Parkinsonism is an umbrella term used to describe a group of movement symptoms that occur in Parkinson’s and several other neurological conditions. It is not a diagnosis on its own. Instead, it refers to a pattern of symptoms that can have different underlying causes.

Common symptoms of parkinsonism include:

  • Slow movement (bradykinesia)
  • Muscle stiffness (rigidity)
  • Tremor
  • Problems with walking, balance and coordination

Many people with parkinsonism may also experience non-movement symptoms. These can include changes in thinking, memory or mood, sleep difficulties, and problems with automatic body functions such as blood pressure regulation, bladder control or bowel function.

Types of Parkinsonism

Parkinson’s disease

Parkinson’s is a progressive neurological condition that affects movement and a range of non-movement functions.

Key features include:

  • Symptoms usually develop gradually and some are one-sided to start (e.g. one side has tremors or loss of arm swing or you drag or can’t pick up your foot on one side)
  • Movement symptoms often respond well to levodopa, particularly in the early stages when you have the most neurons left
  • Both movement and non-movement symptoms can occur, e.g. unexplained apathy, anxiety, or depression

Atypical Parkinsonism

Atypical parkinsonism refers to a group of progressive neurological conditions that share some features of Parkinson’s but have distinct characteristics.

Key features include:

  • Symptoms often progress more quickly than in Parkinson’s
  • Balance, speech, swallowing or cognitive problems may appear earlier
  • Response to levodopa is often limited or absent

Secondary Parkinsonism

Secondary parkinsonism results from an identifiable underlying cause rather than a primary neurodegenerative condition.

Key features include:

  • Symptoms may resemble Parkinson’s
  • Some causes can be treated or reversed
  • Symptoms often improve when the underlying cause is addressed
  • Levodopa is usually less effective

Atypical Parkinsonism (aka Parkinson’s Plus) Conditions

Dementia with Lewy Bodies (DLB)

Common features include:

  • Changes in memory, attention and thinking
  • Fluctuating alertness and concentration
  • Visual hallucinations, often involving people, animals or shadow-like figures

Multiple System Atrophy (MSA)

Common features include:

  • Dizziness or lightheadedness when standing
  • Significant blood pressure changes
  • Bladder and urinary difficulties
  • Progressive problems with movement and coordination

Progressive Supranuclear Palsy (PSP)

Common features of PSP include:

  • Difficulty moving the eyes, particularly up and down
  • Early balance problems and frequent falls
  • Changes in thinking, behaviour or decision-making
  • Slurred, slow or hoarse speech

Corticobasal Syndrome (CBS)

Common features include:

  • Muscle stiffness and involuntary movements
  • Abnormal limb postures, known as dystonia
  • Problems with coordination and skilled movements
  • Difficulty using one side of the body despite preserved strength

Diagnosing Parkinsonism

There is no single test that can confirm a diagnosis of parkinsonism. A neurologist will review your medical history, symptoms and medications, and perform a neurological examination.

Additional investigations may include:

  • MRI brain imaging
  • DaTscan imaging
  • Skin biopsy in selected cases

Your response to levodopa can also provide useful diagnostic information.

Because several conditions share similar symptoms, diagnosis can take time. In some cases, the diagnosis becomes clearer as symptoms develop. Assessment by a neurologist with expertise in movement disorders can improve diagnostic accuracy.

Treatment & Management

Treatment depends on the type of parkinsonism and the symptoms affecting you.

Levodopa may help some people with atypical parkinsonism, but the benefits are often less predictable than in Parkinson’s.

A comprehensive treatment plan may include:

Many people benefit from a multidisciplinary care team that may include movement disorder specialists, rehabilitation professionals, nurses, psychologists, sleep specialists, urologists and other allied health professionals.

Secondary Parkinsonism

Some forms of secondary parkinsonism can improve when the underlying cause is treated.

Examples include:

  • Drug-induced parkinsonism, which may improve after stopping or changing the medication responsible
  • Normal pressure hydrocephalus (NPH), which may be treated through a surgical procedure to drain excess fluid from the brain

Treatment depends on the specific cause and should be guided by an experienced care team.

Practical Tips

  1. Ask your care team to explain your diagnosis if anything is unclear.
  2. Understand that reaching a specific diagnosis may take time and may change.
  3. Learn about your condition and available treatment options.
  4. Seek support from organisations, health professionals and peer networks.
  5. Focus on factors you can influence, lifestyle changes including regular exercise, healthy eating, good sleep and staying connected with activities and relationships that matter to you.

Poster: The Parkinsonism Umbrella

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