Parkinsonism
What is it?
Parkinsonism (including Parkinson’s disease)
Parkinsonism describes a cluster of symptoms including tremor, rigidity (stiffness), akinesia or bradykinesia (loss or slowness of voluntary movement) and postural instability (tendency to fall). Parkinsonism typically affects persons aged 50 years and older. The most common cause of parkinsonism is Parkinson’s disease. Other causes include other brain disorders, toxins, medications and inherited disorders. These various causes lead to parkinsonism through changes in a region of the brain called the basal ganglia. Among persons with Parkinson’s disease, there is evidence of a loss of dopamine-producing neurons in the substantia nigra part of the basal ganglia.
An individual with parkinsonism will experience difficulty with initiation and completion of movement, with fine motor skills and with walking. Other difficulties include effects on swallowing, volume of voice, blinking and initiation of spontaneous facial expressions. Parkinsonism also causes unintentional movement in the form of tremor, which in the hand can resemble the rolling of a pill or small object when the hand is at rest. Symptoms not related to motor function include cognitive impairment, mood disturbance including depression, anxiety and apathy, constipation and bladder disturbance, pain related to rigidity, and disordered sleep – all of which greatly hamper quality of life. In patients with onset before the age of 65, parkinsonism may lead to premature retirement or necessitate disability leave. Parkinsonism also impairs the ability to communicate and interact with the surrounding environment, which often instills a sense of isolation among affected persons. Dopamine replacement medications can help some of the symptoms of parkinsonism, especially in Parkinson’s disease, but these effects are usually transient and there are no cures.
Many symptoms of parkinsonism cause complications leading to hospitalization – among them, pneumonia and other infections and fall-related injuries. Further, individuals with parkinsonism may develop significant cognitive impairment and psychiatric changes including hallucinations leading to nursing home placement. Persons with advanced parkinsonism require caregiver help and may become completely dependent for all activities of self-care.
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- number of people in Ontario with the disorder
- age of people with the disorder
- sex ratio of people with the disorder
- what other brain disorders commonly co-occur
- overlap with mental health and addictions health system use
- costs & cost drivers associated with health system use
Sex breakdown
On April 1, 2019 males accounted for 56% of the 44,503 Ontarians identified with parkinsonism.
Age breakdown
On April 1, 2019 the majority of people with parkinsonism were between the ages of 75 and 84 years, with 81% of people being over the age of 65. The mean age of a person with parkinsonism was 74 ± 12 years.
Number of people
Incidence is the number of people newly diagnosed with a disorder within a given time period while prevalence is the number of people existing with the disorder at a given time.
The incidence and prevalence of Ontarians with parkinsonism are depicted in orange and blue, respectively. Between 2011 and 2019, incidence changed from 46.78 to 49.11 per 100,000 people and prevalence increased from 346.20 to 366.05 per 100,000 people.
In total, the number of people with parkinsonism increased from 35,157 in 2011 to 44,503 people in 2019.
Cost drivers
In 2019, the average total cost to the health system for an Ontarian with parkinsonism was approximately equal for an incident case and a prevalent case. Cost relationship is indicated by total box size. The largest cost driver of incident cases was attributable to hospital care (44%), while long term care (30%) and hospital care (27%) had the highest costs for prevalent cases.
The average total health care costs for a person with parkinsonism (prevalent case) for 1 year are 7X higher for adults and 3X higher for seniors compared to the average Ontarian.
Cost driver breakdown
Overall, health care costs (in Canadian dollars, 2019) for people with parkinsonism are higher for the senior (65+ years) population compared to adults (20 - 64 years) and are also similar for females and males. The cost drivers, those services that drive health care costs, vary depending on age and sex. Amongst senior, long care accounts for the largest cost driver at 32% of all costs, while hospital care drives costs in the adult population at 40% of all costs. Long term care is the largest cost driver in females at 36% and hospital care drives costs in males at 31% of the health care costs.
Co-occurring brain disorders
Of those individuals who were identified as having parkinsonism between 2011 and 2019, 62% (blue) were also identified as having one of the other 12 brain disorders studied using health administrative data. Dementia was the top co-occurring brain disorder, with 42% of those with parkinsonism also having dementia, followed by 8% having had a stroke, and 6% having a traumatic brain injury or concussion.
Mental health
Of those individuals who were identified as having parkinsonism in 2019, their visit rates for mental health and addictions related services were between 3.3X to 11.8X greater than the general Ontario population, depending on visit type.