1.6 Identify a range of different conditions known under the term Parkinsonism

This guide will help you answer 1.6 Identify a range of different conditions known under the term Parkinsonism.

Parkinsonism is a term used to describe a group of conditions that cause movement symptoms similar to those seen in Parkinson’s disease. These symptoms can include tremor, stiffness, slow movement, and problems with balance. Parkinsonism is not a single illness. Instead, it refers to several conditions that share these characteristics but have different causes.

Some forms of Parkinsonism progress rapidly, while others develop more slowly. The causes can range from degenerative brain disorders to side effects from medication. Treatment and management approaches will depend on the specific condition.

Health and social care workers need to recognise the different types of Parkinsonism to support individuals appropriately. In this guide, we look at a range of conditions that fall under this term.

Parkinson’s Disease

Parkinson’s disease is the most well-known form of Parkinsonism. It happens when nerve cells in the brain that produce dopamine become damaged. Dopamine is a chemical messenger that helps control movement. When dopamine levels drop, the brain cannot send messages to the muscles effectively, leading to movement problems.

Typical symptoms include:

• Tremor in the hands, arms, or legs, usually starting on one side
• Slowness of movement
• Muscle stiffness or rigidity
• Balance and coordination problems

Non-motor symptoms can include depression, sleep disturbances, constipation, and difficulty with memory. Parkinson’s disease is a progressive condition, meaning symptoms usually worsen over time.

Treatment can involve medication to increase dopamine levels, physiotherapy to improve movement, and occupational therapy to help with daily activities.

Vascular Parkinsonism

Vascular Parkinsonism is caused by reduced blood flow to parts of the brain that control movement. This damage is often the result of multiple small strokes. The symptoms can be similar to those of Parkinson’s disease but tend to affect the lower body more.

Common signs include:

• Difficulty walking with a shuffling gait
• Muscle stiffness in the legs
• Slowness when starting to walk
• Poor balance

Unlike Parkinson’s disease, tremor is less common in vascular Parkinsonism. Preventing further strokes by managing blood pressure, cholesterol, and diabetes is an important part of treatment. Some individuals may benefit from physiotherapy to improve walking ability.

Drug-Induced Parkinsonism

Certain medications can cause movement symptoms similar to Parkinson’s disease. This is called drug-induced Parkinsonism. Drugs that block dopamine activity in the brain can lead to these effects. Common examples include some antipsychotics and medicines used to reduce nausea.

Symptoms can include:

• Tremor
• Slowness of movement
• Muscle stiffness

Drug-induced Parkinsonism often affects both sides of the body equally from the start. Stopping or changing the medication can lead to improvement, but this must only be done under medical supervision.

Multiple System Atrophy (MSA)

Multiple System Atrophy is a rare degenerative neurological disorder. It affects multiple systems in the body, including movement, blood pressure regulation, and bladder control. MSA has symptoms similar to Parkinson’s disease, such as slow movement, stiffness, and tremor. However, it usually progresses more quickly.

Other symptoms can include:

• Problems with coordination
• Severe difficulties with blood pressure control, causing dizziness or fainting
• Speech and swallowing problems
• Bladder and bowel issues

There are two main types of MSA. One resembles Parkinson’s disease more closely, while the other resembles cerebellar disorders that affect balance and coordination. There is no cure, but treatments can help manage symptoms.

Progressive Supranuclear Palsy (PSP)

Progressive Supranuclear Palsy is another rare degenerative brain disorder. PSP mainly affects balance, movement, vision, speech, and swallowing. It happens when brain cells in areas controlling movement and thinking are damaged.

Typical signs include:

• Difficulty with balance leading to frequent falls, often backwards
• Stiffness
• Slowness of movement
• Problems moving the eyes, particularly looking up and down
• Speech and swallowing difficulties

PSP progresses more quickly than Parkinson’s disease, and tremor is uncommon. Understanding the differences helps in identifying the correct condition and planning care.

Corticobasal Degeneration (CBD)

Corticobasal Degeneration is a rare condition that affects movement and cognitive abilities. CBD damages nerve cells in specific areas of the brain, leading to asymmetrical symptoms that usually start on one side of the body.

Key symptoms include:

• Stiffness and slowness of movement in one arm or leg
• Poor coordination
• Difficulty performing tasks despite having the physical ability, known as apraxia
• Muscle jerking or spasms
• Speech and language problems

CBD can also affect thinking and memory. This condition does not respond well to standard Parkinson’s medication, making therapy and support for daily living important.

Dementia with Lewy Bodies (DLB)

Dementia with Lewy Bodies is a condition where abnormal protein deposits called Lewy bodies develop in brain cells. These deposits affect memory, thinking, movement, and behaviour. DLB shares symptoms with both Alzheimer’s disease and Parkinson’s disease.

Movement symptoms can include:

• Slowness
• Muscle stiffness
• Tremor

Other features include:

• Fluctuating attention and alertness
• Visual hallucinations
• Severe sensitivity to certain medications

Support involves both managing movement symptoms and providing help with memory and thinking problems.

Wilson’s Disease

Wilson’s disease is a rare genetic disorder. It causes copper to build up in the body, including in the brain. Copper toxicity can damage the areas that control movement, resulting in Parkinsonism symptoms.

Signs can include:

• Stiffness
• Tremor
• Slow movements
• Speech and swallowing problems

Early diagnosis and treatment with medicines that remove excess copper can prevent further damage.

Normal Pressure Hydrocephalus (NPH)

Normal Pressure Hydrocephalus happens when there is a build-up of fluid in the brain’s ventricles. This causes pressure that can lead to walking and thinking difficulties. NPH can mimic some features of Parkinsonism.

Classic symptoms are:

• Difficulty walking with a wide-based, shuffling gait
• Problems with memory and concentration
• Loss of bladder control

Surgical treatment to drain the excess fluid can improve symptoms in some people, making it one of the few treatable causes of Parkinsonism.

Post-Encephalitic Parkinsonism

Post-Encephalitic Parkinsonism can develop after severe brain inflammation caused by encephalitis. This inflammation can damage areas that produce dopamine.

Symptoms may include:

• Tremor
• Slowness of movement
• Stiffness

This form became well known after an epidemic of encephalitis lethargica in the early 20th century. Though rare now, it shows how infections can lead to Parkinsonism.

Toxin-Induced Parkinsonism

Exposure to certain poisons can cause Parkinsonism by damaging dopamine-producing cells. Substances linked to this include manganese, carbon monoxide, and some pesticides.

Symptoms can include:

• Tremor
• Stiffness
• Slowness

Preventing exposure in the workplace and environment is key. Some people may improve once the toxin is removed, but damage can be permanent.

Secondary Parkinsonism from Brain Injury

Severe or repeated head injuries can damage brain areas that control movement. This can lead to symptoms typical of Parkinsonism.

Features may include:

• Slow movement
• Stiffness
• Tremor

This form may be seen in people with a history of repeated concussions, such as some sports players. Support and symptom management are similar to other forms.

Autoimmune-Related Parkinsonism

Some autoimmune diseases can cause inflammation in the brain areas linked to movement control. The immune system mistakenly attacks healthy brain tissue, leading to damage.

This type can sometimes improve with medications that suppress the immune response. Diagnosis may require specialist tests and scans.

Infectious Causes of Parkinsonism

Rarely, other infections besides encephalitis can cause Parkinsonism. Human immunodeficiency virus (HIV), syphilis, and certain viral illnesses have been linked in some cases. Treating the infection can reduce symptoms, but damage may remain if diagnosis is delayed.

Distinguishing Features Across Conditions

Although all these conditions share movement problems, there are differences that can help in identification:

• Tremor presence and type: Common in Parkinson’s disease, less so in vascular Parkinsonism or PSP.
• Symmetry of symptoms: Parkinson’s disease often starts on one side, drug-induced forms tend to be symmetrical.
• Associated problems: Conditions like MSA present with early autonomic symptoms, while DLB includes hallucinations and memory loss.
• Response to treatment: Parkinson’s disease symptoms usually improve with dopamine-based drugs, but other forms may not respond well.

Understanding these clues helps healthcare workers identify the nature of a person’s Parkinsonism.

Supporting People with Parkinsonism

Good care involves recognising individual needs. While symptoms may be similar, the cause, rate of progression, and treatment response can vary greatly. Workers should:

• Record any changes in symptoms
• Report to appropriate healthcare professionals
• Assist with mobility and prevent falls
• Support with personal care tasks
• Provide emotional support
• Encourage independence where possible
• Work with therapists delivering exercise or rehabilitation programmes

Communication should be clear, reassuring, and adapted to the person’s needs. Some will struggle with speech, so patience and alternative communication methods may be necessary.

Final Thoughts

Parkinsonism is a broad term that covers many conditions affecting movement, balance, and in some cases memory and thinking. While Parkinson’s disease is the most common, there are several causes ranging from rare degenerative disorders to side effects of medication. Each type has its own pattern of symptoms, speed of progression, and response to treatment.

As a health and social care worker, recognising that not everyone with Parkinsonism has Parkinson’s disease is important. Awareness of the different types and their specific characteristics allows for better support and informed care planning. By understanding how each form affects the person, you can contribute to improving quality of life and promoting dignity for those living with the condition.