Types of Parkinsonisms

Parkinson’s disease is the most common primary cause of parkinsonism. It can be further subdivided into sporadic (most common) and familial (hereditary) PD.

Atypical parkinsonian disorders can also be sporadic or familial.

• The sporadic cases include progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and dementia with Lewy bodies (DLB), as well as other rarer causes.
• Familial (heredodegenerative) disorders that may present with atypical parkinsonism include Huntington disease, spinocerebellar ataxias, X-linked dystonia-parkinsonism (Lubag disease) and neuronal brain iron accumulation disorders.

Drug-induced parkinsonism can be difficult to distinguish from Parkinson’s, though the tremors and postural instability may be less severe. It is usually the side effect of drugs that affect dopamine levels in the brain, such as antipsychotics, some calcium channel blockers and stimulants like amphetamines and cocaine. If the affected person stops taking the drug(s), symptoms usually go away over time, but may take as long as 18 months.

Vascular parkinsonism is usually caused by clotting in the brain from multiple small strokes. People with vascular parkinsonism tend to have more problems with gait than tremor and have more problems in the lower body. The disorder progresses very slowly in comparison to other types of parkinsonism. People might report an abrupt onset of symptoms or symptoms that get worse then plateau for a while. Symptoms in vascular parkinsonism may or may not respond to levodopa.

• Metabolic diseases, such as Wilson’s disease
• Endocrine diseases, such as hypothyroidism
• Heavy metals, such as manganese
• Infectious diseases, such as Whipple’s disease
• Normal pressure hydrocephalus
• Toxins, such as MPTP
• Repetitive head trauma

Parkinsonism can also be categorized based on the abnormal proteins that accumulate in the brain, such as alpha synuclein.

DLB is second only to Alzheimer’s as the most common cause of dementia in elderly people. It causes progressive intellectual and functional deterioration. In addition to the signs and symptoms of Parkinson’s disease, people with DLB tend to have frequent changes in thinking ability, level of attention or alertness and visual hallucinations. They usually do not have a tremor or have only a slight tremor. The parkinsonian symptoms may or may not respond to levodopa.

PSP is slightly more common than amyotrophic lateral sclerosis (ALS), also called Lou Gehrig disease. Symptoms usually begin in the early 60’s. Common early symptoms include loss of balance while walking that results in unexplained falls, forgetfulness and personality changes.

The visual problems associated with PSP generally occur three to five years after the walking problems and involve the inability to aim the eyes properly because of weakness or paralysis of the muscles that move the eyeballs. People with PSP may have some response to dopaminergic treatment but may require higher doses than people with Parkinson’s disease. Learn more about PSP.

MSA (also referred to as Shy-Drager syndrome) is the term for a group of disorders in which one or more systems in the body stop working. In MSA, the autonomic nervous system is often severely affected early in the course of the disease.

Symptoms include bladder problems resulting in urinary urgency, hesitancy or incontinence and orthostatic hypotension (nOH). In nOH the blood pressure drops so low when standing that fainting or near fainting can occur. When lying down, blood pressure can be quite high (called supine hypertension). For men, the earliest sign may be loss of erectile function. Other symptoms that may develop include impaired speech, difficulties with breathing and swallowing, and inability to sweat.

Like the other parkinsonism conditions, MSA symptoms respond either very little, or not at all to Parkinson’s medications. Learn more about MSA.

CBS is the least common atypical parkinsonism. It usually develops after age 60. Symptoms include a loss of function on one side of the body, involuntary and jerky movements of a limb and speech problems. It may become difficult or impossible to use the affected limb although there is no weakness or sensory loss. People with CBD may feel as if their limb is not under his/her voluntary control. There is no specific treatment for CBD. Treatment is focused on reducing symptoms and improving quality of life.