If you or a loved one are living with Parkinson’s disease, you’ve likely heard the term “parkinsonism” — but you may not know how it differs from Parkinson’s. “Getting very confused about the difference between Parkinson’s and parkinsonism,” wrote one MyParkinsonsTeam member.
Parkinson’s disease is a brain condition that advances slowly over time in the majority of people. The condition involves the loss of brain cells (neurons) in a part of the brain called the substantia nigra. The substantia nigra makes a chemical called dopamine, which plays a role in body functions including memory, movement, and pleasure. As these dopamine-producing neurons decrease in number, Parkinson’s symptoms begin to appear.
Parkinsonism is a broad term referring to several neurological conditions with movement issues — including Parkinson’s disease. Types of parkinsonism other than Parkinson’s disease are sometimes referred to as “Parkinson’s plus” or “atypical Parkinson’s disease.” Around 85 percent to 90 percent of diagnosed cases of parkinsonism are types other than Parkinson’s disease.
Despite their differences, the various types of parkinsonism — including Parkinson’s disease — share some common signs and symptoms. As a result, they sometimes can be misdiagnosed as a different type.
Each of the most common types of parkinsonism are typically characterized by muscle stiffness, slow movement, and difficulty with balance and walking. However, doctors look for several signs of each type of parkinsonism to distinguish them from one another.
Drug-induced parkinsonism (DIP) is caused by certain medications that alter the levels of dopamine in the brain. DIP is the second most common type of parkinsonism in older people — just behind Parkinson’s.
Researchers and neurologists believe medications that block the effect of dopamine are the main cause of DIP. Health care providers prescribing these types of medications should monitor people for signs of DIP and other movement disorders.
Examples of medicines that may cause DIP include:
Within four days to one month after starting a medication, a person with DIP may develop symptoms of parkinsonism.
DIP can be difficult to distinguish from Parkinson’s disease. People with DIP may experience less severe resting tremors and balance difficulties. The biggest difference between the two conditions, however, is that Parkinson’s progresses and worsens over time while DIP does not.
Progressive supranuclear palsy (PSP) generally appears in people in their early 60s. The disease is caused by clumps of a protein called tau that builds up in specific parts of the brain. This tau protein can lead to a slow loss of neurons.
PSP symptoms usually worsen at a faster rate than those of Parkinson’s. Although resting tremors are common in Parkinson’s, they are rare in PSP. Speech and swallowing difficulties appear earlier and are often more severe in people with PSP.
Symptoms of PSP can include:
Multiple system atrophy (MSA) includes a group of neurological disorders that affect movement. MSA involves the autonomic nervous system, which is responsible for regulating digestion and controlling blood pressure.
Symptoms of MSA can include:
Vascular parkinsonism usually results from several small strokes that lead to clotting in the brain. The main symptoms of vascular parkinsonism include movement issues with the lower body, such as a shuffling gait and unsteadiness while walking. Tremors aren’t a symptom of vascular parkinsonism as they are with Parkinson’s disease.
Dementia with Lewy bodies (DLB) is the second most common contributor to dementia in older people. People with DLB may also experience the typical symptoms of Parkinson’s, which makes the condition especially difficult to distinguish from Parkinson’s. However, several characteristics make DLB stand out.
Among them, dementia is the first sign of DLB, which can include inattentiveness, decreased alertness, memory loss, and visual hallucinations. People with DLB usually start to experience dementia and movement issues around the same time or less than one year apart. People with DLB generally don’t experience tremor, and if they do, it’s slight.
Corticobasal degeneration is the least common type of parkinsonism. The condition usually occurs in people over 60. Symptoms of corticobasal degeneration typically include:
Differences in signs and symptoms distinguish Parkinson’s from other types of parkinsonism.
Some symptoms of Parkinson’s affect a person’s ability to move. These symptoms are often called motor symptoms, and they include:
Other symptoms of Parkinson’s don’t affect a person’s movement. These nonmotor symptoms may include:
Parkinson’s symptoms may take several years to appear. A majority of people with Parkinson’s live for many years with the condition.
Parkinson’s disease and other types of parkinsonism share some common symptoms, such as stiffness, tremors, and slow movement. However, other types of parkinsonism tend to progress more quickly than Parkinson’s, and people with other types generally start experiencing balance issues sooner. Additionally, people with other types of parkinsonism show only a short-term response — if any — to levodopa, a common medication for Parkinson’s.
There is no test to definitively diagnose each type of parkinsonism. Doctors will always take a complete medical history. They may order a variety of movement tests. In the end, diagnosis of each type of parkinsonism is largely based on observation by a health care professional.
DIP is diagnosed when a doctor or health care provider notices signs of parkinsonism connected with a certain medication that can reduce the effect of dopamine in the brain.
The PSP symptoms which differ most from Parkinson’s are:
A health care provider can make note of these symptoms and use them to make a PSP diagnosis.
A doctor can distinguish MSA from Parkinson’s disease by noticing the following differences:
There are several signs and symptoms a health care provider will look for to distinguish vascular parkinsonism from Parkinson’s disease:
Several key symptoms set DLB apart from Parkinson’s:
Signs and symptoms of corticobasal degeneration that set it apart from Parkinson’s include the following:
Since parkinsonism is an umbrella term for many types of conditions, medical treatment often varies. Once a health care provider has diagnosed a specific type of parkinsonism, they will typically start a treatment plan for that type.
Usually, the quickest treatment for DIP is to halt or slowly lower the dosage of the drug causing the symptoms. It’s important to work with your neurologist when making changes to any medication.
All symptoms of DIP may completely go away once a person stops the specific medication involved. However, a person may need up to 18 months for all their DIP symptoms to resolve.
People with PSP do not usually respond well to medication. For this reason, health care professionals often prescribe the following therapies:
Parkinson’s medications usually aren’t effective for MSA. However, doctors can treat symptoms, such as low blood pressure and bladder issues, that accompany MSA. Currently, there are no medications to slow the overall progression of this condition.
Treatment for vascular parkinsonism may or may not include levodopa. Some people with vascular parkinsonism respond well to the medication, while others do not.
The main focus of vascular parkinsonism treatment is lowering the risk of having more strokes. This entails controlling the risk factors for stroke, including:
The treatment of DLB sometimes involves using levodopa to address motor symptoms. However, the movement disorder symptoms of DLB may not respond to levodopa.
Currently, no cure for DLB exists, nor are there any therapies to slow the progression of the disease. Medicine may help with the mental symptoms of DLB. Maintaining a safe home environment and providing assistive equipment can make daily living easier.
At this time, no specific treatment for corticobasal degeneration exists. Regardless, medical management of the condition frequently involves one or all of the following:
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