Parkinsonism refers to a group of neurological disorders that cause movement problems similar to those seen in Parkinson’s disease (PD), such as tremor, rigidity, slowness of movement (bradykinesia), and postural instability. It may be caused by Parkinson’s disease itself or by other medical conditions (secondary parkinsonism).
Parkinsonism can be categorized based on its cause:
1. Primary Parkinsonism (Idiopathic Parkinson’s Disease) – Most common form, cause is unknown but involves degeneration of dopaminergic neurons in the substantia nigra.
2. Secondary Parkinsonism – Caused by:
• Medications (e.g., antipsychotics, antiemetics like metoclopramide)
• Toxins (e.g., carbon monoxide, manganese)
• Infections (e.g., encephalitis)
• Cerebrovascular disease (multi-infarct Parkinsonism)
• Head trauma (e.g., repeated injuries in athletes)
• Normal pressure hydrocephalus
• Brain tumors
3. Atypical Parkinsonism (Parkinson-plus syndromes):• Multiple system atrophy (MSA)
• Progressive supranuclear palsy (PSP)
• Corticobasal degeneration (CBD)
• Dementia with Lewy bodies (DLB)
- Age (most common in people over 60)
- Genetic predisposition (mutations in LRRK2, PARK genes, etc.)
- Male sex (higher incidence in men)
- Exposure to environmental toxins (e.g., pesticides, herbicides)
- Family history of Parkinson’s disease
- History of head injury
Motor Symptoms:
o Tremor at rest (typically a “pill-rolling” tremor)
o Bradykinesia (slowness of movement)
o Rigidity (muscle stiffness)
o Postural instability (difficulty maintaining balance)
o Shuffling gait
o Reduced facial expression (masked face)
Non-Motor Symptoms:
o Depression and anxiety
o Cognitive decline or dementia
o Sleep disturbances
o Constipation
o Autonomic dysfunction (e.g., blood pressure fluctuations, bladder issues)
o Speech and swallowing difficulties
Medications:
- Levodopa + Carbidopa – Most effective for motor symptoms.
- Dopamine agonists – Pramipexole, Ropinirole.
- MAO-B inhibitors – Selegiline, Rasagiline.
- COMT inhibitors – Entacapone, Tolcapone.
- Anticholinergics – For tremor (e.g., benztropine).
- Amantadine – For dyskinesia and mild symptoms.
Advanced Therapies:
- Deep Brain Stimulation (DBS)
- Apomorphine pump
- Levodopa-carbidopa intestinal gel
- Management of Secondary Parkinsonism:
- Identify and remove cause (e.g., stop causative medication)
Treat underlying condition (e.g., stroke management)
for People with Parkinson’s Disease
1. Regular Physical Activity
Why it’s important: Exercise helps improve mobility, balance, flexibility, and mood.
Recommended activities:
- Walking, swimming, cycling
- Tai Chi or yoga for balance and flexibility
- Strength training and stretching exercises
- Physical therapy guided exercises
Tip: Choose safe, enjoyable activities and aim for 30 minutes most days of the week.
2. Mental and Cognitive Health
Support mental well-being by:
- Engaging in social activities
- Doing puzzles, reading, or learning new skills
- Attending support groups or therapy for depression or anxiety
- Maintaining regular sleep routines
3. Healthy Diet and Nutrition
Goals: Maintain energy, prevent constipation, and support overall health.
Diet tips:
- High-fiber foods (fruits, vegetables, whole grains) to ease constipation
- Hydration: Drink plenty of water daily
- Balanced meals with lean protein, healthy fats, and complex carbs
- Limit sugary, salty, and processed foods
- Medication timing: If on levodopa, take it away from high-protein meals to improve absorption
4. Daily Living and Safety
Improve home safety and independence:
- Use grab bars, non-slip mats, and raised toilet seats
- Remove clutter and loose rugs to prevent falls
- Install good lighting, especially in hallways and bathrooms
- Use adaptive tools (e.g., utensils with large handles, walking aids)
5. Medication Management
- Take medications on schedule
- Use pill organizers or mobile reminders
- Understand potential side effects and report changes to your doctor
- Keep an updated list of medications and dosages
6. Speech and Swallowing Support
- Speech therapy (SLP) can help with voice volume and articulation
- Practice speaking slowly and clearly
- For swallowing issues: eat small bites, chew thoroughly, and sit upright while eating
7. Regular Medical Checkups
- See a neurologist or movement disorder specialist regularly
- Consult with physical, occupational, and speech therapists
- Manage other health conditions like high blood pressure, diabetes, etc.
8. Emotional and Social Support
- Join a Parkinson’s support group
- Stay connected with family and friends
- Seek counseling if feeling isolated, anxious, or depressed
9. Daily Routine and Time Management
- Keep a consistent daily schedule
- Break tasks into smaller steps and allow more time
- Rest between activities to avoid fatigue