parkinsonismi

Parkinsonismi, or parkinsonism, is a clinical syndrome defined by bradykinesia and at least one of rigidity, rest tremor, or impaired postural reflexes. It encompasses Parkinson's disease as well as other conditions that produce similar movement abnormalities through dopaminergic dysfunction in the basal ganglia.

The most common form is idiopathic Parkinson's disease. Other causes include drug-induced parkinsonism (antipsychotics, metoclopramide), vascular parkinsonism from cerebrovascular disease, and neurodegenerative syndromes such as progressive supranuclear palsy, multiple system atrophy, or corticobasal degeneration. Toxins and infections may also contribute.

Symptoms include the cardinal motor signs—bradykinesia, rigidity, tremor, and postural instability—plus nonmotor features such as constipation, sleep disturbances, mood changes, and cognitive impairment in later stages.

Diagnosis is clinical. Imaging like DAT-SPECT can support differentiation from other tremor disorders and MRI can help identify secondary causes. A good dopaminergic response to treatment supports the diagnosis of degenerative parkinsonism.

Treatment is tailored to the cause and individual. For idiopathic Parkinson's disease, levodopa is the most effective symptomatic therapy, often combined with carbidopa, with adjuncts such as MAO-B inhibitors, COMT inhibitors, or dopamine agonists. Physical and occupational therapy and, in selected cases, deep brain stimulation may help.

Prognosis varies with age, etiology, and disease progression. Idiopathic Parkinson's disease generally progresses gradually over years, while secondary parkinsonism may improve if the underlying cause is addressed.