokes, Parkinson’s disease has no identifiable external cause and includes unique non-motor symptoms like cognitive decline.

Causes of Parkinsonism

Parkinsonism has many causes that depend on genetics, lifestyle, and, in some cases, age-related factors. It can be identified through tests and diagnostics.

Neurodegenerative Disorders

Parkinsonism mainly results from neurodegenerative disorders, the most common being Parkinson's disease. Neurodegenerative disorders are progressive conditions characterised by the loss of neurons, specifically in areas that control movement within the brain. The loss of dopamine causes poor motor control. The patient's symptoms include trembling, stiffness, and slowed movements. These diseases can also result in cognitive and emotional deficits, which calls for long-term treatment.

Drug-Induced Parkinsonism

Certain medications, especially antipsychotics and anti-nausea drugs, can block dopamine receptors and mimic symptoms of parkinsonism. Unlike Parkinson's disease, this condition does not involve neuronal degeneration and may resolve if the drug is discontinued.

Vascular Parkinsonism

Vascular parkinsonism results from decreased blood supply to the brain caused by strokes or small vessel disease. The condition is common in the lower limbs, where it causes difficulties in walking and postural instability. Symptoms of vascular parkinsonism are not as responsive to dopamine-based medications as those with Parkinson's disease.

Toxin Exposure

Exposure to environmental toxins such as pesticides, herbicides, or heavy metals may destroy dopamine-producing neurons, which could lead to symptoms related to movement. These toxins can, over time, impact the neurons, which can impact mobility, balance and thought processing. Although the condition may progress slowly, minimising exposure and implementing safety measures can reduce the risk.

Genetic Factors and Inherited Risks

Genetic mutations are responsible for increased risks of Parkinsonism, particularly in familial cases of Parkinson's disease. These include LRRK2, SNCA, and PARK7 gene mutations. The hereditary forms are rare; however, when genetic predisposition is coupled with environmental factors, the susceptibility is triggered. It is important to understand the family history to detect any signs of Parkinsonism at an early stage.

Head Trauma and Injury

Recurrent head trauma or traumatic brain injury can cause an increased risk of parkinsonism. Disruption of dopamine-producing areas of the brain may result in movement-related symptoms. Chronic traumatic encephalopathy is one of the conditions that are known to show Parkinsonism features. Injuries to the brain can often result in memory loss, tremors, and loss of balance - all of which can be signs of parkinsonism and will need immediate care.

Environmental Triggers and Toxins

Parkinsonism is related to environmental exposure, including industrial chemicals, polluted air, and pesticides. These might disrupt the normal metabolism of dopamine or destroy neurons. Risk increases with increased exposure periods, especially if this is related to work.

Age-Related Degeneration

Probably one of the most important factors is ageing: the brain tends to degenerate with age as dopamine-producing cells are gradually eliminated. This inevitably leads to decreased dopamine levels associated with symptoms that include tremors and stiffness without a specific underlying neurodegenerative disease; however, lifestyle factors appear to influence, albeit modestly, the life span of those remaining neurological capacities.

Role of Infections in Parkinsonism

Like any medical condition, infections play an important role in aggravating a condition. In the case of Parkinsonism, it is likely that infections can trigger inflammation or directly affect the nervous system. Viral infections like encephalitis lethargic or post-viral syndromes may damage dopamine-producing neurons, leading to movement-related symptoms. Chronic infections and immune responses can compromise nerve functions and can increase the risk of Parkinsonism.

Types of Parkinsonism

Types of Parkinsonism differ by underlying causes, including neurodegeneration (Parkinson’s disease), vascular issues, drug side effects, or toxins.

Primary Parkinsonism

Primary parkinsonism is caused by the progressive loss of dopamine-producing neurons in the brain, primarily through neurodegenerative processes. This includes idiopathic Parkinson's disease, where the cause is unknown. Symptoms generally include tremors, stiffness, slow movements, and balance difficulties, all indicative of the disruption in motor pathways necessary for voluntary movements.

Idiopathic Parkinsonism (Parkinson's Disease)

The most common form of idiopathic parkinsonism, which has no identified external cause, is Parkinson's disease. It is the gradual degeneration of dopamine-producing neurons in the substantia nigral. Core symptoms include tremors, bradykinesia, rigidity, and postural instability. Most patients present with non-motor features like sleep disturbances, mood changes, and cognitive decline in the later stages.

Atypical Parkinsonian Disorders

Atypical parkinsonian disorders are conditions that have features of parkinsonism but have different pathologies and natural histories. They are multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). Because of this, these conditions usually present with other manifestations such as rapid progression, autonomic dysfunction, or marked cognitive impairment more than what is seen in Parkinson's disease.

Secondary Parkinsonism

Secondary parkinsonism is a condition that is caused by external factors like drugs, infections, or toxins rather than neurodegeneration. It typically manifests with similar motor symptoms, including tremors and stiffness, but may have a more sudden onset.

Drug-Induced Parkinsonism

Certain medications, such as antipsychotics and antiemetics, block dopamine receptors and can mimic Parkinson's symptoms. This condition does not involve neuron degeneration and often resolves upon discontinuation of the causative drug. Symptoms in such cases are tremors, bradykinesia, and rigidity, which resemble Parkinson’s disease but without the progressive nature of neurodegenerative disorders.

Vascular Parkinsonism

Vascular parkinsonism results from cerebrovascular events like strokes or chronic small vessel disease. The symptoms often affect the lower body, causing difficulties in walking, postural instability, and freezing of gait. Unlike Parkinson’s disease, it lacks a clear dopamine deficit and may show abrupt or stepwise progression related to vascular damage in the brain.

Post-Traumatic Parkinsonism

Repetitive head traumas or profound traumatic brain damage may cause the problem of post-traumatic parkinsonism. From damage to areas of the dopaminergic system or motor systems, symptoms originate. Patients display tremors or bradykinesia; some may appear rigid. There is a unique condition known as chronic traumatic encephalopathy (CTE), which also results from frequent concussions as well as those types of parkinsonism.

Toxin-Induced Parkinsonism

People who work in toxic environments where they are exposed to environmental toxins, like pesticides, herbicides, or heavy metals, can damage the dopamine-producing neurons and lead to toxin-induced Parkinsonism. The symptoms may resemble those seen in Parkinson's but are strongly associated with toxic exposure. This can happen over decades in some cases and in some people in a few months. It is important for people to use protective equipment when working in such hazardous places.

Juvenile Parkinsonism

Juvenile parkinsonism occurs in children less than 21 years old and is typically associated with genetic mutations. It presents similarly to Parkinson's disease but often with non-motor features like dystonia. It has a slower progression than typical Parkinson's disease and distinct underlying causes of the genetic kind.

Atypical Parkinsonism

Atypical parkinsonism represents a group of disorders with features of parkinsonism but based on different mechanisms and presentations. Rapid progression and limited response to dopamine-based treatment characterise these, as well as other unique presentations. Examples are multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD).

Multiple System Atrophy (MSA)

Multiple System Atrophy (MSA) is a neurodegenerative disorder that is slowly progressive, with symptoms such as parkinsonism, autonomic dysfunction, and cerebellar ataxia. It involves widespread neuronal loss in many brain systems. The symptoms could be just tremors and rigidity, loss of extreme balance, and alterations in bladder function and blood pressure. MSA progresses more rapidly than Parkinson's disease and does not respond well to standard treatments for dopamine.

Progressive Supranuclear Palsy (PSP)

Progressive Supranuclear Palsy (PSP) is a neurodegenerative disease characterised by parkinsonism, vertical gaze palsy, and postural instability. It happens due to the collection of tau protein in brain cells, giving rise to motor and cognitive impairments. Patients experience difficulties with eye movements, frequent falls, and slurred speech. In contrast to Parkinson's, PSP is more rapid and has specific clinical features.

Corticobasal Degeneration (CBD)

Corticobasal Degeneration (CBD) is a rare neurodegenerative disorder that presents with asymmetrical motor symptoms, such as rigidity, tremors, or apraxia. It is caused by the deposition of tau protein in the brain, leading to atrophy in specific regions. Non-motor symptoms can include impairments like cognitive problems and language problems. People suffering from CBD  often don't respond well to dopamine-based treatments and localised distribution of its symptoms.

Dementia with Lewy Bodies (DLB)

DLB is a neurodegenerative disorder with parkinsonism and progressive declining cognition. In DLB, neurodegenerative changes are typified by deposits of abnormal amounts of alpha-synuclein protein within Lewy bodies in the brain. These patients with DLB commonly present with difficulty in movements, visual hallucinations, and fluctuation in levels of attention together with autonomic dysfunction.

Symptoms of Parkinsonism

Symptoms of Parkinsonism are easy to identify as it is often associated with muscular function and mobility. In most cases, motor and non-motor symptoms over a period of time can help understand the condition.

Motor Symptoms

Tremors, muscle rigidity, bradykinesia, slowing of movement, and postural instability are considered common motor symptoms in Parkinsonism. The various impairments impair coordination, balance, and voluntary movements. Other typical characteristics include freezing of gait, and reduction in arm swing with walking. As the condition worsens, they significantly influence normal daily activities as well as movement.

Nonmotor Symptoms

Non-motor symptoms of parkinsonism include cognitive decline, mood disorders, sleep disturbances, autonomic dysfunction, constipation or blood pressure irregularities. Patients can also experience fatigue, loss of smell, and hallucinations. These symptoms often occur ahead of motor problems and significantly affect the quality of life.

Diagnosis of Parkinsonism

There are no specific tests that can easily identify Parkinsonism, but the neurologist or a qualified medical professional can run a series of tests and scans that can identify patterns related to Parkinsonism. Clinical examination of symptoms such as tremors, rigidity, bradykinesia, and postural instability. MRI or CT scans may help eliminate structural causes, and dopamine transporter scans (DaTscans) determine dopamine levels. Blood tests and review of medications may help in differentiating idiopathic parkinsonism, juvenile parkinsonism, and postencephalitic parkinsonism, which is crucial for treatment.

Treatment Options for Parkinsonism

Treatment for Parkinson's is designed to help reduce stress and improve mobility in the person. Medication is prescribed to balance dopamine levels, surgical intervention in advanced cases, physical therapy to improve mobility, and mental health support. Complementary therapies such as yoga or acupuncture may also be beneficial. 

Medication-Based Treatments

Medications include levodopa, dopamine agonists, and MAO-B inhibitors. These medications would help manage the motor symptoms of Parkinson's by replenishing or mimicking dopamine. Anticholinergics may reduce tremor symptoms, while amantadine reduces dyskinesia. Secondary parkinsonism may require adjustments in the causative drugs. Regular monitoring ensures efficacy and minimises side effects since drug requirements often change over time.

Surgical Options

Advanced parkinsonism is also treated with surgical interventions, which include deep brain stimulation (DBS). It is a procedure wherein electrodes are placed in certain areas of the brain to control irregular signals, which helps in managing motor symptoms. Other techniques used are lesioning procedures, wherein affected areas may be targeted. It is important to consult a medical professional who can outline these procedures or explore alternative treatment plans that work well.

Physical Therapy and Rehabilitation

Physical therapy and rehabilitation are some of the most common and effective forms of treatment for Parkinsonism as it helps in building muscle strength and improving hand-eye coordination. Based on the severity of your condition, a physiotherapist will outline a detailed plan that will address both short-term and long-term needs. Care can happen at a hospital or at home, depending on the person's comfort level. At Physiotattava, our team of experts helps in providing a comprehensive plan that can help improve overall health and well-being. Drop us a call today to learn more.

Mental Health and Counselling Support

Mental health support deals with the emotional and psychological effects of parkinsonism. Counselling or therapy helps in the management of anxiety, depression, and cognitive changes. Finding people with similar conditions through support groups can provide a sense of community and learn new ways to manage the conditions.  Emotional support is essential, particularly in postencephalitic parkinsonism, which may include cognitive challenges.

Alternative and Complementary Therapies

Alternative therapies, like yoga, tai chi, or acupuncture, complement the traditional approaches by enhancing flexibility, balance, and relaxation. Dietary modification, herbal supplementation, and mindfulness practice can boost general well-being. Although scientific evidence for most of these techniques is not uniform, they still may offer ancillary benefits if added to complete care plans.

Living with Parkinsonism: Lifestyle Adjustments and Support

• Lifestyle Changes: Engage in regular exercise to keep mobile and balanced, maintain a healthy diet to keep the body in good condition, and have a routine daily schedule to control symptoms.
• Engaging with support systems, family, and caregivers- this can help them understand your conditions, and help them understand how to care for the person best. It will also help create a sense of community and keep your emotional well-being positive.
• Home Modifications: Provide living spaces as safe as possible, such as installing grab bars and reducing fall hazards. People with Parkinsonism are prone to risks of falls, so avoid sharp edges, climbing multiple floors, etc.

Managing Parkinsonism with Expert Support at Physiotattva

Struggling with parkinsonism? Physiotattva understands the challenge and supports you every step of the way. Our team provides personalised therapy plans, such as physiotherapy and rehabilitation, to help improve mobility and enhance quality of life. We can help guide you through your journey with care and compassion. Don't wait! Contact us today to start effectively managing parkinsonism with our specialised services!

At Physiotattva physiotherapy clinics in Bangalore and Hyderabad, you receive personalised care tailored to your specific needs, ensuring effective results and comfort throughout your journey to recovery. 

Don’t wait to start your recovery! Get in touch with Physiotattva for more details! Contact us at +91 89510 47001.

FAQs

What is the cause of Parkinsonism?

Parkinsonism is caused by a deficiency in dopamine in the brain, typically resulting from neurodegeneration, vascular damage, or other external causes, such as medication, toxins, or infections. Causes vary with type, and most are the result of genetic mutations, repeated head injuries, or conditions such as Parkinson's disease, the most common type.

What are the four cardinal symptoms of Parkinsonism?

The four cardinal symptoms of parkinsonism are tremors (shaking), bradykinesia (slowness of movement), muscle rigidity (stiffness), and postural instability (balance difficulties). 

What is the last stage of Parkinsonism?

The final stage of parkinsonism is characterised by severe motor and non-motor symptoms. Patients have lost all mobility and are unable to perform daily activities without assistance. Non-motor challenges include cognitive decline, speech difficulties, and autonomic dysfunction.

How common is Parkinsonism?

Parkinsonism affects about 1% of individuals aged over 60 years. Most cases are due to Parkinson's disease, while secondary Parkinsonism and atypical disorders are less common.