Parkinson’s Disease: Classification

Parkinson’s syndromes are divided into four groups:

1. Idiopathic Parkinson’s disease (IPS, Parkinson’s disease, approximately 75% of all PS), classified into the following courses with respect to clinical symptoms:
   • Akinetic-rigid type (immobility, rigidity of movement; stiffness of the muscles due to an increase in muscle tone).
   • Equivalent type
   • Tremor dominance type
   • Monosymptomatic rest tremor/rest tremor (rare variant).
2. Genetic forms of Parkinson’s disease.
   • Monogenetic forms (PARK 1-16).
3. Parkinsonian syndromes in the setting of other neurodegenerative diseases (atypical Parkinsonian syndromes):
   • Multisystem atrophy (MSA): parkinsonian type (MSA-P) or cerebellar type (MSA-C).
   • Lewy body type dementia (DLK).
   • Progressive supranuclear gaze palsy (PSP; synonym: Steele-Richardson-Olszewski syndrome (SRO)) – neurodegenerative disorder of unknown etiology associated with progressive cell destruction in the basal ganglia.
   • Corticobasal degeneration (CBD).
4. Symptomatic (secondary) parkinsonian syndromes.
   • drug-induced:
     • Flunarizine-type calcium antagonists: cinnarizine, flunarizine.
     • Classical neuroleptics, antiemetics, reserpine.
     • Lithium
     • Valproic acid
   • Tumor-related
   • Post-traumatic (e.g., boxer’s encephalopathy/traumatic brain injury of (professional) boxers after single or multiple hits to the head).
   • Toxin-induced ( e.g., by manganese, carbon monoxide, methyl alcohol, cobalt, cyanide, MPTP (1-methyl-1-4-phenyl-1,2,3,6-tetrahydropyridine), disulfiram)
   • Inflammatory (AIDS encephalopathy or rare encephalitides).
   • Metabolic (metabolic: e.g. Wilson’s disease (copper storage disease), hypoparathyroidism (parathyroidism)).

The neurodegenerative parkinsonian syndromes (item 1 [IPS] and item 3 [atypical parkinsonian syndromes]) are now also classified according to pathological criteria into synucleinopathies (IPS, MSA, DLK) and tauopathies (PSP, CBD).