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Types of Parkinsonisms
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Types of Parkinsonisms

Parkinsonism is a term used to describe the collection of signs and symptoms found in Parkinson’s Disease (PD). These include slowness (bradykinesia), stiffness (rigidity), tremor and imbalance (postural instability). Conditions other than Parkinson’s may have one or more of these symptoms, mimicking Parkinson’s.

Idiopathic Parkinson’s is the most common form of Parkinsonism. However, about 15% of those with symptoms suggesting Parkinson’s Disease have one of several diseases termed, atypical parkinsonism disorders. These conditions are typically more difficult to treat and Parkinson’s and include the below.

Multiple System Atrophy
Progressive Supranuclear Palsy
Corticobasal Syndrome
Dementia With Lewy Bodies
Drug - Induced Parkinsonism
Vascular Parkinsonim

  • Multiple system atrophy (MSA) is a term encompassing several neurodegenerative disorders in which one or more systems in the body deteriorates
  • Similar syndromes to MSA include; Shy-Drager Syndrome, Striatonigral Degeneration & Olivopontocerebellar Atrophy
  • Average age of onset is in the mid 50s
  • In 2007 MSA was placed into two new classifications MSA-P in which parkinsonism dominates, MSA-C in which cerebellar ataxia (incoordination) dominates
  • Symptoms include incoordination (ataxia), dysfunction and the nervous system that controls things like blood pressure and bladder function. These are in addition to variable degrees of parkinsonisms including slowness stiffness and in balance
  • Initially it may be difficult to distinguish MSA from Parkinson's. Clues for doctors to determine which it is includes a more rapid progression, poor response to common Parkinson's Disease medications and the development of other symptoms
  • The diagnosis of MSA is based on clinical features as there is no specific test that provides the diagnosis

  • Most common degenerative type of atypical parkinsonism
  • Average age of the onset is in the mid 60's
  • Symptoms tend to progress more rapidly than Parkinson's Disease. Patients may fall more frequently in the early course of the disease and later symptoms include limitation of eye movements, particularly looking up and down
  • Other symptoms include difficulties in swallowing, producing speech, sleep, memory, and thinking problems
  • The diagnosis is based upon clinical features as there is no specific test to diagnose PSP and there is no specific treatment although it is based on alleviating their symptoms

  • CBS is the least common of the atypical causes of parkinsonism
  • Usually begins with symptoms affecting one limb. Other symptoms include abnormal posturing of affected limb, fast and jerky movements, difficulty with some motor tasks, and difficulty with language
  • Onset typically begins after the age of 60
  • CBS progresses more rapidly than Parkinson's there is no specific test to diagnose CBS and the treatment Focuses on their symptoms
  • Supportive treatments that have been found helpful include: Botulinum toxin (Botox), antidepressants, speech and physical therapy

  • Dementia with Lewy bodies is a progressive neurodegenerative disorder in which abnormal deposits of a protein called alpha-synuclein build up in multiple areas of the brain
  • DLB is second to Alzheimer's as the most common cause of degenerative dementia that first causes progressive problems with memory fluctuation in thinking as well as hallucinations. These symptoms are joined later in the course of the disease by Parkinsonism with slowness, stiffness, and other similar symptoms to Parkinson's
  • While the same abnormal protein (alpha-synuclein) is found in the brains of those patients with Parkinson's, when individuals develop memory and thinking problems, it tends it occur later in the course of the disease than DLB
  • There are no specific treatments for DLB but treatments focus on alleviating their symptoms

  • This is the most common form of what is known as secondary Parkinsonism
  • Ide effects of some drugs, especially those affecting brain dopamine levels such as anti-psychotic or anti-depressant medication; can cause parkinsonism
  • Although tremor and postural instability may be less severe, this condition may be difficult to distinguish from Parkinson's medications that can cause the development of Parkinsonism include:
    - Anti-psychotics
    - Certain antiemetics (anti-nausea medications)
    - Some antidepressants
    - Reserpine
    - Tetrabenazine
    - Some calcium channel blockers
  • Usually after stopping these medications, Parkinsonisms gradually disappear over weeks to months, however some symptoms may last for up to a year

  • This is some evidence to suggest the multiple small strokes in key areas of the brain may cause parkinsonism
  • No specific clinical features or diagnostic tests reliably differentiate Parkinson's and Vascular Parkinsonism, though some features may suggest VP
  • A severe onset of Parkinsonism immediately following a stroke may indicate VP
  • Other signs that can indicate VP include: evidence of vascular disease on an MRI of the brain as well as varying levels of deterioration, prominent early cognitive problems and lower body issues, such as early gate and balance problems
  • Dopaminergic medication, like Levodopa, may possibly have modest benefits depending on the location of vascular disease in the brain