Defining parkinsonism in the Canadian Study of Health and Aging

This study sought an operational definition of parkinsonism in elderly people (n = 2,914) who underwent a clinical examination in the Canadian Study of Health and Aging (CSHA). Parkinsonism was defined as having two of the following features: (1) bradykinesia of face or limbs, (2) resting tremor, (3) rigidity, and (4) abnormality of gait and posture. The association of parkinsonism with other parkinsonian-related features (prior diagnosis of Parkinson's disease, use of drugs with extrapyramidal side effects, and use of antiparkinsonian medications) and variables not expected to be related to parkinsonism (stroke and Hachinski score > 5) was determined. Parkinsonism was identified in 337 people (11.6%). It was significantly more likely with other parkinsonian-related characteristics, and was not associated with a history of stroke, but was slightly higher among those subjects with a Hachinski score > 5. Posture and gait abnormalities were significantly associated with other parkinsonian-related variables, but were also more common among subjects with stroke-related features. When the gait and posture disturbance category was excluded as a parkinsonian sign, the narrower definition was more specific but less sensitive in detecting cases with a clinical diagnosis of Parkinson's disease. Despite limitations, the approach presented in this article is a valid method to operationalize parkinsonism from the dataset.