Atypical Parkinson’s & Parkinsonisms

Overview: There are a handful of movement disorders and Parkinson’s-like symptoms referred to as “Parkinsonisms.” Your neurologist will assess your symptoms and progression to determine if you have Parkinson’s or atypical Parkinson/Parkinsonism. Because Parkinson’s is a clinical diagnosis (meaning the diagnosis is reached through observation, testing, and process of elimination), you may get a Parkinson’s diagnosis that evolves into a Parkinsonism diagnosis. 

Parkinson’s – Parkinson’s is a progressive neurodegenerative condition characterized by neuron death and loss of dopamine in the substantia nigra area of the brain, which ultimately affects muscle control, speech, mood, and memory. 

Atypical Parkinsonism – Atypical Parkinson’s disorders, also called “Parkinson’s Plus,” are a group of neurodegenerative conditions with similar symptoms to Parkinson’s that advance at a quicker pace, often within 1-3 years. They may be less responsive to levodopa medications and other classic Parkinson’s treatments. These conditions include (but are not limited to): 

● Dementia with Lewy Bodies (DLB) – Lewy bodies are abnormal deposits of alpha-synuclein protein on the nerve cells in the brain, which affects the production of dopamine, causing Parkinson’s symptoms. However, DLB is characterized initially by dementia and cognitive disorders; Parkinson’s motor symptoms appear later. 

● Multiple System Atrophy (MSA) – MSA affects multiple systems in the body; both motor skills and involuntary or autonomic systems in the body are impacted, with the autonomic nervous system severely impacted early in the disease progression. Symptoms may include bladder problems, orthostatic hypotension, impaired speech, and difficulty breathing and swallowing. MSA does not respond strongly to Parkinson’s medications. 

● Progressive Supranuclear Palsy (PSP) – Sometimes referred to as “Parkinson’s on steroids,” PSP is characterized by vision problems and loss of balance. Nuclei damaged in the brain control eye movements, so people with PSP may have trouble focusing their eyes, may complain of blurred vision, and

may have trouble with balance, resulting in higher likelihood of falls. People with PSP tend to lean backwards, as opposed to people with Parkinson’s, who tend to hunch forward as they walk. PSP progresses more rapidly than Parkinson’s; it may respond to levodopa treatments but at higher doses. 

● Corticobasal Degeneration (CBD) – CBD primarily causes problems with movement and is characterized by loss of function on one side of the body, especially involuntary muscle jerks, along with speech and swallowing issues. Treatments include physical and occupational therapy. 

● Vascular Parkinsonism – This condition is caused by small strokes which cause clotting in the brain. It is most strongly associated with shuffling gait and unsteadiness. This condition is a cerebrovascular disease – a gradual loss of nerve cells is caused by one or more small strokes that affect blood supply to the brain. This condition is not progressive. 

Drug-Induced Parkinsonism – Some symptoms of Parkinson’s are caused by medications. Drug-induced Parkinson’s (DIP) is due to side effects of medications that affect dopamine levels in the brain. This is the second most common cause of Parkinson’s in the elderly. Drugs associated with DIP are often used to treat brain disorders including psychotic disorders (like schizophrenia) and dementia. Drugs associated with DIP are Abilify, Haldol, Reglan and others. DIP can be stopped or reversed through a slow decrease in the dosage of the medication causing symptoms. This should be overseen with the assistance of a medical professional. 

Parkinsonism Treatments – One hallmark of Parkinsonisms is how they respond to levodopa treatment. Parkinson’s patients respond well to levodopa, while atypical Parkinsonisms respond poorly or not at all. Physical therapy, occupational therapy, speech therapy, massage therapy, and other symptom management techniques used for Parkinson’s can be helpful in the treatment of Atypical Parkinson’s. 

Conclusion – Atypical Parkinson’s/Parkinsonisms may be difficult to diagnose initially. Monitor your symptoms and talk to your doctor. Atypical Parkinson’s often moves at a faster pace than Parkinson’s; it’s important to have frank conversations with your family and loved ones about your condition, your timelines, and to plan early to put your estate in good order.