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What is atypical parkinsonism and how does it differ from PD?

Monday June 24, 2013

Atypical parkinson’s, parkinsonism, and parkinson’s plus are all terms used to describe syndromes that share features similar to Parkinson’s disease but are different conditions. These conditions are described below.

Just like Parkinson’s disease, the diagnosis is often a clinical one relying on an examination by a neurologist knowledgeable in these conditions. Because of this, the diagnosis may not be obvious at your first doctor’s visit and an accurate diagnosis may take time.

Common features of atypical parkinsonism that differentiate it from Parkinson’s disease are:
  • Symptoms present on both sides of the body at onset.
  • Early cognitive problems.
  • Early problems with balance, falls and/or freezing of gait.
  • Early problems with autonomic function such as orthostatic hypotension (lightheadedness when standing from low blood pressure.)
  • Earlier speech and swallowing problems.
  • Faster progression
  • Limited improvement with medicine.
  • Significant visual problems such as double vision, trouble focusing while reading.

Specific conditions include (note:  this list does not include all disorders)

Neurodegenerative Conditions. These conditions are associated with degeneration or nerve cell loss over time.

  • Lewy Body Disease. Cognitive problems, hallucinations and fluctuations in levels of alertness are present within the first year of movement problems. Motor symptoms can otherwise mimic Parkinsons disease.
  • Multiple System Atrophy (MSA): Slowness, walking problems, imbalance, and early autonomic nervous system problems (Orthostatic hypotensionconstipationbladder control) predominant in this disorder. [Click herefor more information on the MSA foundation.]
  • Progressive Supernuclear Palsy  (PSP): Slowness, walking problems, imbalance, eye movement problems, speech and thinking problems predominate in this disorder. [Click here for information on the PSP Society.]
  • Normal Pressure Hydrocephalus (NPH): Early walking, thinking and bladder control problems predominate in this disorder. Brain MRI reveals enlarged ventricles and therefore is helpful in detecting this condition.
  • Wilson’s disease: A genetic condition with personality changes, thinking problems, dystonia and other movement problems.  Brain imaging, blood and urine copper testing can aid in making this diagnosis especially in young people.

Secondary Parkinsonism. These conditions are caused by other problems.

  • Drug induced parkinsonism.  Many antipsychotic medicines and anti-nausea medicines can cause symptoms of parkinsonism or even worsen movement problems when given to people with Parkinson’s disease.
  • Vascular parkinsonism. Can cause problems with slowness, shuffling gait and thinking problems.  Head CT or MRI may be helpful in determining this.  Treatment includes careful control and treatment of cardiovascular and stroke risk factors such as smoking, high blood pressure, high cholesterol, diabetes, depression and sedentary lifestyle.  Strokes
  • Brain injury. Repeated brain trauma with concussion (ie. Boxing) and injury from lack of oxygen such as after cardiac arrest.
  • Toxin exposure such as carbon monoxide poisoning, heavy metal exposure (industrial exposure to manganese, lead, cobalt or mercury), agent orange.

Monique L. Giroux, MDMonique L. Giroux, MD
Medical Director, Northwest Parkinson's Foundation

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