Clinical Syndromes, Clinical Features Of Parkinsonism, Neuroanatomical Considerations, TreatmentPrognosis
Parkinsonism is a term that describes a group of disorders in which patients present with varying combinations of tremor, muscle rigidity, slowed movements (bradykinesia), and postural disturbances, including falls. In addition to these signs (not all of which need to be present), patients with parkinsonism also exhibit other neurological symptoms. Parkinsonism needs to be distinguished from idiopathic Parkinson's disease, in which the cardinal diagnostic features of tremor, rigidity, bradykinesia, and postural disturbance are present. To make a diagnosis of Parkinson's disease, each of these symptoms must be present and responsive to levodopa, a medication that is converted to dopamine, which is a natural substance depleted in Parkinson's disease. In addition, from a neuropathological point of view, patients with idiopathic Parkinson's disease have dopaminergic cell degeneration in substantia nigra, an area found in the deep part of the brain, and these cells contain characteristic debris within the nuclei of the cells, called Lewy bodies. Patients with parkinsonism, in general, do not have these neuropathological findings in the substantia nigra to the same extent and, clinically, they are poorly responsive to levodopa.
Parkinsonism, either alone, (as in Parkinson's disease) or in association with other neurological illnesses, appears to reduce life expectancy in older adults. How this occurs is not clear, nor is it clear what role treatment plays. These and other issues suggest that further research is needed to come to grips with the challenge of parkinsonism in an aging society.
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