Chapter 14. Movement Disorders

Burton Scott, Ph.D., M.D.
DOI: 10.1176/appi.books.9781585623754.391510



As people age, a variety of movement disorders can either appear for the first time or progress after onset earlier in life. Arthritis, bursitis, tendonitis, and other non–central nervous system conditions can in some ways mimic neurological conditions by causing stooped posture and overall slowing of movement. In this chapter, I discuss central nervous system–based movement disorders that occur in elderly individuals and result in impaired or abnormal movement.

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Table 14–1. Clinical features of parkinsonism
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Table 14–2. Differential diagnosis of parkinsonism
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Table 14–3. Motor complications of Parkinson's disease
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Table 14–4. Nonmotor features of Parkinson's disease
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Table 14–5. Medical treatment of Parkinson's disease


Benito-Leon J, Louis ED: Clinical update: diagnosis and treatment of essential tremor. Lancet 369:1152–1154, 2007
Chouinard G, Jones B, Remington G, et al: Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients. J Clin Psychopharmacol 13:25–40, 1993
de Bruin VMS, Lees AJ, Daniel SE: Diffuse Lewy body disease presenting with supranuclear gaze palsy, parkinsonism, and dementia: a case report. Mov Disord 7:355–358, 1992
DeLeon ML, Jankovic J: Clinical features and management of tardive dyskinesias, tardive myoclonus, tardive tremor, and tardive tourettism, in Drug Induced Movement Disorders. Edited by Sethi K. New York, Marcel Dekker, 2004, pp 77–109
Forno LS: Neuropathology of Parkinson's disease. J Neuropathol Exp Neurol 55:259–272, 1996
Foster NL, Wilhelmsen K, Sima AAF, et al: Frontotemporal dementia and parkinsonism linked to chromosome 17: a consensus conference. Participants of the Chromosome 17–Related Dementia Conference. Ann Neurol 41:706–715, 1997
Gibb WRG, Luthert PJ, Marsden CD: Clinical and pathological features of corticobasal degeneration. Adv Neurol 53:51–54, 1990
Golbe LI: Alpha-synuclein and Parkinson's disease. Mov Disord 14:6–9, 1999
Golbe LI, Davis PH: Progressive supranuclear palsy, in Parkinson's Disease and Movement Disorders, 2nd Edition. Edited by Jankovic J, Tolosa E. Baltimore, MD, Williams & Wilkins, 1993, pp 145–161
Hallett M, Fahn S, Jankovic J, et al (eds): Psychogenic Movement Disorders: Neurology and Neuropsychiatry. Philadelphia. Lippincott Williams & Wilkins, 2006
Jankovic J: Progressive supranuclear palsy: clinical and pharmacologic update. Neurol Clin 2:473–486, 1984
Jankovic J: Essential tremor: clinical characteristics. Neurology 54:S21–S25, 2000
Jankovic J, Friedman DI, Pirozzolo FJ, et al: Progressive supranuclear palsy: motor, neurobehavioral, and neuro-ophthalmic findings. Adv Neurol 53:293–304, 1990
Koller WC, Lang A, Vetere-Overfield B, et al: Psychogenic tremors. Neurology 39:1094–1099, 1989
Kraft E, Schwarz J, Trenkwalder C, et al: The combination of hypointense and hyperintense signal changes on T2-weighted magnetic resonance sequences: a specific marker for multiple system atrophy? Arch Neurol 56:225–228, 1999
Lang AE, Lozano AM: Parkinson's disease: first of two parts. N Engl J Med 339:1044–1053, 1998a
Lang AE, Lozano AM: Parkinson's disease: second of two parts. N Engl J Med 339:1130–1143, 1998b
Litvan I: Progressive supranuclear palsy revisited. Acta Neurol Scand 98:73–84, 1998
Litvan I, Agid Y, Calne D, et al: Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology 47:1–9, 1996
Litvan I, Agid Y, Goetz C, et al: Accuracy of the clinical diagnosis of corticobasal degeneration: a clinicopathologic study. Neurology 48:119–125, 1997
Lund and Manchester Groups: Clinical and neuropathological criteria for frontotemporal dementia. J Neurol Neurosurg Psychiatry 57:416–418, 1994
Meltzer HY: The mechanism of action of clozapine in relation to its clinical advantages, in Novel Antipsychotic Drugs. Edited by Meltzer HY. New York, Raven, 1992, pp 1–13
Mendis T, Mohr E, George A, et al: Symptomatic relief from treatment-induced psychosis in Parkinson's disease: an open-label pilot study with remoxipride. Mov Disord 9:197–200, 1994
Miyasaki JM, Shannon K, Voon V, et al: Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review). Neurology 66:996–1002, 2006
Mutch WJ, Dingwall-Fordyce I, Downie AW, et al: Parkinson's disease in a Scottish city. Br Med J (Clin Res Ed) 292:534–536, 1986
Myers BH, Scott BL: A case of combined orthostatic tremor and primary gait ignition failure. Clin Neurol Neurosurg 105:277–280, 2003
Pahwa R, Factor SA, Lyons KE, et al: Practice parameter: Treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review). Neurology 66:983–995, 2006
Papapetropoulos S, Singer C: Botulinum toxin in movement disorders. Semin Neurol 27:183–194, 2007
Patrick LR: Restless legs syndrome: pathophysiology and the role of iron and folate. Altern Med Rev 12:101–112, 2007
Quinn NP: Multiple system atrophy, in Movement Disorders 3 (Butterworth-Heinemann International Medical Reviews. Neurology 12). Edited by Marsden CD, Fahn S. Boston, MA, Butterworth-Heinemann, 1994, pp 262–281
Riley DE, Lang AE: Clinical diagnostic criteria, in Corticobasal Degeneration (Advances in Neurology, Vol 82). Edited by Litvan I, Goetz CG, Lang AE. Philadelphia, PA, Lippincott Williams & Wilkins, 2000, pp 29–34
Savoiardo M, Grisoli M, Girotti F: Magnetic resonance imaging in CBD, related atypical parkinsonian disorders, and dementias, in Corticobasal Degeneration (Advances in Neurology, Vol 82). Edited by Litvan I, Goetz CG, Lang AE. Philadelphia, PA, Lippincott Williams & Wilkins, 2000, pp 197–208
Schneider JA, Watts RL, Gearing M, et al: Corticobasal degeneration: neuropathologic and clinical heterogeneity. Neurology 48:959–969, 1997
Scott BL: Evaluation and treatment of dystonia. South Med J 93:746–751, 2000
Scott BL, Jankovic J: Delayed-onset progressive movement disorders after static brain lesions. Neurology 46:68–74, 1996
Sheppard DM, Bradshaw JL, Purcell R, et al: Tourette's and comorbid syndromes: obsessive compulsive and attention deficit hyperactivity disorder: a common etiology? Clin Psychol Rev 19:531–552, 1999
Shulman LM, Weiner WJ: Multiple-system atrophy, in Movement Disorders: Neurologic Principles and Practice. Edited by Watts RL, Koller WC. New York, McGraw-Hill, 1997, pp 297–306
Shy GM, Drager GA: A neurological syndrome associated with orthostatic hypotension. Arch Neurol 2:511–527, 1960
Steele JC, Richardson JC, Olszewski J: Progressive supranuclear palsy: a heterogeneous degeneration involving the brain stem, basal ganglia and cerebellum, with vertical gaze and pseudobulbar palsy, nuchal dystonia and dementia. Arch Neurol 10:333–359, 1964
Suchowersky O, Gronseth G, Perlmutter J, et al: Practice parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review). Neurology 66:976–982, 2006a
Suchowersky O, Reich S, Perlmutter J, et al: Practice parameter: diagnosis and prognosis of new onset Parkinson disease (an evidence-based review). Neurology 66:968–975, 2006b
Sutcliffe RL, Prior R, Mawby B, et al: Parkinson's disease in the district of the Northampton Health Authority, United Kingdom: a study of prevalence and disability. Acta Neurol Scand 72:363–379, 1985
Tarsy D, Simon DK: Dystonia. N Engl J Med 355:818–829, 2006
Vercueil L: Myoclonus and movement disorders. Neurophysiol Clin 36:327–331, 2006
Walker FO: Huntington's disease. Semin Neurol 27:143–150, 2007
Wenning GK, Ben Shlomo Y, Magalhaes M, et al: Clinical features and natural history of multiple system atrophy: an analysis of 100 cases. Brain 117:835–845, 1994

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Sample questions:
Parkinsonism has been associated with the use of antipsychotic medications. Which of the following agents is least likely to produce parkinsonism symptoms?
Parkinson's disease is a chronic, progressive, neurodegenerative illness that produces a constellation of motoric symptoms. Which of the following symptoms usually does not occur in Parkinson's disease?
There are a number of motor complications of Parkinson's disease. Which of the following symptoms is usually secondary to medications used to treat Parkinson's disease?
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