


Parkinsonism is a term used to describe the collection of signs and movement symptoms associated with several conditions — including Parkinson’s disease (PD). Signs include slowness (bradykinesia), stiffness (rigidity) and resting tremor. Conditions other than Parkinson’s disease may have one or more of these symptoms, mimicking PD. Your neurologist should assess your symptoms when making a diagnosis.
Below are the more common medical conditions that can present with Parkinsonian disorders (parkinsonism). Parkinsonism can be classified into two major groups: primary and secondary.

Parkinson’s disease is the most common primary cause of parkinsonism. It can be further subdivided into sporadic (most common) and familial (hereditary) PD.
Primary Parkinsonism
Primary parkinsonian disorders include Parkinson’s disease and atypical parkinsonian disorders. Both can be misdiagnosed, however a neurologist with training in movement disorders can help make an accurate diagnosis and coordinate care.
Parkinson Disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.
Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in an area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.
Secondary Parkinsonism
This type of parkinsonism includes neurological disorders commonly caused by brain tumors, toxins or medications. Symptoms are similar to those seen in Parkinson’s disease and may sometimes go away with treatment, depending on the disorder. Unlike Parkinson’s disease, the medication Levodopa does not improve symptoms.
There are many secondary or acquired causes of parkinsonism:
-Drug Induced Parkinsonism-Drug-induced parkinsonism can be difficult to distinguish from Parkinson’s, though the tremors and postural instability may be less severe. It is usually the side effect of drugs that affect dopamine levels in the brain, such as antipsychotics, some calcium channel blockers and stimulants like amphetamines and cocaine. If the affected person stops taking the drug(s), symptoms usually go away over time, but may take as long as 18 months.
-Vascular Parkinsonism -Vascular parkinsonism is usually caused by clotting in the brain from multiple small strokes. People with vascular parkinsonism tend to have more problems with gait than tremor and have more problems in the lower body. The disorder progresses very slowly in comparison to other types of parkinsonism. People might report an abrupt onset of symptoms or symptoms that get worse then plateau for a while. Symptoms in vascular parkinsonism may or may not respond to levodopa.
Other secondary causes of Parkinsonism:
- Metabolic diseases, such as Wilson’s disease
- Endocrine diseases, such as hypothyroidism
- Heavy metals, such as manganese
- Infectious diseases, such as Whipple’s disease
- Normal pressure hydrocephalus
- Toxins, such as MPTP
- Repetitive head trauma
Parkinsonism can also be categorized based on the abnormal proteins that accumulate in the brain, such as alpha synuclein.
Atypical Parkinson’s Conditions:
Dementia with Lewy Bodies (DLB):
DLB is second only to Alzheimer’s as the most common cause of dementia in elderly people. It causes progressive intellectual and functional deterioration. In addition to the signs and symptoms of Parkinson’s disease, people with DLB tend to have frequent changes in thinking ability, level of attention or alertness and visual hallucinations.
Progressive Supranuclear Palsy (PSP):
PSP is slightly more common than amyotrophic lateral sclerosis (ALS), also called Lou Gehrig disease. Symptoms usually begin in the early 60’s. Common early symptoms include loss of balance while walking that results in unexplained falls, forgetfulness and personality changes.
The visual problems associated with PSP generally occur three to five years after the walking problems and involve the inability to aim the eyes properly because of weakness or paralysis of the muscles that move the eyeballs.
Multiple System Atrophy (MSA):
MSA (also referred to as Shy-Drager syndrome) is the term for a group of disorders in which one or more systems in the body stop working. In MSA, the autonomic nervous system is often severely affected early in the course of the disease.
Symptoms include bladder problems resulting in urinary urgency, hesitancy or incontinence and orthostatic hypotension (nOH). In nOH the blood pressure drops so low when standing that fainting or near fainting can occur. When lying down, blood pressure can be quite high (called supine hypertension). For men, the earliest sign may be loss of erectile function. Other symptoms that may develop include impaired speech, difficulties with breathing and swallowing, and inability to sweat.
Corticobasal Degeneration (CBD):
CBD is the least common atypical parkinsonism. It usually develops after age 60. Symptoms include a loss of function on one side of the body, involuntary and jerky movements of a limb and speech problems. It may become difficult or impossible to use the affected limb although there is no weakness or sensory loss. People with CBD may feel as if their limb is not under his/her voluntary control. There is no specific treatment for CBD. Treatment is focused on reducing symptoms and improving quality of life.
Parkinsonian disorders and Levodopa
Various parkinsonian disorders can be categorized based on how they respond to the medication called levodopa. PD tends to respond well to levodopa therapies, while most atypical parkinsonian disorders do not.
Sometimes people with parkinsonian symptoms who do not respond well to levodopa may be referred to as having parkinsonism. This can be confusing since parkinsonism technically refers to a set of movement symptoms, rather than a specific diagnosis.
Understanding about your diagnosis:
Despite recent research and diagnostic advances, the diagnosis of PD and types of atypical parkinsonian still relies primarily on a clinical evaluation. There are many overlapping signs and symptoms among PD, atypical parkinsonisms, and secondary parkinsonisms, making it difficult to diagnose. An accurate diagnosis can take months or even years to determine.
You may be diagnosed right away with “typical” or idiopathic Parkinson’s, or your doctor may tell you that you have parkinsonism. A “diagnosis” of parkinsonism may simply mean that you have movement symptoms, like slowness, rigidity and tremor. It might also mean that your doctor does not have enough information to know if your symptoms will respond well to levodopa.
Additionally, some doctors use the term parkinsonism interchangeably with atypical parkinsonism. Talk to your doctor if you have questions about what your diagnosis means.
There are three types of Parkinson’s disease and they are grouped by age of onset:
1-Adult-Onset Parkinson’s Disease – This is the most common type of Parkinson’s disease. The average age of onset is approximately 60 years old. The incidence of adult onset PD rises noticeably as people advance in age into their 70’s and 80’s.
2-Young-Onset Parkinson’s Disease – The age of onset is between 21-40 years old. Though the incidence of Young-Onset Parkinson’s Disease is very high in Japan (approximately 40% of cases diagnosed with Parkinson’s disease), it is still relatively uncommon in the U.S., with estimates ranging from 5-10% of cases diagnosed.
3-Juvenile Parkinson’s Disease – The age of onset is before the age of 21. The incidence of Juvenile Parkinson’s Disease is very rare.
Parkinson’s disease can significantly impair quality of life not only for the patients but for their families as well, and especially for the primary caregivers. It is therefore important for caregivers and family members to educate themselves and become familiar with the course of Parkinson’s disease and the progression of symptoms so that they can be actively involved in communication with health care providers and in understanding all decisions regarding treatment of the patient.
According to the American Parkinson’s Disease Association, there are approximately 1.5 million people in the U.S. who suffer from Parkinson’s disease – approximately 1-2% of people over the age of 60 and 3-5% of the population over age 85. The incidence of PD ranges from 8.6-19 per 100,000 people. Approximately 50,000 new cases are diagnosed in the U.S. annually. That number is expected to rise as the general population in the U.S. ages. Onset of Parkinson’s disease before the age of 40 is rare. All races and ethnic groups are affected.
Knowledge is Critical when Dealing with a Life-Altering Condition such as Parkinson’s Disease and being able to make the changes to last longer and at your optimal level of functioning! First step is accept you have it!
If you or a loved one has been diagnosed with Parkinson’s disease, it’s critical to learn everything you possibly can about this condition so that you can make informed decisions about your treatment. That’s why the Medifocus Guidebook on Parkinson’s Disease was developed, a comprehensive 170 page patient Guidebook that contains vital information about Parkinson’s disease and is so helpful.
The Medifocus Guidebook on Parkinson’s Disease starts out with a detailed overview of the condition and quickly imparts fundamentally important information about Parkinson’s disease, including:
The theories regarding the underlying causes of Parkinson’s disease.
What Are the Possible Risk factors that can be a cause of Parkinson’s Disease?
The Parkinson’s Disease Foundation notes even after decades of intense study, the causes of Parkinson’s disease are not really understood. However, many experts believe that the disease is caused by several genetic and environmental factors, which can vary in each person.
1-Genetic Factors
For some patients, genetic factors could be the primary cause; but in others, there could be something in the environment that led to the disease. Scientists have noted that aging is a key risk factor. There is a 2-4% risk for developing the disease for people over 60. That is compared to 1-2% risk in the general population.
2-Environmental Factors
Some scientists believe that PD can result from overexposure to environmental toxins, or injury. Research by epidemiologists has identified several factors that may be linked to PD. Some of these include living in rural areas, drinking well water, pesticides and manganese.
Some studies have indicated that long term exposure to some chemicals could cause a higher risk of PD. These include the insecticides permethrin and beta-hexachlorocyclohexane (beta-HCH), the herbicides paraquat and 2,4-dichlorophenoxyacetic acid and the fungicide maneb. In 2009, the US Veterans Affairs Department stated that PD could be caused by exposure to Agent Orange.
We should remember that simple exposure to a single toxin in the environment is probably not enough to cause PD. Most people who are exposed to such toxins do not develop PD.
Last Reviewed 04/06/26 by Elizabeth Lynch RN BSN