1.3 What is parkinsonism?

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‘Parkinsonism’ is an umbrella term used to cover a range of conditions. These conditions share the symptoms of slowness of movement, stiffness and tremor.

Most people with a form of parkinsonism have idiopathic Parkinson’s, also known as Parkinson’s, which this course focuses on. However, other types of parkinsonism are described below.

Multiple system atrophy

Both multiple system atrophy (MSA) and Parkinson’s can cause stiffness and slowness of movement in the early stages. But the additional problems that develop in MSA, such as difficulty with swallowing, incontinence and dizziness, are unusual in early Parkinson’s.

Progressive supranuclear palsy

Progressive supranuclear palsy (PSP) is a very rare condition characterised by a problem with a person’s eye gaze, sometimes referred to as ‘doll’s eyes’. A person with PSP has to move their head to follow a finger rather than just moving their eyes, will have difficulties looking down, may also experience frequent episodes of falling backwards and have issues with mobility, speech and swallowing. Problems with speech are unusual in early Parkinson’s. PSP is sometimes called Steele-Richardson-Olszewski syndrome.

Corticobasal degeneration

This condition is similar to PSP and very rare. People with corticobasal degeneration may experience sudden difficulty in controlling one of their limbs – usually their hand or arm, but sometimes their leg can be affected. They may experience muscle stiffness, rigidity and spasms in the affected limb.

The three conditions mentioned above progress more quickly than Parkinson’s, are harder to treat and may not respond to medication as effectively.

Vascular parkinsonism Parkinson’s

People may experience this form of parkinsonism (also known as arteriosclerotic parkinsonism) if they have had a stroke. Often the stroke can be so mild that they didn’t notice it. The most common symptom of vascular parkinsonism can be difficulty with walking – the condition is sometimes called lower body parkinsonism. Other symptoms include rigid facial muscles (hypomimia), difficulty with swallowing or speaking, and bladder and bowel problems. People with this condition may not respond as well to Parkinson’s medication as those with idiopathic Parkinson’s.

Drug-induced parkinsonism

Drugs that block the action of dopamine in the brain can result in people developing symptoms of drug-induced parkinsonism. These drugs include ‘antipsychotics’ or ‘neuroleptics’, which are sometimes used to treat dementia, symptoms associated with learning difficulties or severe mental health problems, such as schizophrenia.

This condition tends to remain static and does not progress. The only way to relieve the symptoms is for the person to stop taking the drug that is causing the symptoms of drug-induced parkinsonism. If this is possible, some people will recover within a few months.

Unfortunately, this is not always possible, as some people may have few other drug options available to manage their condition. Parkinson’s medications are contraindicated when taking these drugs, so the person has to live with the symptoms.

Have you come across this before or do you now recognise something you did not understand in a person you have been caring for?

Essential tremor

This is the most common type of tremor. It is a trembling of the hands, head, legs, body and/or voice. It is most noticeable when a person is moving and stops when someone is resting.

An essential tremor can be difficult to tell apart from a Parkinson’s tremor.

In Parkinson’s, a resting tremor usually goes away when a person is doing something like picking up and drinking their cup of tea. It will be most obvious when they are resting, such as watching television.

For people diagnosed with a benign tremor condition, multiple system atrophy or progressive supranuclear palsy, the following organisations can offer more specific support, including advice for professionals.

1.2 Why are we here?

1.4 What is Parkinson’s?