# Parkinsonism, schmarkinsonism! What do all of these terms mean?!

Learn more about the term “parkinsonism” and how it relates to Parkinson’s Disease and other related disorders.

*Jaime Hatcher-Martin, MD, PhD  
April 14, 2023*

People are often confused by the term “parkinsonism” and how it relates to terms like Parkinson’s disease, atypical parkinsonism, Parkinson’s plus syndromes, Lewy body dementia, Parkinson’s disease dementia, drug-induced parkinsonism, and vascular parkinsonism. Here’s a brief summary of what all of these terms mean!

**Parkinsonism** refers to a constellation of symptoms including some or all of the following symptoms: tremors, impairment of fine motor skills (writing, buttoning, etc.), stiffness or rigidity of the muscles, bradykinesia or slowness of movement, soft voice (hypophonia), postural instability (imbalance), shuffling gait or walking, and stooped posture.

**Parkinson's disease (PD)** is the most common cause of parkinsonism. PD refers to the neurodegenerative disorder caused by the degeneration of dopamine-producing neurons (brain cells) in the region of the brain known as the substantia nigra (among other changes). Someone does not typically exhibit clear symptoms of PD until they’ve lost ~80% of the brain cells in this region! This is an important point so remember it for later.

**Atypical parkinsonism** (synonymous with Parkinson’s-plus syndromes) refers to a group of disorders that share many of the symptoms of PD but have additional features that distinguish them from PD. These disorders include:

- Progressive supranuclear palsy (PSP): Characterized by difficulty with balance, leading to significant falls, difficulty with eye movement, dystonia (abnormal postures of limbs), and cognitive decline.
- Multiple system atrophy (MSA): Degeneration of several areas of the brain, leading to parkinsonism and severe autonomic dysfunction, symptoms can include swings in blood pressure and heart rate.
- Corticobasal degeneration (CBD): A rare disorder that leads to symptoms including parkinsonism, dystonia, cognitive decline, and apraxia.

Many people ask, “How can I tell which one I have? They all sound so similar.” I always like to give the (very simplified) example of pasta: you can have noodles, ricotta, mozzarella, and a red sauce. It’s all the SAME ingredients - but the SHAPE of the noodles and how you put the ingredients together that dictates what the dish is.

**Lewy body dementia (LBD)** refers to two different disorders on the same spectrum: Dementia with Lewy Bodies (DLB) and Parkinson’s disease with dementia (PDD).
- **DLB**: Onset of significant cognitive impairment (dementia) and parkinsonism within one year of each other.
- **PDD**: Onset of significant cognitive impairment (dementia) at least one year after a clear diagnosis of PD.

The dementia component may include visual hallucinations, illusions, and paranoia.

**Drug-induced parkinsonism** can occur when the effects of dopamine are blocked by certain medications, leading to symptoms similar to PD.

**Vascular parkinsonism**: Symptoms similar to PD are not due to degeneration of dopamine brain cells, but rather damage to brain regions due to strokes or other vascular issues.

I hope this brief overview helps clarify the terms used to describe the various types of parkinsonism. Let us know if you want to hear more or have additional thoughts for topics to cover in the future!