“Don’t give up. Do what you can as long as you can. On top of 10 years with Parkinson’s, I had a stroke. Now, at age 91, unable to stand or take a step, I get around in an electric wheelchair in a life-care community and still do as much for myself as I can. Focus on what you have left, not on what you have lost.”
—VERNA W., PWP
If you’ve been diagnosed with Parkinson’s disease, your neurologist or movement disorder specialist may have referred to it as “idiopathic.” This means the cause of the disease is unknown. Approximately 10 percent of people diagnosed with Parkinson’s have a genetic form of the disease.10
If instead you have Parkinson’s-like symptoms but your doctor knows or suspects a cause for them, or if you don’t respond to the usual PD therapy, your doctor may have told you that you have a type of parkinsonism.
There are many types of parkinsonism, and it is important to note that it’s often difficult to distinguish between them and idiopathic PD, especially when the condition is mild. Also, many people don’t show all the signs of any one type of parkinsonism. If this occurs, your doctor may diagnose you as simply having parkinsonism.
Below are more detailed descriptions of idiopathic PD and parkinsonism.
Idiopathic Parkinson’s disease is the name for the most common form of the disease. You may have also heard it called classic Parkinson’s.
People with idiopathic Parkinson’s are diagnosed when they have at least two of the four cardinal motor symptoms (bradykinesia plus one of three: rigidity, resting tremor, or balance problems); when there is no history of brain injury or other illness affecting the brain, or any other known cause of the symptoms; and when there is a good response to levodopa, the main medicine for Parkinson’s. In idiopathic Parkinson’s, the progression tends to be slow and varies from person to person.
Parkinsonism is the umbrella term given to a group of neurological disorders that feature Parkinson’s movement symptoms such as bradykinesia, tremor, stiffness of muscles, and gait and balance problems.
The types of parkinsonism can be categorized as either neurodegenerative (also known as atypical parkinsonism, previously Parkinson’s plus) or secondary parkinsonism.
Parkinson’s symptoms may appear in patients with other neurological disorders, such as the following.
• Dementia with Lewy bodies (DLB)
• Multiple system atrophy (MSA)
• Progressive supernuclear palsy (PSP)
• Corticobasal degeneration (CBD)
• Parkinsonism–Dementia–Amyotrophic Lateral Sclerosis Complex (PD–ALS)
You can read more about these types of parkinsonisms in chapter 6.
Parkinson’s symptoms may be caused by certain medicines or another illness. These types of parkinsonism include the following.
This form of parkinsonism is reversible and occurs when medications cause movement symptoms such as tremor, stiffness, and slowness. The medications often at fault are dopamine blockers, such as those used to treat schizophrenia and other psychiatric illnesses.11
A drug used to treat nausea and indigestion (metoclopramide), as well as one used to treat dizziness and nausea (prochlorperazine), may also produce Parkinson’s symptoms.12 Stopping or lowering the dosage of these medications causes the symptoms to go away.
This type of parkinsonism is sometimes known as pseudoparkinsonism. It results from damage to blood vessels due to multiple small strokes. You probably won’t see tremors in this type of parkinsonism, but you most likely will see prominent gait and balance problems and cognitive impairment (loss of mental skills and abilities).
Drugs used to treat PD don’t really help people with this type of parkinsonism. Treatment of vascular parkinsonism focuses on trying to lower the chances of having additional strokes in the future by attempting to control risk factors.
Some toxins, like manganese dust, carbon disulfide, and carbon monoxide, can also cause parkinsonism. A chemical known as MPTP (methyl-phenyl-tetrahydropyridine) causes a permanent form of parkinsonism that closely resembles PD.
Researchers discovered this reaction in the 1980s when heroin addicts in California who had taken an illicit street drug contaminated with MPTP started to develop severe parkinsonism.13
MPTP-induced parkinsonism is very rapid in its onset (as quick as a few days to full symptoms), whereas idiopathic PD has a slow progression and may take years to become evident.
Parkinsonism symptoms may also appear as a result of brain injury, brain damage caused by anesthesia drugs (such as during surgery), meningitis, narcotics overdoses, mercury poisoning, and HIV/AIDS.