Hypokinetic rigid syndrome is a clinical syndrome presenting with any combination of bradykinesia (slowness of movement or speed) with rest tremor, rigidity, and postural instability. The most common form of hypokinetic rigid syndrome is Parkinson disease (PD), a chronic, progressive disorder caused by degenerative loss of dopaminergic neurons in the brain. The diagnosis PD is made by a neurologist and based on distinctive clinical features from the history and neurological examination. At a minimum, bradykinesia plus either (asymmetrical) tremor or rigidity must be present in order to consider the diagnosis of PD. Postural instability usually appears later in the course of PD. An unequivocal, beneficial response to dopaminergic therapy supports the diagnosis.
Hypokinetic rigid syndrome is also called parkinsonism. Parkinsonism with other causes than PD, e.g. medication-induced parkinsonism (antipsychotics, antiemetics), vascular parkinsonism or other rare causes, respond poorly to dopaminergic therapy.
Blood tests or radiologic imaging to confirm the diagnosis are not available. The GP refers a patient with (suspected) parkinsonism or PD to a neurologist or Parkinson expertise centre to confirm the diagnosis and startsymptomatic dopaminergic therapy. There is no cure for PD. In the Netherlands, over 3700 primary care and hospital professionals with expertise in parkinsonism collaborate closely in regional healthcare networks within the national ‘ParkinsonNet’ (www.parkinsonnet.nl). Within these networks, specialised nurses, physical therapists, occupational therapists and others provide daily care to patients and build multidisciplinary networks, leading to improved expertise and improved collaborations.
In ICPC-2, parkinsonism (including Parkinson disease) is coded with N87.
PD / parkinsonism has an incidence of 0.2 per 1000 patient years, indicating 2 new diagnoses per 10.000 patients in a year. It is a disease of older age: a diagnosis before the age of 65 is rare. The incidence is highest in patients aged 75 years and older, with men being affected more often than women (2.1 versus 1.2 per 1000 patient years). Link/Figure 1
The prevalence of PD / parkinsonism is 1.7 per 1000 patient years, indicating that among 1000 patients in a year less than two seek help from their GP for PD / parkinsonism. These encounters include consultations at the GP practice, at the patient’s home or by telephone, as well as (repeat) medication prescriptions and administrative contacts (e.g. writing or receipt of letters / notes). Link/Figure 2
In patients aged 65 years and over, PD / parkinsonism is not among the most prevalent conditions as seen by FaMe-Net GPs. Link/Table 3 This means that, although PD / parkinsonism is a serious disease with large implications for patients’ daily activities, it is not a condition for which a high proportion of the GP practice population seeks medical help over the course of one year – and that the GP is not regularly consulted for PD / parkinsonism.
The most common initial complaint (reason for encounter) of patients with PD / parkinsonism contacting their GP is abnormal involuntary movements (N08). Link/Table 4
During a year, in 72% of all episodes of PD / parkinsonism medication is prescribed by the GP. Link/Table 5 The mostly prescribed medication types are dopa and dopa derivates, and dopamine agonists, such as (combinations of) levodopa, decarboxylase inhibitors and COMT inhibitors. Link/Table 6
Next to this, referrals to other primary health care providers (in 23% of the episodes PD / parkinsonism) and to a specialist (in 18%) are relatively common. Link/Table 5 GPs refer mostly to physical therapy (10%) and occupational therapy (8%) in primary care. Link/Table 7 Specialist referrals occur mostly to neurology. Link/Table 8 Note that these are mean percentages calculated per calendar year, and not throughout the entire episode of PD / parkinsonism, which makes these percentages seem relatively low.
Dutch guideline: https://richtlijnen.nhg.org/standaarden/ziekte-vanparkinson#volledige-tekst (2011)
Chou KL. Clinical manifestations of Parkinson disease. In: UpToDate, Hurtig HI, Eichler AF (Eds), UpToDate, Waltham, MA, 2023
Sturkenboom I, Nijkrake M, Woltjer H, Fritz J, Kaysen A, Tiemessen M, Kalf J. Implementation of the ParkinsonNet care concept shows better expertise and work satisfaction of health professionals, but improvement of multidisciplinary collaboration takes longer than one year [abstract]. Mov Disord. 2020; 35 (suppl 1). Accessed December 28, 2022.
