Parkinson's disease is one of the most common nervous system disorders affecting the elderly.
Parkinson's disease occurs when the nerve cells in the brain that make a chemical called dopamine are slowly destroyed. Dopamine helps control muscle movement. Without dopamine, the nerve cells in that part of the brain cannot properly send messages. This leads to the loss of muscle function. The damage gets worse with time. Exactly why these brain cells waste away is unknown.
Secondary parkinsonism may be caused by health problems, including:
There have been cases of secondary parkinsonism among IV drug users who injected a substance called MPTP, which can be produced when making a form of heroin. These cases are rare and have mostly affected long-term drug users.
The health care provider may be able to diagnose secondary parkinsonism after performing a physical exam and asking questions about your medical history and symptoms. However, the symptoms may be difficult to assess, particularly in the elderly.
Examination may show:
Difficulty starting or stopping voluntary movements
Increased muscle tone
Problems with posture
Slow, shuffling walk
Reflexes are usually normal.
Tests may be used to confirm or rule out other disorders that can cause similar symptoms.
If the condition is caused by a medication, your doctor may recommend changing or stopping the medicine. However, the benefits of the medication should be weighed against the severity of symptoms. Medications should be stopped or changed if the risks outweigh the benefits.
Treating underlying conditions such as stroke or infections can reduce symptoms.
If your symptoms make it hard to do everyday activities, your doctor may recommend medication. Many of the medications used to treat this condition can cause severe side effects. It is important that you see your doctor for check-ups. Secondary parkinsonism tends to be less responsive to medical therapy than Parkinson's disease. However, medications are worth trying if the cause of the condition is not treatable.
Discuss the situation with your health care provider if you are unable to care for the person at home (after treatment begins).
Treating conditions that cause secondary parkinsonism may decrease the risk.
People with conditions that require long-term use of antipsychotics should be carefully monitored to prevent the development of secondary parkinsonism. Newer antipsychotic medications are less likely to cause secondary parkinsonism.
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Lang AE. When and how should treatment be started in Parkinson disease? Neurology. 2009;72(7 Suppl):S39-43.
Lewitt PA. Levodopa for the treatment of Parkinson's disease. N Engl J Med. 2008;359(23):2468-76.
Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.