Bradykinesia: Slowness of Movement — What It Means and When to See a Neurologist

Bradykinesia — the abnormal slowing of voluntary movement — is one of the defining motor features of Parkinson's disease and is required for the clinical diagnosis of Parkinsonism. Patients or their families notice: slower walking (shorter steps, reduced arm swing); difficulty rising from a chair; slowness buttoning clothes or typing; decreased facial expression (hypomimia — the "masked face" of Parkinson's); reduced blinking; quiet speech (hypophonia); micrographia (progressively smaller handwriting).

Causes of Bradykinesia

Parkinson's disease: The most important neurological cause. Bradykinesia in PD is due to dopamine depletion in the substantia nigra, reducing the drive to initiate and sustain movements. Combined with resting tremor and rigidity (the three cardinal features). Asymmetric onset (one side first) is characteristic. Drug-induced Parkinsonism: One of the most commonly missed diagnoses. Dopamine-blocking medications — metoclopramide (widely used in India for nausea and gastroparesis, including Perinorm), promethazine, haloperidol, risperidone, olanzapine — block dopamine receptors and produce all features of Parkinsonism, including bradykinesia. This reverses on stopping the medication. Review ALL medications before diagnosing Parkinson's. Hypothyroidism: Can cause slowed movements, cognitive slowing, and depression — TSH is mandatory in all new movement disorder presentations. Depression: Psychomotor slowing (slowed movement and speech) is a feature of severe depression — differentiating from Parkinson's requires careful examination and trial of antidepressant.

Examination

Rapid alternating movements: ask the patient to tap their thumb and index finger together as fast as possible — bradykinesia produces progressive slowing and amplitude decrease (decrement) with repetition. This is the most sensitive bedside test for bradykinesia. For movement disorder evaluation: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.