- Conditions that Mimic Parkinson’s
- Atypical Parkinsonian Disorders
- What are atypical Parkinsonian disorders?
- What are the symptoms of atypical Parkinsonian disorders?
- Primary parkinsonism
- Secondary parkinsonism (parkinsonian syndrome or atypical parkinsonism)
- Essential tremor
- Parkinsonian syndroms
- Review guide to diseases similar to Parkinson’s
- Progressive Supranuclear Palsy: An Atypical Parkinsonian Syndrome
- Hallmarks of PSP
- What causes PSP?
- How is PSP managed?
- Hallmarks of Parkinson’s
- What causes Parkinson’s?
- How is Parkinson’s managed?
- Future research
- Parkinson’s Disease
- What Causes Parkinson’s Disease?
- Symptoms of Parkinson’s Disease
- Diagnosis of Parkinson’s Disease
- Treatment of Parkinson’s Disease
- For More Information About Parkinson’s Disease
- Parkinson Disease & Mimics
- Dementia from Parkinson’s disease
Conditions that Mimic Parkinson’s
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 PD may have one or more of these symptoms, mimicking Parkinson’s.
- Essential tremor (ET) is common amongst the elderly population, yet may begin at any age.
- Different from the PD tremor in that it generally affects both hands, often involves head tremor and a shaky quality to the voice.
- Thought to be a different condition from PD, though some symptoms can overlap.
- Evidence suggests that those with ET may be at higher risk of developing PD than the general population.
- The diagnosis of ET is clinical and treatment is generally with medications, though surgery can be used in severe cases.
Normal Pressure Hydrocephalus
- A person with Normal Pressure Hydrocephalus (NPH) has fluid inside the brain that does not drain properly, which results in difficulty in walking, slowed thinking and loss of bladder control.
- Specialized brain scans, lumbar puncture (spinal tap) and a physical examination can lead to a diagnosis.
- Treatment often involves surgery where a shunt is placed to help drain excess fluid.
Dementia with Lewy Bodies
- Dementia with Lewy bodies (DLB) is a progressive, neurodegenerative disorder in which abnormal deposits of a protein called alpha-synuclein build up in multiple areas of the brain.
- DLB first causes progressive problems with memory and fluctuations in thinking, as well as hallucinations. These symptoms are joined later in the course of the disease by parkinsonism with slowness, stiffness and other symptoms similar to PD.
- While the same abnormal protein (alpha synuclein) is found in the brains of those with PD, when individuals with PD develop memory and thinking problems it tends to occur later in the course of their disease.
- There are no specific treatments for DLB. Treatment focuses on symptoms.
Multiple System Atrophy
- Multiple system atrophy (MSA) may resemble PD parkinsonism, but comes with additional symptoms and signs.
- Symptoms include incoordination (ataxia) and dysfunction in the autonomic nervous system, which automatically controls things such as blood pressure and bladder function. Diagnosis is made based on clinical features. There is no specific test that provides a definitive diagnosis.
- There is no specific treatment for MSA. Treatment focuses on alleviating symptoms.
- Corticobasal syndrome (CBS) is rare. It usually begins with symptoms affecting one limb.
- In addition to parkinsonism, other symptoms can include abnormal posturing of the affected limb (dystonia), fast, jerky movements (myoclonus), difficulty with some motor tasks despite normal muscle strength (apraxia), difficulty with language (aphasia) among others.
- There is no specific test for CBS.
- Treatment focuses on symptoms.
Progressive Supranuclear Palsy
- Progressive supranuclear palsy (PSP) is a disease that mimics PD, particularly early in its course, but that comes with additional distinctive signs and symptoms.
- Individuals with PSP may fall frequently early in the course of disease. Later symptoms include limitations in eye movements, particularly looking up and down, which also contributes to falls.
- Those with PSP also often have problems with swallowing (dysphagia), difficulty in producing speech (dysarthria), sleep problems and thinking problems.
Page reviewed by Dr. Ryan Barmore, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence.
Atypical Parkinsonian Disorders
What are atypical Parkinsonian disorders?
Atypical Parkinsonian disorders are progressive diseases that present with some of the signs and symptoms of Parkinson’s disease, but that generally do not respond well to drug treatment with levodopa. They are associated with abnormal protein buildup within brain cells.
The term refers to several conditions, each affecting particular parts of the brain and showing a characteristic course:
- Dementia with Lewy bodies, characterized by an abnormal accumulation of alpha-synuclein protein in brain cells (“synucleinopathy”)
- Progressive supranuclear palsy, involving tau protein buildup (“tauopathy”) affecting the frontal lobes, brainstem, cerebellum and substantia nigra
- Multiple system atrophy, another synucleinopathy that affects the autonomic nervous system (the part of the nervous system that controls internal functions such as heartbeat, blood pressure, urination digestion), substantia nigra and at times the cerebellum
- Corticobasal syndrome, a rare tauopathy that typically affects one side of the body more than the other and makes it difficult for patients to see and navigate through space
What are the symptoms of atypical Parkinsonian disorders?
Like classic Parkinson’s disease, atypical Parkinsonian disorders cause muscle stiffness, tremor, and problems with walking/balance and fine motor coordination.
Patients with atypical Parkinsonism often have some degree of difficulty speaking or swallowing, and drooling can be a problem. Psychiatric disturbances such as agitation, anxiety or depression may also be part of the clinical picture.
Dementia with Lewy bodies (DLB) can cause changes in attention or alertness over hours or days, often with long periods of sleep (two hours or more) during the day. Visual hallucinations — typically of small animals or children, or moving shadows in the periphery of the visual field — are common in DLB. DLB is second only to Alzheimer’s disease as a cause of dementia in the elderly, and it most commonly affects patients in their 60s.
Patients with progressive supranuclear palsy (PSP) may have difficulties with eye movements, particularly when looking downward, and with balance — when descending stairs, for instance. Backward falls are common and may occur during the early course of the disease. PSP is not usually associated with tremor, unlike Parkinson’s disease.
Multiple system atrophy (MSA) can affect autonomic function, with urinary urgency, retention and incontinence, constipation, lightheadedness when standing (orthostasis) and significant otherwise unexplained erectile dysfunction in men. Patients may experience color and temperature changes in hands and feet, such as redness and coldness. When MSA affects the cerebellum, patients may have ataxia, characterized by a wide-based unsteady gait, and lack of coordination in the hands, feet or both.
The symptoms of corticobasal syndrome (CBS) often appear only on one side of the body. Dystonia (abnormal posture of the limbs) and myoclonus (sudden jerking) may occur. Some patients may have difficulties with simple arithmetic early on. Patients may suffer from an inability to demonstrate or recognize the use of common objects. For instance, a CBS sufferer may not be able to show how a hammer is used to strike a nail or how a spoon scoops food and directs it to the mouth. Another unusual symptom of CBS is alien limb phenomenon, in which the patient experiences his or her arm or leg as a foreign structure over which the patient has no control. Patients may repeatedly pick at buttons or zippers on their clothing without realizing it. Alien limb phenomenon can cause patients great fear and distress.
A group of neurological disorders that display very similar symptoms to Parkinson’s disease are included under the general term of parkinsonism.
The majority of patients (around 80-85 percent) diagnosed with Parkinson’s disease have what is called primary parkinsonism or idiopathic Parkinson’s disease (meaning that the disease has no known cause). This type tends to respond well to drugs that work by increasing or substituting dopamine molecules in the brain.
Secondary parkinsonism (parkinsonian syndrome or atypical parkinsonism)
The remaining types of Parkinson’s are termed secondary or atypical parkinsonism or Parkinson’s Plus. In these cases, the cause of the disease is generally known and although it is very difficult to differentiate idiopathic Parkinson’s disease and secondary parkinsonism, a key difference is that patients with secondary parkinsonism do not respond well to dopaminergic medications such as levodopa.
Secondary parkinsonism includes drug-induced parkinsonism, vascular parkinsonism, normal pressure hydrocephalus (NSA), corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), and multiple system atrophy (MSA).
Certain medications, such as antipsychotics, can result in the patient developing the symptoms of Parkinson’s disease. Drug-induced parkinsonism may be difficult to distinguish from Parkinson’s disease, but the symptoms of tremors and postural instability will generally improve in the weeks or months after use of the medication has stopped.
Also called cerebrovascular disease, this type of parkinsonism is caused by a series of small strokes, resulting in the death of parts of the brain, leading to the Parkinson’s disease-like symptoms. The condition often only displays symptoms in the lower half of the body (walking difficulties and urinary incontinence) and memory loss. It tends to be less responsive to typical Parkinson’s disease medication especially as it progresses. Vascular parkinsonism becomes more common with age, especially in people with diabetes.
Normal pressure hydrocephalus (NSA)
The symptoms of NSA are very similar to those seen in vascular parkinsonism. The condition can be treated by removing spinal fluid in the short term or by lumbar puncture to permanently divert the spinal fluid as a long-term treatment.
Corticobasal degeneration (CBD)
CBD is caused by a build-up of proteins called tau, which damage parts of the brain. The condition tends to start on one side of the body and slowly spread to other areas over time. This is the least common of the atypical parkinsonisms.
Progressive supranuclear palsy (PSP)
PSP is one of the more common forms of secondary parkinsonism. As with idiopathic Parkinson’s disease, progressive supranuclear palsy has a late age of onset, but the symptoms tend to progress far more rapidly once they appear. However, dementia tends to have a later onset as the disease progresses. The cause of PSP is a build-up of the protein tau, as in CBD.
Multiple system atrophy (MSA)
MSA is caused by an overproduction of a protein called alpha-synuclein in the brain, leading to damage in multiple areas of the brain. This results in symptoms that are similar to idiopathic Parkinson’s disease, but with a much faster progression.
In addition, some infections can cause symptoms of parkinsonism, such as encephalitis and AIDS. Other causes such as exposure to toxins (like carbon monoxide), brain trauma, tumors, hypoxia (a lack of oxygen) in the brain, and some metabolic disorders have been shown to lead to parkinsonism-like symptoms.
There are also several conditions associated with Parkinson’s disease. One such condition is dementia with Lewy bodies (DLB), or Lewy Body Dementia (LBD), which is a particular form of dementia associated with Parkinson’s disease. DLB is caused by Lewy bodies (clumps of alpha-synuclein protein) forming in the brain. The condition tends to occur early in the progression of the disease and leads to a progressive deterioration of cognitive functions such as thinking, memory, and judgment.
Parkinson’s disease psychosis is another condition associated with Parkinson’s disease. It is a condition that more than half of Parkinson’s disease patients develop over the course of the disease, with the primary symptom being hallucinations and delusions.
Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
In popular beliefs, tremor is often associated with Parkinson’s disease. That is why Parkinson’s disease is often mistaken with essential tremor, which manifests itself solely by a tremor, unlike Parkinson’s disease. The person is not inconvenienced with the slowness and rigidity typical to Parkinson’s disease.
The fundamental difference between those two states resides in the type of tremor. In Parkinson’s disease, tremor manifests itself mostly at rest and fades as the person tries to perform an action. In essential tremor, it is present when executing an action, like holding a cup. Despite this theoretical difference, differentiation between essential tremor and resting tremor associated with Parkinson’s disease in practice may be complex and is sometimes a difficult task.
Parkinsonian syndromes refer to a whole set of diseases presenting symptoms typically associated with Parkinson’s disease, such as slowness, tremor, stiffness and balance disorder, but are accompanied with additional symptoms, designated as “Parkinson Plus”.
This is the list of different diseases that may be mistaken with Parkinson’s disease:
- Progressive supranuclear palsy
- Multiple system atrophy
- Striatonigral degeneration
- Sporadic olivopontocerebellar atrophy
- Shy-Drager syndrome
- Corticobasal ganglionic degeneration
- Dementia with Lewy bodies
It may be difficult for the neurologist to make a specific diagnosis in the early stages. Differences between Parkinson’s disease and a parkinsonian syndrome are very subtle. Therefore, the presence of symptoms that are not typical to Parkinson’s disease, such as loss of vision, falls in the early stage, important cognitive losses and the discovery of atypical signs at the clinical exam may lead to a parkinsonian syndrome diagnosis.
A parkinsonian syndrome diagnosis is often confirmed after a levodopa treatment because in this case, there is no or very little response to this pharmacological treatment. Parkinsonian syndromes often have a faster progress than Parkinson’s disease and unfortunately, very few therapeutic interventions are able to alleviate the symptoms of the affected person.
Review guide to diseases similar to Parkinson’s
Some movement disorders have PD symptoms
Parkinson’s disease (PD) is not related to other well-known neurological conditions such as multiple sclerosis, muscular dystrophy, or Lou Gehrig’s disease (amyotrophic lateral sclerosis). However, there is a variety of syndromes and diseases that look like PD but have other clinical features and pathology. The American Parkinson Disease Asso ciation in Staten Island, NY, describes 14 such diseases, as follows:
• Benign (familial) essential tremor: Essen tial tremor is commonly mistaken for PD, but the tremor quality is different. It is primarily at its worst during action, less severe during posture-holding, and rare at rest. The hands are affected, and there may be a tremor of the head and neck, usually a head nod. Also, the voice has a tremulous quality, which is not seen in PD. The legs are rarely affected, and there is no slowness, stiffness, or other features of PD. Some patients with presumed essential tremor eventually may develop PD.
• Progressive supranuclear palsy: The most common of the atypical parkinsonisms, this is known in England as Steele-Richardson-Olszewski syndrome for the doctors who first described it. The palsy may appear initially like typical PD; patients may complain of gait disorder, frequent falls, visual abnormalities, or speech and swallowing problems. Tremor is usually absent. The disease’s course is shorter than that of PD, and patients may have problems with falling and imbalance much earlier. The neck may be rigid, with hyperextension. Patients assume a wide-eyed astonished stare. The hallmark of the disease is the inability to look down voluntarily, and other eye movement abnormalities may occur at later stages. No medications have been found to be useful consistently for more advanced cases.
• Multiple systems atrophy: This term refers to three main disorders, called olivopontocerebellar atrophy (OPCA), Shy-Drager syndrome (SDS or primary or progressive autonomic failure), and striatonigral degeneration (SND). All of these may be characterized by parkinsonism, although rest tremor is slight or absent. Again, the course is more rapid than PD, and treatment is usually not productive. Distinguishing features are:
— OPCA: unsteadiness or imbalance, where the impairments of balance, stability, and coordinated movements are out of proportion to other signs and symptoms.
— SDS: parkinsonism with dysautonomia, where the dysautonomia precedes or dwarfs the parkinsonism.
— SND: may appear clinically identical to PD, although tremor tends to be less prominent, and gait and balance problems may occur early. Diagnosis is usually considered in patients with parkinsonism in whom there is no response at all to levodopa or other antiparkinson drugs.
• Cortical-basal ganglionic degeneration: A parkinsonian syndrome that is characterized by very asymmetric involvement of one arm, before it eventually involves the other side, with these symptoms: extreme rigidity; a foreign feeling in or an involuntary positioning of the limb; a loss of knowing what to do with the hand, such as forgetting to brush one’s teeth; and a loss of some sensations on that side. There is infrequent rest tremor, and dementia may occur early. It almost never occurs before age 50, and the course is relatively short, with no effective treatments.
• Post-encephalitic parkinsonism (PEP): A consequence of Von Economo’s or epidemic encepha litis or encephalitis lethargica (not the post-World War I influenza epidemic) that occurred worldwide in the second and third decades of the 20th century. PEP accounted for about 12% of parkinsonism seen at major centers in the first half of the century, but there are very few patients left with this disorder. The cause was apparently a virus that has never been identified. Development of this condition ranged from weeks or months to years after the encephalitis exposure. The most dramatic feature is a dystonic deviation of the eyes. Other features include young onset, bizarre personality, behavioral changes, paralysis, and extreme fatigue. When levodopa was introduced, a population of PEP patients were started on this drug, but few could tolerate the side effects. A description of this condition is found in the book and movie Awakenings by Oliver Sacks, MD.
• Normal pressure hydrocephalus: This is an uncommon but potentially reversible condition that has a parkinsonian syndrome. It is distinguished by gait disorder, urinary incontinence, and dementia and caused by enlargement of the fluid cavities of the brain, called the ventricles. There is compression of the centers that control walking, voiding, and thinking. It sometimes may be improved by removing the fluid from the brain, most effectively done by insertion of a shunt from the brain to another part of the body (often the abdomen) to drain the fluid away.
• Vascular diseases: Strokes due to hardening of the arteries or small blood vessels (arteriosclerosis) usually come on suddenly, causing paralysis of one side of the body. Rarely, multiple little strokes in deep parts of the brain, each too small to be noticed or causing only brief weakness, eventually may result in cumulative damage to the circuit that causes the symptoms of parkinsonism. Vascular parkinsonism is generally thought to be a lower-body parkinsonism, causing problems with gait and balance but rarely tremor. Sometimes, mental impairment occurs. Patients tend to be older with a history of high blood pressure, diabetes, or heart conditions.
• Drugs and toxins: A variety of drugs and toxins have been found to be responsible for the development of parkinsonian syndromes. Most cause only temporary problems, but one toxin has resulted in permanent parkinsonism.
The toxin is MPTP, a designer drug similar to heroin. In humans and animals, it causes an irreversible, very rapidly developing parkinsonism, clinically indistinguishable from PD except for the speed of development following exposure. Severity appears to relate to degree of exposure. Patients respond well to antiparkinson medications. Also, poisoning with manganese has been reported to cause parkinsonism.
Reversible cases of drug-induced parkinsonism have been associated with the following drugs: antipsychotic medications used to treat schizophrenics, such as haloperidol (Haldol), fluphenazine (Prolixin), and chlorpromazine (Thorazine); certain antinausea drugs that are chemically related to the antipsychotic drugs, such as prochlorperazine (Compazine); metoclopramide (Reglan), a highly prescribed medication for improving stomach and bowel move – ment; and alpha-methyl dopa (Aldomet), a formerly popular antihypertensive.
• Dystonia: Primary, or idiopathic, dystonia occurs in individuals of any age. In childhood, it tends to start in the foot and gradually involve the entire body. Adult-onset dystonia tends to remain in one body location (focal Dystonia). Most frequently it involves the neck (torticollis), eyelids (blepharospasm), lower face (Meige syndrome), or hand (writer’s cramp dystonia).
• Dopa-responsive dystonia: This disorder usually begins in childhood and is more common in girls than boys. It is characterized by mild parkinsonism with more pronounced dystonia, worsening as the day wears on. It has dramatic, prolonged response to low-dose levodopa and may be confused with juvenile-onset PD.
• Alzheimer’s disease: Occasionally, some patients with Alzheimer’s disease may demonstrate features of parkinsonism. In addition, occasionally the pathology of PD and AD may occur in the same person. Nevertheless, PD is not Alz heimer’s disease, nor does it lead to Alzheimer’s disease.
Progressive Supranuclear Palsy: An Atypical Parkinsonian Syndrome
Progressive supranuclear palsy (PSP) is not Parkinson’s disease (PD), but is a Parkinsonian-like syndrome. PSP is a rare brain disorder that causes serious and progressive problems with gait and balance, as well as eye movement and thinking problems. It gets its name because it begins slowly and continues to get worse (progressive), it causes weakness (palsy) by damaging certain parts of the brain structures called nuclei that control eye movements (supranuclear).1
Like Parkinson’s, PSP has no known cause, no cure and is not life-threatening. Neither has a diagnostic lab test and both can be characterized as movement disorders. Both PSP and PD tend to present around age 60. PSP can cause complications, like pneumonia, that can reduce life expectancy. Unlike PD, PSP has no effective treatment. PSP is considered rare, affecting around 20,000 Americans, while PD is more common with over 50,000 new cases diagnosed each year. Many symptoms of PSP are also identifiable in people with Parkinson’s, resulting in PSP often being misdiagnosed as PD.2
Hallmarks of PSP
PSP affects balance, movement, gait, vision, speech, thinking, mood and behavior displays. PSP symptoms that are similar to those of PD include difficulties with balance, unexplained falls, and awkward gait. A classic early sign of PSP is visual disturbance – the inability to control the movement of the eyes. Changes in vision and control of the eyes can be diagnostic clues that differentiate PSP. The inability to move your eyes up and down or look a person in the eyes can create awkward interpersonal interactions.
Cognitive symptoms including changes in executive function, mood and behavior are also common in PSP. There can be losses of emotional stability characterized by sudden and uncontrollable bouts of laughter or crying which can result in embarrassing and inappropriate behavior in social or work situations.
What causes PSP?
First described in 1964 by three scientists, it has also been known by their names as Steele-Richardson-Olszewski syndrome. PSP is considered a sporadic neurodegenerative disease, one that develops by chance.3 Build up of the Tau protein in the brain causes cellular damage and thus affects the normal function of neurons. PSP is considered a tauopathy as is Alzheimer’s and other frontotemporal brain disorders.
How is PSP managed?
There is neither a cure nor an effective treatment for PSP. Most symptoms don’t respond to drug therapy. Some anti-parkinsonian medications like levodopa have been tried but therapeutic effects, if any, are generally short-lived.
Hallmarks of Parkinson’s
Parkinson’s disease is a chronic neurodegenerative disorder that is generally thought of as a motor disorder. Symptoms develop slowly over time and vary from person to person. The key motor characteristics are tremor, slowness of movement, frozen limbs and difficulty with gait. People with Parkinson’s also experience changes in mood and behavior. Cognitive impairment can range from depression and anxiety, to psychosis. In fact, many find living with the non-motor changes of PD to be more difficult than the motor symptoms.
What causes Parkinson’s?
First described in 1917 by James Parkinson as the shaking palsy, PD is characterized by a loss of neurons in the substantia nigra portion of the brain. A buildup of the protein alpha-synuclein causes dopamine producing cells to fail and die. There is no known specific cause of PD but it is considered to be a combination of genetic and environmental factors just like PSP.
How is Parkinson’s managed?
Symptoms of PD develop over years. Dopamine replacement therapy is the first line treatment for Parkinson’s. Since each case of Parkinson’s is unique, there is no telling which symptoms may develop. There are 5 stages of Parkinson’s and not everyone will progress through each stage.
New research is looking at gene mutations that could either cause the disease or be instrumental in directing the development of future specific therapies. PSP is being studied as part of the National Institute of Neurological Disorders and Stroke (NINDS) Parkinson’s Disease Biomarkers Program.2 Improved brain imaging may also help with earlier and more accurate diagnoses, disease monitoring, and progression.
Research is also examining the gene-environmental interaction, the influence of the environment on the expression of genes resulting in disease susceptibility. Scientists are also evaluating symptoms that are now considered precursors to disease development. For example, some non-motor symptoms like the loss of the sense of smell and having difficulty sleeping may precede the development of motor symptoms in PD. As a way to detect both diseases earlier, the intent is to develop treatments that can slow or stop progression.
Parkinson’s disease is a brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination.
Parkinson’s symptoms usually begin gradually and get worse over time. As the disease progresses, people may have difficulty walking and talking. They may also have mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue.
Both men and women can have Parkinson’s disease. However, the disease affects about 50 percent more men than women.
One clear risk factor for Parkinson’s is age. Although most people with Parkinson’s first develop the disease at about age 60, about 5 to 10 percent of people with Parkinson’s have “early-onset” disease, which begins before the age of 50. Early-onset forms of Parkinson’s are often, but not always, inherited, and some forms have been linked to specific gene mutations.
What Causes Parkinson’s Disease?
Parkinson’s disease occurs when nerve cells, or neurons, in an area of the brain that controls movement become impaired and/or die. Normally, these neurons produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.
People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many automatic functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.
Many brain cells of people with Parkinson’s contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinson’s disease and Lewy body dementia.
Although some cases of Parkinson’s appear to be hereditary, and a few can be traced to specific genetic mutations, in most cases the disease occurs randomly and does not seem to run in families. Many researchers now believe that Parkinson’s disease results from a combination of genetic factors and environmental factors such as exposure to toxins.
Symptoms of Parkinson’s Disease
Parkinson’s disease has four main symptoms:
- Tremor (trembling) in hands, arms, legs, jaw, or head
- Stiffness of the limbs and trunk
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include depression and other emotional changes; difficulty swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.
Symptoms of Parkinson’s and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson’s as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.
Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.
Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.
Many people with Parkinson’s note that prior to experiencing stiffness and tremor, they had sleep problems, constipation, decreased ability to smell, and restless legs.
Diagnosis of Parkinson’s Disease
A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.
Treatment of Parkinson’s Disease
Although there is no cure for Parkinson’s disease, medicines, surgical treatment, and other therapies can often relieve some symptoms.
Medicines for Parkinson’s Disease
Medicines prescribed for Parkinson’s include:
- Drugs that increase the level of dopamine in the brain
- Drugs that affect other brain chemicals in the body
- Drugs that help control nonmotor symptoms
The main therapy for Parkinson’s is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy—such as nausea, vomiting, low blood pressure, and restlessness—and reduces the amount of levodopa needed to improve symptoms.
People with Parkinson’s should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.
Other medicines used to treat Parkinson’s symptoms include:
- Dopamine agonists to mimic the role of dopamine in the brain
- MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
- COMT inhibitors to help break down dopamine
- Amantadine, an old antiviral drug, to reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
Deep Brain Stimulation
For people with Parkinson’s who do not respond well to medications, deep brain stimulation, or DBS, may be appropriate. DBS is a surgical procedure that surgically implants electrodes into part of the brain and connects them to a small electrical device implanted in the chest. The device and electrodes painlessly stimulate the brain in a way that helps stop many of the movement-related symptoms of Parkinson’s, such as tremor, slowness of movement, and rigidity.
Other therapies may be used to help with Parkinson’s disease symptoms. They include physical, occupational, and speech therapies, which help with gait and voice disorders, tremors and rigidity, and decline in mental functions. Other supportive therapies include a healthy diet and exercises to strengthen muscles and improve balance.
For More Information About Parkinson’s Disease
Michael J. Fox Foundation for Parkinson’s Research
This content is provided by the National Institute on Aging (NIA), part of the National Institutes of Health. NIA scientists and other experts review this content to ensure that it is accurate, authoritative, and up to date.
Content reviewed: May 16, 2017
Parkinson Disease & Mimics
Atypical Parkinsonisms are most likely to affect people in their 50s and 60s, and include disorders such as:
- Dementia with Lewy bodies (DLB), which is second only to Alzheimer’s disease as a degenerative cause of dementia
- Progressive supranuclear palsy (PSP), a disorder that affects patients’ vision and balance with frequent falls
- Multiple system atrophy (MSA), which involves the autonomic nervous system (the part of the nervous system that controls internal functions such as digestion, heartbeat and breathing) and can affect coordination
- Corticobasal syndrome (CBD), a rare atypical Parkinsonian disorder in which symptoms often involve one side of the body more than the other
Dementia with Lewy Body
Mimics Parkinson’s but with more cognitive decline, visual hallucinations
Dementia from Parkinson’s disease
Initially, Parkinson’s disease causes physical symptoms. Problems with cognitive function, including forgetfulness and difficulty with concentration, may arise later. As the disease gets worse with time, many people develop dementia, which causes profound memory loss and makes it difficult to maintain relationships with others.
Parkinson’s disease dementia can cause problems with:
- Speaking and communicating with others
- Being able to solve problems
- Understanding abstract concepts
- Difficulty paying attention
If you have Parkinson’s disease and dementia, eventually you probably won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if your Parkinson’s disease allows you to physically perform daily tasks.
Living with Parkinson’s Disease
Coping with Parkinson’s disease, the motor system disorder, can be frustrating because of its common symptoms—trembling, stiffness (often called rigidity), slow movements, and the loss of balance and coordination. A good deal of that frustration comes from the loss of control that you once had over your body. It can also be emotionally overwhelming to know that there is currently no cure for the disease.
Nonetheless, people have a number of tools at their disposal for better managing the symptoms of Parkinson’s disease and living a healthy, enjoyable life.
Here’s what can help:
- Advanced Parkinson Disease & Triple ‘P’ Treatments (Patch, Pipe & Pump)
- Neuro Interventions & Nerve Blocks