Episode 158: Atypical Parkinsonism Series: Overview, Diagnosis and Prevalence
Considered “atypical Parkinsonian syndromes,” over half of people with progressive supranuclear palsy (PSP), corticobasal degeneration (CBD)/corticobasal syndrome (CBS), and multiple system atrophy (MSA) are initially misdiagnosed with Parkinson’s disease (PD) due to similarities in early symptoms as well as lack of awareness of these rare, neurodegenerative diseases among many healthcare professionals and the general public.
This is the first of three podcast episodes within our atypical parkinsonism podcast series, organized in partnership with CurePSP and designed to address the overview, treatment and care of PSP, CBD and MSA.
In this first episode of the series, Dr. Alex Pantelyat, Associate Professor of Neurology at Johns Hopkins University School of Medicine shares an overview of atypical parkinsonism, overlaps and differences with Parkinson's disease, the red flags and how PSP, CBD and MSA are diagnosed.
Dr. Pantelyat has disclosed that he is a Scientific Advisory Board Consultant for MedRhythms, Inc. and a consultant for both Ferrer Internacional, S.A. and SciNeuro Pharmaceuticals.
Podcast host, Dan Keller, has disclosed that he has no relevant financial disclosures.
Released: September 5, 2023
Alexander Pantelyat, MD, FAAN is an associate professor of Neurology at the Johns Hopkins University School of Medicine. He is the director of the Johns Hopkins Atypical Parkinsonism Center, the co-Director of the Johns Hopkins Movement Disorders Fellowship Program, and the co-Founder and Director of the Johns Hopkins Center for Music and Medicine.
Dr. Pantelyat's research is focused on the diagnosis and treatment of atypical parkinsonian disorders, such as dementia with Lewy bodies, progressive supranuclear palsy, corticobasal syndrome/degeneration and multiple system atrophy; cognitive aspects of movement disorders; and music-based rehabilitation of neurodegenerative diseases.
Dr. Pantelyat earned his medical degree from Temple University School of Medicine in Philadelphia, where he was elected a member of the Alpha Omega Alpha Honor Medical Society and received the Matthew T. Moore Prize in Neurology. He completed his residency training in Neurology at the University of Pennsylvania in Philadelphia, and a fellowship in movement disorders at the University of Pennsylvania/Philadelphia VA Medical Center.
He is a 2013 American Academy of Neurology Palatucci Advocacy Leader and grant recipient, a 2014-15 American Academy of Neurology Emerging Leader, and a 2014 Johns Hopkins University School of Medicine Osler Attending Program inductee.
Rarely is there a time that I don’t think about Warren. It’s uncanny. I don’t love him, yet he is with me all the time, so I seek ways to accept him. Warren is the name my three kids and I gave to my diagnosis of young-onset Parkinson’s disease (YOPD). Instead of saying the scary term, “Parkinson’s disease,” we laugh and say things like, “Warren is around,” or “Warren kept me awake all night.” I have no choice but to respect him, as he has taught me about gratitude and the importance of being present.
I was diagnosed with YOPD at 41 years old. Following the diagnosis, I began to realize how many of my symptoms were signs of Parkinson’s. I had lost my sense of smell seventeen years earlier. At the time, I thought my son was especially sensitive to smells, and I often joked that he “took my sense of smell.” I was also a marathon runner and I started to fall a lot during training. My foot also started doing this funky, painful turn. I had no idea that this may have been a symptom of PD.
Two years later, and with much stress in my life, I developed a tremor in my arm and sought medical advice. When I visited a neurologist, she watched me walk and noticed that my left arm did not swing. I had never even noticed that!
I never imagined being diagnosed with YOPD. I was a single mom and a full-time teacher raising three kids. I tried to find child-friendly literature to explain Parkinson’s to my kids; there were some books, but most of them included a surplus of medical jargon. I am currently working on a children’s book to provide families with the springboard they need to discuss this disease and how it may impact them.
I was in denial about PD for a long time, and it was my daughter’s school project that pushed me to accept my diagnosis. She created a carnival “Go Fish” game titled, “Fishing for a Cure for Parkinson’s.” WOW. Kids say the darndest things.
Now ten years later, I “runwa” (run/walk) and try to get my heart rate up nearly every day. I walk “BIG” and do a variety of exercises. I also try to challenge my brain daily. I am stronger than I have ever been, and I put my physical and mental health first. It hasn’t been easy, and Warren sometimes still shows up, but I eat healthy and I have finally figured out how to stay asleep! I work hard to keep a positive attitude.
I was first introduced to the Parkinson’s Foundation through the Community Partners in Parkinson’s Care program. Now that my children are older, I can devote more of my time to supporting the Foundation and assisting the Parkinson’s community! One way I show my support is through fundraising for Moving Day. This past year I raised more than $1,200 for Moving Day Twin Cities, and I plan on surpassing that amount next year.
I look forward to sharing my knowledge about PD and finding more creative ways to raise money for research. I hope that one day, I can finally break up with Warren!
I am 63 years old now, but I was diagnosed with tremor-dominant Parkinson’s disease (PD) four years ago. After much encouragement from my children, I decided to visit a neurologist to get answers.
I underwent a 30-minute diagnosis session with my local neurologist. At the appointment, he said, “You have Parkinson’s. You have 10 years to live, and it will not be good.” Then he walked out of the office.
I sat there in shock, not knowing which way to go.
A dear friend connected me to Dr. Joseph Jancovic from Baylor College of Medicine, a Parkinson’s Foundation Center of Excellence. Dr. Jancovic is a specialist in Parkinson’s and movement disorders. After a thorough exam, he affirmed the PD diagnosis but decided to completely change to my medications. Within two days after this appointment my symptoms diminished, and my sense of self returned.
I have retired from work and filed for disability because Parkinson’s has affected my mental capacity, especially when it comes to dealing with stress. Despite this, I am determined to not allow Parkinson’s disease to define who I am.
I do everything I can to exercise and stay active. In the last four years I’ve hiked to tops of mountains in Colorado, taken up long range rifle marksmanship at 1,000 yards or more and continued with my love of Argentine tango. I have also put 1,000 miles in my bicycle in the last three months, and I do not plan on stopping.
I found out about the Parkinson’s Foundation while searching Facebook for Parkinson’s-related groups. I have started looking through the resources on their website for support as I continue to navigate this disease.
My best advice is to live life day by day — and sometimes minute by minute. You never can tell what will happen next.
Find a good a PD care team. Know that there will be good days in there, too, and make the most of them.
Moving Day is an inspiring and empowering annual fundraising walk event that unites people around the country living with Parkinson’s disease (PD), their care partners and loved ones to help beat PD. Moving Day is more than just a walk. It’s a celebration of movement – proven to help manage Parkinson’s symptoms.
Leading up to the event, participants and teams fundraise to help the Parkinson’s Foundation provide vital resources and deliver quality care to more than 364,000 people living with Parkinson’s and other movement disorders, while improving Parkinson’s treatments through research.
Moving Day proceeds help bring quality care to more people with Parkinson’s, further Parkinson’s research, education and outreach initiatives. Moving Day raises awareness of Parkinson’s both nationally and in the local community.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
Moving Day is an inspiring and empowering annual fundraising walk event that unites people around the country living with Parkinson’s disease (PD), their care partners and loved ones to help beat PD. Moving Day is more than just a walk. It’s a celebration of movement – proven to help manage Parkinson’s symptoms.
Leading up to the event, participants and teams fundraise to help the Parkinson’s Foundation provide vital resources and deliver quality care to more than 364,000 people living with Parkinson’s and other movement disorders, while improving Parkinson’s treatments through research.
Moving Day proceeds help bring quality care to more people with Parkinson’s, further Parkinson’s research, education and outreach initiatives. Moving Day raises awareness of Parkinson’s both nationally and in the local community.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
Today we focus on total body functional exercises that incorporate aerobic activity, strength, agility, and balance. The instructors will offer modifications that allow you to choose to increase or decrease the challenge. Items needed: sturdy chair with arms and water bottle. Enjoy the session!
Instructors
Courtney Roca, PT, DPT, EdD - Board Certified Clinical Specialist in Neurologic Physical Therapy; Assistant Professor, Gannon University, DPT Program; Co-Director, Purposeful Movement and Wellness Program for People with PD - Parkison Parnters of Northwest PA
Constance Lewis, PT, DPT - Board Certified Clinical Specialist in Geriatric Physical Therapy; Assistant Teaching Professor, Gannon University, DPT Program; Co-Director, Purposeful Movement and Wellness Program for People with PD - Parkinson Partners of Northwest PA
There is no charge to attend, but registration is required. This program is open to people with Parkinson's, their family, friends, and the community.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
Get out and move with your community! Every dollar raised supports the Parkinson’s Foundation mission to make life better for people affected by Parkinson’s disease (PD). At Moving Day Community Walks across the country, we’re fighting Parkinson’s and celebrating movement — proven to help manage Parkinson’s symptoms — and we’re doing it together. The Moving Day Community Walk Program is a complement to the Parkinson’s Foundation Moving Day, A Walk for Parkinson’s. These walks are family-friendly and help the Foundation make life better for people with PD.
The Community Walk program offers volunteers an opportunity to organize a walk in their own community that does not have a Moving Day event. The program leverages the personal experiences and community leadership of passionate volunteers to promote Parkinson’s awareness and raise funds for the Parkinson’s Foundation.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
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Participants will learn how research helps shape treatments and identify new care strategies for managing Parkinson’s symptoms. This program will also provide information on current research in Parkinson’s, including PDGENEration and Dr. Singh’s Motor and Cognitive Control Laboratory in Sioux Falls.
*This program may include moderately scientific terms and concepts.
Attendees will have the opportunity to participate in PDGENEration testing on-site.
Speakers
Kamalini Ghosh Galvelis, MS
Director, Clinical Research, Parkinson’s Foundation
Arun Singh, PhD
Assistant Professor, University of South Dakota
There is no charge to attend, but registration is required. This program is open to people with Parkinson's, their family, friends and the community.
Thank you to our sponsor: Seed for Success Foundation
COVID SAFETY: The health and safety of our participants, sponsors, volunteers and staff are our top priority. We continue to monitor CDC recommendations and will adhere to state and local COVID guidelines in place on the event day. Adjustments will be made if necessary.
Parkinson’s Champions athletes raise funds and awareness for the Parkinson’s Foundation while competing in some of the world’s most popular races. Every step we take brings us closer to a future without Parkinson’s disease, because Parkinson’s isn’t a sprint, it’s a marathon.
8 Questions You’ve Always Wanted to Ask an Occupational Therapist
Occupational therapists help people with Parkinson’s disease (PD) remain independent and pursuing the activities they enjoy. Heather Simpson, OTD, OTR/L is an occupational therapist at the Norman Fixel Institute for Neurological Diseases at the University of Florida. At the Fixel Institute, she treats people with Parkinson's and other movement disorders while serving as co-clinical coordinator for their Parkinson’s Foundation Center of Excellence. In this article, Heather answers the most frequently asked questions about Parkinson’s and occupational therapy (OT).
What is your definition of occupational therapy?
Occupational therapy is a form of rehab therapy in which therapists use everyday activities to promote health, wellbeing and your ability to participate in meaningful activities in your life. OT works on “occupations,” which include self-care activities (like dressing, eating, bathing and toileting), home management activities (like cooking and driving) and leisure activities. Occupational therapy is individualized, but our goal is to make each person feel comfortable with who they are and help them live independently for as long as possible.
When should a person with PD start occupational therapy?
Research supports that occupational therapy intervention, along with physical therapy and speech therapy, can be very helpful for people with Parkinson’s disease. Starting occupational therapy early on is highly recommended. Even if you are independent when you first get diagnosed with Parkinson’s, starting OT can provide you with a home program that reacts to existing PD symptoms and prevents additional PD symptoms from occurring. OT can also give you tips and strategies to make sure you're feeling your best during daily activities.
What are the benefits of occupational therapy for people with Parkinson’s?
What I love about OT is that it's holistic. We provide evidence-based interventions to help people enjoy life through everyday activities. OT is also tailored to your individual needs as a person with Parkinson’s. For movement symptoms, we can help with posture, rigidity, bradykinesia and fine motor skills. For non-movement skills, we work on improving sleep, vision, cognition and mood. Occupational therapy is useful because it’s available in many different settings — it can be found in outpatient therapy, inpatient therapy, hospitals, nursing homes and more.
Is it better to go to a specialized facility for occupational therapy?
Getting occupational therapy services is important no matter what, but therapists at Parkinson’s Foundation Centers of Excellence are specialized in Parkinson's and related disorders. They do a lot of research and learning, particularly about Parkinson's, and can work together with your local providers to give PD-specific recommendations.
Occupational therapists at specialized facilities also work directly with the physicians on your multidisciplinary team. This type of collaboration can help make sure that we're understanding your symptoms and your needs.
How does an occupational therapist collaborate with the Parkinson’s care team?
Occupational therapists are an important part of the care team for people living with Parkinson’s. We are directly involved with physicians and nurses, as well as physical therapists and speech-language pathologists. Since occupational therapists may work with you more regularly than you see your neurologist, we can be the eyes and the ears for other members of the team.
For example, if you come into an OT session and we notice you are experiencing new movement fluctuations, we can reach out to your doctor on your behalf to address the issue. Occupational therapists coordinate closely with your doctor and help make critical decisions for your care.
Can you share an inspirational story about one of your PD clients?
Occupational therapy is meaningful because it is person-centered and works to meet an individual’s needs. One of my clients was highly motivated by her role as a mother and a grandmother. She had a hard time moving her arms, hands and fingers, but through OT we found ways to adapt board games so she could play with her grandkids when they came to visit. Even though she had limited physical ability, we were able to maintain what she found important in her daily activities through these personalized interventions.
How do you manage the stress that can accompany helping other people?
I love what I do for work, but I think it’s also very important to maintain the other roles I play in my life: friend, sister, daughter and spouse. I take time to pursue activities outside of work that fulfill those roles. I exercise, go to therapy and plan specialized date nights with my friends.
People in the Parkinson’s community may have a similar experience when it comes to the roles they play in life. When someone is diagnosed with PD, they may feel like they have to exercise full-time. Care partners may feel like they need to be a care partner at all times, and they lose their role as a spouse. I think it’s important to find a balance between your various roles whenever possible.
What is a takeaway the PD community should know about occupational therapy?
Occupational therapy is an individualized therapy that ensures safety, independence and happiness. It allows you to maintain your sense of self. OT is critical throughout all stages of Parkinson’s, from diagnosis to palliative care, but it is designed to help you maintain a sense of self and be happy with who you are.
For help finding an occupational therapist near you, contact our Helpline at 1-800-4PD-INFO (1-800-473-4636).
Heather Simpson graduated with a B.S. in Exercise and Sport Science in 2007 and her master’s in Occupational Therapy (OT) in 2009, both from the University of Florida. She then went on to obtain a post-professional clinical doctorate from the University of St. Augustine for Health Sciences in 2017.
Heather currently serves as an occupational therapist at the Norman Fixel Institute for Neurological Diseases at UF Health in Gainesville, Florida, where she has worked since 2011. In 2020, Heather became a co-coordinator at the Parkinson’s Foundation Center of Excellence for the Institute, where she focuses on outreach for people with Parkinson’s and care partners.
From Gatorade to The Quaker Oats Company, I’ve worked at some of the biggest companies, focused on clinical research that links exercise and nutrition parameters in health and athletic performance. As a nutritional biochemist and scientific researcher, I worked to understand how our bodies work and what happens when they stop functioning the way they should.
In 2013, I received the sobering news that I had Parkinson’s disease (PD). Like most people with PD, after I was initially diagnosed, I wanted to understand the long-term implications of this progressive disease. As a former researcher, I began searching for answers.
My initial thoughts and feelings were about how my health would change and how PD would affect my family. I worried about keeping up with my daily routine, driving my sons to practice, working around the house or golfing — things many people take for granted.
Over the last 10 years, I’ve grasped how PD affects me, my family and lifestyle. My PD is tremor-predominant, but I deal with slowness and other non-movement symptoms, like low energy and sleep disturbances. It continues to be a challenge, but I’m taking it one day at a time.
Tracking Progress
Just over a year ago, my engineer son began working for Rune Labs, a company that created an app called StrivePD that helps people with PD track exercise, symptoms, medications, treatment side effects and sleep behavior. As a former PhD-level scientist, I can appreciate the data and its insights. My son asked me to try the app, so I did.
My outlook on PD has changed after using the app for just a few months. I feel I have more control over my disease, allowing more time to do things I love, like spending time with my family. It has improved my medication timing, workouts and dietary decisions. Since it links to my AppleWatch, it takes no conscious effort.
While Parkinson’s remains a struggle, StrivePD has helped me realize the importance of exercise and how it dramatically reduces my mobility issues. It motivates me to stretch, lift weights, complete core workouts and visit my physical therapist twice a week. Exercise has dramatically reduced my symptoms and helps me control them.
Looking Toward the Future
As I continue to use StrivePD, I plan to share my data with my clinician to better understand how my daily routine affects my disease, specifically exercise and how I can improve my energy and sleep. It can be daunting to encapsulate months of my disease experience in a one-hour visit. StrivePD helps capture symptom changes and a bigger picture of how things are going. I am proud of how my son continues to help build StrivePD so that people like me can better manage this disease.
Energy with exercise. After a decade of dealing with Parkinson’s, that has become my mantra. Exercise gives me the energy to go about my day and helps keep me alert. I urge my fellow PD community to have a goal and not let this disease control you.