Many of us are familiar with Parkinson’s disease, but the term parkinsonism may not be as familiar.
Parkinsonism is a term for a group of neurological conditions that cause difficulty with movement. Some of the defining symptoms of parkinsonism include:
Other types of parkinsonism are collectively known as atypical parkinsonian disorders or Parkinson-plus syndromes. There are many types of parkinsonism that closely mimic symptoms of Parkinson’s, and diagnosis can be difficult.
In this article, we look at the different types of parkinsonism and break down the symptoms and treatment of each.
Parkinson’s disease is one of many types of parkinsonism. It’s caused by a loss of cells in the part of your brain that produces the neurotransmitter dopamine.
Parkinson’s disease and the different types of parkinsonism progress in different ways. Some may progress more rapidly than Parkinson’s disease. Others, like secondary parkinsonism, may be reversible.
The conditions also respond differently to treatments. For instance, someone who has a type of parkinsonism may not respond to the drug levodopa, which is commonly used for Parkinson’s disease.
It can be hard to tell the difference between types of parkinsonism. Here’s a look at some of the identified categories of parkinsonism with their typical symptoms and treatments.
Types of atypical parkinsonism include:
Multiple system atrophy
Multiple system atrophy is a rare and progressive disease that’s characterized by abnormal deposits of protein in the nervous system. The cause is unknown, and it affects about 15,000 to 50,000 Americans.
The initial symptoms are similar to those of Parkinson’s disease, but they tend to progress more quickly. They include:
- slowness of movement
- croaking or quivering voice
- fainting or light-headedness
- bladder control problems
There’s currently no treatment for multiple system atrophy that’s known to delay the progression of the disease. Treatment involves targeting individual symptoms.
Progressive supranuclear palsy
Progressive supranuclear palsy is a disorder caused by damage to parts of the brain controlling the cranial nerves. Symptoms vary between people, but the first sign is often loss of balance while walking. This condition also progresses faster than Parkinson’s disease.
Other signs include:
- abrupt and unexplained falls
- may fall backward
- stiff and awkward gait
- slow movement
- blurred vision and problems controlling eyes
- alterations in mood
- slurred speech
- difficulty swallowing
There’s no effective treatment for progressive supranuclear palsy, and it usually doesn’t respond to medication. Treatment revolves around targeting individual symptoms.
Corticobasal syndrome is a progressive neurological disorder that leads to the deterioration of certain areas of your brain. The initial sign is often trouble moving one limb. Eventually, this movement difficulty spreads to all limbs.
The onset of this syndrome is usually between ages 50 to 70. It affects roughly 5 in 100,000 people.
Symptoms vary greatly but may include:
- progressive stiffness of muscles
- inability to make voluntary movements
- brief muscle spasms
- speech and language problems
- involuntary muscle contractions
No treatment has been found to slow the progression of corticobasal syndrome. Parkinson’s drugs are generally ineffective but may help manage stiffness in some people.
Dementia with Lewy bodies
Dementia with Lewy bodies is a disease that leads to deposits of alpha-synuclein proteins in the brain. These proteins are also called Lewy bodies.
Abnormal build-up of these chemicals can cause movement, behavior, mood, and cognitive changes.
More than 1 million people in the United States have Lewy body dementia. It most often occurs in adults over 50 and can progress for 2 to 20 years from its onset to death.
Movement symptoms include:
- muscle stiffness
- shuffling walk
- trouble balancing
- stooped posture
- poor coordination
- difficulty swallowing
Cognitive symptoms can include:
- unpredictable alertness, attention, and wakefulness
- loss of thinking abilities
- memory problems
- changes in mood and behavior
- poor judgment
Secondary parkinsonism is when a medical condition or medication leads to symptoms that resemble Parkinson’s. The most common cause of secondary parkinsonism is a side effect of medications, also known as pseudoparkinsonism.
Drugs that cause parkinsonism
Some drugs can interfere with dopamine transmission in your brain and cause symptoms resembling Parkinson’s.
Drugs that are known to induce parkinsonism include:
- neuroleptics (antipsychotics)
- dopamine depleting drugs
- calcium-channel blockers
- mood stabilizers
- antiepileptic drugs
Treatment usually involves lowering the dose or ceasing use of the offending medication.
Conditions that cause parkinsonism
A number of underlying conditions can potentially lead to brain damage that causes parkinsonism. Some conditions include:
Treatment for parkinsonism caused by an underlying condition involves targeting the root cause and treating the symptoms.
It’s thought that multiple small strokes in the part of your brain that controls movement can lead to a condition called vascular parkinsonism. Vascular parkinsonism is characterized by parkinsonism symptoms primarily in the lower limbs and an unsteady gait in the absence of tremors.
- shuffling gait
- balance problems
- primarily lower body symptoms
- postural instability
Vascular parkinsonism is typically poorly responsive to the medication levodopa. Treatment primarily focuses on treating symptoms. Physical therapy and lifestyle changes to improve cardiovascular health are often recommended.
Infantile parkinsonism-dystonia is a rare disorder that’s also known as dopamine transporter deficiency syndrome. It causes a progressive decline in involuntary muscle contractions and other symptoms that resemble those of Parkinson’s disease. It usually begins in infants.
There’s no cure for infantile parkinsonism-dystonia, and it’s caused by a mutation of the gene SLC6A3.
Symptoms of infantile parkinsonism-dystonia include:
- involuntary and long-lasting muscle contractions and cramps
- difficult with daily activities
- impairments with speaking, eating, drinking, walking, and picking up objects
- slow movements
- muscle stiffness
- impaired balance and coordination
Other symptoms can be present, like:
- abnormal eye movement
- reduced facial expressions
- trouble sleeping
- digestive problems
- recurrent pneumonia
Treatment involves targeting individual symptoms to increase quality of life. Medications to control involuntary muscular contractions and physical therapy are also commonly used.
Juvenile parkinsonism develops before the age of 21. Juvenile parkinsonism that responds to the medication levodopa is most often caused by mutations in the genes PARK-Parkin, PARK-PINK1, or PARK-DJ1.
The symptoms of juvenile parkinsonism are the same as late-onset parkinsonism, but the onset is at a younger age.
The medication levodopa is the most common treatment. But other supportive therapies may also be used, like botulinum toxin for treating involuntary spasms, as well as deep brain stimulation and physical therapy.
No single test can diagnose parkinsonism disorders. Doctors use a combination of tests to rule out other possible conditions and make a diagnosis based on your symptoms and medical history.
For many types of parkinsonism, the exact cause isn’t known. Genetic and environmental factors are both believed to play a role.
Parkinson’s disease has been linked to exposure to pesticides and herbicides, as well as living close to industrial plants. Some genes are also associated with an elevated risk of developing Parkinson’s.
Conditions that cause brain damage, like traumatic injuries, tumors, and exposure to certain toxins, are also potentially contributing factors to the development of parkinsonism.
The outlook of parkinsonism is highly variable depending on factors like the age of onset, the underlying cause, and your overall health. For example, late-onset Parkinson’s disease tends to progress faster and cause earlier cognitive dysfunction than early-onset Parkinson’s.
Parkinsonisms are progressive conditions that get worse over time. Initiating treatment shortly after symptoms begin can help increase life expectancy and improve quality of life.
For Parkinson’s, the primary treatment is the medication levodopa. Treatment varies for other types of parkinsonism, but primarily involves managing symptoms.