Pseudoparkinsonism: A review of a common nonparkinsonian hypokinetic movement disorder
ABSTRACT
This article reviews the syndrome pseudoparkinsonism, a movement disorder described in the literature that resembles parkinsonism but differs qualitatively. Patients with this disorder have apraxic slowness, paratonic rigidity, frontal gait disorder and elements of akinesia that, taken together, may be mistaken for true parkinsonism. Pseudoparkinsonism appears to be common and is most often due to Alzheimer’s disease or vascular dementia. It seems that patients with even mild cognitive deficits can present with pseudoparkinsonism and that the primary dementing disorder may be overlooked. The authors emphasize the importance of pseudoparkinsonism and implications for clinical diagnosis, treatment and research.
This article reviews the syndrome pseudoparkinsonism, a movement disorder described in the literature that resembles parkinsonism but differs qualitatively. Patients with this disorder have apraxic slowness, paratonic rigidity, frontal gait disorder and elements of akinesia that, taken together, may be mistaken for true parkinsonism. Pseudoparkinsonism appears to be common and is most often due to Alzheimer’s disease or vascular dementia. It seems that patients with even mild cognitive deficits can present with pseudoparkinsonism and that the primary dementing disorder may be overlooked. The authors emphasize the importance of pseudoparkinsonism and implications for clinical diagnosis, treatment and research.
Cite this paper
Kurlan, R. and Rabin, M. (2013) Pseudoparkinsonism: A review of a common nonparkinsonian hypokinetic movement disorder. Advances in Parkinson's Disease, 2, 108-112. doi: 10.4236/apd.2013.24020.
Kurlan, R. and Rabin, M. (2013) Pseudoparkinsonism: A review of a common nonparkinsonian hypokinetic movement disorder. Advances in Parkinson's Disease, 2, 108-112. doi: 10.4236/apd.2013.24020.
References
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Archives of Neurology, 50, 140-148. http://dx.doi.org/10.1001/archneur.1993.00540020018011 [24] Rajput, A.H., Rozdilsky, B. and Rajput, A. (1991) Accuracy of clinical diagnosis in parkinsonism: A prospective study. Canadian Journal of Neurological Sciences, 18, 275-278. [25] Gorelick, P.B., Scuteri, A., Black, S.E., et al. (2011) AHA/ ASA Scientific Statement: Vascular contributions to cognitive impairment and dementia. Stroke, 42, 2672-2713. http://dx.doi.org/10.1161/STR.0b013e3182299496 [26] McGinn, A.P., Kaplan, R.C., Verghese, J., et al. (2008) Walking speed and risk of incident ischemic stroke among postmenopausal women. Stroke, 39, 1233-1239. http://dx.doi.org/10.1161/STROKEAHA.107.500850 [27] Briley, D.P., Wasay, M., Sergent, S. and Thomas, S. (1997) Cerebral white matter changes (leukoariosis), stroke, and gait disturbance. Journal of the American Geriatrics Society, 45, 1434-1438. [28] Baloh, R.W., Yue, Q., Socotch, T.M. and Jacobsen, K.M. (1995) White matter lesions and disequilibrium in older people. Archives of Neurology, 52, 970-974. http://dx.doi.org/10.1001/archneur.1995.00540340062013 [29] Sorond, F.A., Kiely, D.K., Galica, A., et al. (2011) Neurovascular coupling is impaired in slow walkers: The MOBILIZE Boston study. Annals of Neurology, 70, 213-220. http://dx.doi.org/10.1002/ana.22433 [30] Dodge, H.H., Mattek, N.C., Austin, D., et al. (2012) Inhome walking speed and variability trajectories associated with mild cognitive impairment. Neurology, 78, 1946-1952. http://dx.doi.org/10.1212/WNL.0b013e318259e1de
[1] Kabat, H. (1959) Drug therapy of cerebellar ataxia and disorders of the basal ganglia, based on cerebellar-striatal antagonism. Annals of Internal Medicine, 50, 1438-1448. http://dx.doi.org/10.7326/0003-4819-50-6-1438 [2] Crane, G.E. (1972) Pseudoparkinsonism and tardive dyskinesia. Archives of Neurology, 27, 426-430. http://dx.doi.org/10.1001/archneur.1972.00490170058008 [3] Janowsky, D.S., el-Yousef, M.K., Davis, J.M., et al. (1972) Effects of amantadine on tardive dyskinesia and pseudo-parkinsonism. The New England Journal of Medicine, 286, 785. http://dx.doi.org/10.1056/NEJM197204062861424 [4] Yassa, R. and Nair, V. (1988) The association of tardive dyskinesia and pseudoparkinsonism. Neuro-Psychopharmacology and Biological Psychiatry, 12, 909-914. [5] Chang, C.M., Yu, Y.L., Ng, H.K., et al. (1992) Vascular pseudoparkinsonism. Acta Neurologica Scandinavica, 86, 588-592. http://dx.doi.org/10.1111/j.1600-0404.1992.tb05492.x [6] Sibon, I., Fenelon, G., Quinn, N.P. and Tison, F. (2004) Vascular parkinsonism. Journal of Neurology, 251, 513-524. http://dx.doi.org/10.1007/s00415-004-0421-4 [7] Demirkirn, M., Bozdemir, H. and Sarica, Y. (2001) Vascular parkinsonism: A distinct, heterogeneous clinical entity. Acta Neurologica Scandinavica, 104, 63-67. http://dx.doi.org/10.1034/j.1600-0404.2001.104002063.x [8] Zijlmans, J.C., Daniel, S.E., Hughes, A.J., et al. (2004) Clinicopathological investigation of vascular Parkinsonism. Movement Disorders, 19, 630-640. http://dx.doi.org/10.1002/mds.20083 [9] Kurlan, R., Richard, I.H., Papka, M. and Marshall, F. (2000) Movement disorders in Alzheimer’s disease: More rigidity of definitions is needed. Movement Disorders, 15, 24-29. http://dx.doi.org/10.1002/1531-8257(200001)15:1<24::AID-MDS1006>3.0.CO;2-X [10] Pearce, J. (1974) The extrapyramidal disorder of Alzheimer’s disease. European Neurology, 12, 94-116. http://dx.doi.org/10.1159/000114608 [11] Molsa, P.K., Marttila, R.J. and Rinne, U.K. (1984) Extrapyramidal signs in Alzheimer’s disease. Neurology, 34, 1114-1116. http://dx.doi.org/10.1212/WNL.34.8.1114 [12] Chui, H.C., Lyness, S.A., Sobel, E. and Schneider, L.S. (1994) Extrapyramidal signs and psychiatric symptoms predict faster cognitive decline in Alzheimer’s disease. Archives of Neurology, 51, 676-681. http://dx.doi.org/10.1001/archneur.1994.00540190056015 [13] Chui, H.C., Teng, E.L., Henderson, V.W. and Moy, A.C. (1988) Clinical sub-types of dementia of the Alzheimer’s type. Neurology, 35, 1544-1550. http://dx.doi.org/10.1212/WNL.35.11.1544 [14] Stern, Y., Albert, M., Brandt, J., et al. (1994) Utility of extrapyramidal signs and psychosis as predictors of cognitive and functional decline, nursing home admission and death in Alzheimer’s disease: Prospective analyses from the Predictors Study. Neurology, 44, 2300-2307. http://dx.doi.org/10.1212/WNL.44.12.2300 [15] Schmidt, C., Wolff, M., Weitz, M., et al. (2001) Rapidly progressive Alzheimer’s disease. Archives of Neurology, 68, 1124-1130. http://dx.doi.org/10.1001/archneurol.2011.189 [16] Berardelli, A., Rothwell, J.C., Thompson, P.D., et al. (2001) Pathophysiology of bradykinesia in Parkinson’s disease. Brain, 124, 2131-2146. http://dx.doi.org/10.1093/brain/124.11.2131 [17] Hobbelen, J.H.S.M., Koopmans, R.T.C.M., Verhey, F.R.J., et al. (2006) Paratonia: A Delphi procedure for consensus definition. Journal of Geriatric Physical Therapy, 29, 6-12. http://dx.doi.org/10.1519/00139143-200608000-00002 [18] Nutt, J.G., Marsden, C.D. and Thompson, P.D. (1993) Human walking and higher level gait disorders, particularly in the elderly. Neurology, 43, 268-279. http://dx.doi.org/10.1212/WNL.43.2.268 [19] Bhatt, M.H., Obeso, J.A. and Marsden, C.D. (1993) Time course of postanoxic akinetic-rigid and dystonic syndromes. Movement Disorders, 43, 314-322. [20] Singer, C., Berger, J.R., Bowen, B.C., et al. (1993) Akineticrigid syndrome in a 13-year-old girl with HIV-related progressive multifocal leukoencephalopathy. Movement Disorders, 8, 113-116. http://dx.doi.org/10.1002/mds.870080120 [21] Bhatt, M., Desai, J., Mankodi, A., et al. (2000) Posttraumatic akinetic-rigid syndrome resembling Parkinson’s disease: A report on three patients. Movement Disorders, 15, 313-317. http://dx.doi.org/10.1002/1531-8257(200003)15:2<313::AID-MDS1017>3.0.CO;2-P [22] Iansek, R., Huxham, F. and McGinley, J. (2006) The sequence effect and gait festination in Parkinson’s disease: Contributors to freezing of gait? Movement Disorders, 21, 1419-1424. http://dx.doi.org/10.1002/mds.20998 [23] Hughes, T.A., Daniel, S.E., Blankson, S. and Lees, A.J. (1993) A clinicopathologic study of 100 cases of Parkinson’s disease. Archives of Neurology, 50, 140-148. http://dx.doi.org/10.1001/archneur.1993.00540020018011 [24] Rajput, A.H., Rozdilsky, B. and Rajput, A. (1991) Accuracy of clinical diagnosis in parkinsonism: A prospective study. Canadian Journal of Neurological Sciences, 18, 275-278. [25] Gorelick, P.B., Scuteri, A., Black, S.E., et al. (2011) AHA/ ASA Scientific Statement: Vascular contributions to cognitive impairment and dementia. Stroke, 42, 2672-2713. http://dx.doi.org/10.1161/STR.0b013e3182299496 [26] McGinn, A.P., Kaplan, R.C., Verghese, J., et al. (2008) Walking speed and risk of incident ischemic stroke among postmenopausal women. Stroke, 39, 1233-1239. http://dx.doi.org/10.1161/STROKEAHA.107.500850 [27] Briley, D.P., Wasay, M., Sergent, S. and Thomas, S. (1997) Cerebral white matter changes (leukoariosis), stroke, and gait disturbance. Journal of the American Geriatrics Society, 45, 1434-1438. [28] Baloh, R.W., Yue, Q., Socotch, T.M. and Jacobsen, K.M. (1995) White matter lesions and disequilibrium in older people. Archives of Neurology, 52, 970-974. http://dx.doi.org/10.1001/archneur.1995.00540340062013 [29] Sorond, F.A., Kiely, D.K., Galica, A., et al. (2011) Neurovascular coupling is impaired in slow walkers: The MOBILIZE Boston study. Annals of Neurology, 70, 213-220. http://dx.doi.org/10.1002/ana.22433 [30] Dodge, H.H., Mattek, N.C., Austin, D., et al. (2012) Inhome walking speed and variability trajectories associated with mild cognitive impairment. Neurology, 78, 1946-1952. http://dx.doi.org/10.1212/WNL.0b013e318259e1de