Parkinsonism and Parkinson’s Plus Syndromes

Reviewed by: HU Medical Review Board | Last reviewed: October 2021

Parkinsonism is a group of conditions that are characterized by certain symptoms. Parkinson’s disease (PD) is the most common form of Parkinsonism. The motor symptoms that characterize Parkinsonism conditions include:1,2

  • Tremor
  • Rigidity (stiffness)
  • Postural instability (balance problems)
  • Bradykinesia (gradual loss of spontaneous movement)

Parkinson’s plus syndromes

Parkinson’s plus syndromes are a group of conditions that cause symptoms like PD but are not the same disease. These conditions are also sometimes called atypical Parkinsonism. Examples include:1-4

  • Multiple system atrophy (MSA)
  • Dementia with Lewy bodies (DLB)
  • Progressive supranuclear palsy (PSP)
  • Corticobasal degeneration (CBD)

Atypical Parkinsonism is usually diagnosed if someone shows symptoms of PD but does not respond to standard PD treatments. Unfortunately, there are no treatments that slow or stop the development of atypical Parkinsonism. However, there are treatments that can help manage symptoms.1,3

Multiple system atrophy

MSA is the name of a group of disorders that affect the central and autonomic nervous systems. The central nervous system is made up of the brain and spinal cord. The autonomic nervous system controls functions like breathing, heartbeat, and intestine movement. In MSA, certain cells in the brain are damaged by accumulations of a protein called alpha-synuclein.2,4

There are 2 types of MSA:2,4

  • MSA-P – Parkinsonism symptoms are more noticeable
  • MSA-C – Problems with coordination are more noticeable

Symptoms of MSA may depend on which type you have. But in general, symptoms include:1,3,4

  • Frequent falls
  • Lack of coordination
  • Unsteady walk
  • Difficulty controlling the bladder
  • Constipation

It can be difficult to tell the difference between PD and MSA, especially with MSA-P. In most cases, MSA progresses faster than PD. Also, people with MSA will not respond to standard PD drugs.4

Dementia with Lewy bodies

DLB causes thinking and memory problems along with movement problems. DLB is the second most common type of dementia after Alzheimer’s disease. DLB is named for the abnormal protein deposits of alpha-synuclein (Lewy bodies) found throughout the brain.1-3

Symptoms of DLB include:1-3

  • Hallucinations (seeing things that are not real)
  • Difficulty focusing
  • Difficulty processing information
  • Paranoia
  • Acting out dreams (REM sleep behavior disorder)

With DLB, the symptoms of dementia tend to appear before the movement symptoms. However, both types of symptoms tend to appear within a year.1

Progressive supranuclear palsy

PSP is the most common type of atypical Parkinsonism. People with PSP often have difficulties with eye movements, such as looking down. They may also have balance issues and often fall backwards. It is rare for people with PSP to have tremors.1-3

Other symptoms of PSP include:1-3

  • Problems with swallowing (dysphagia)
  • Difficulty speaking
  • Sleep problems
  • Memory or thinking problems
  • Mood problems, such as depression

PSP is caused by the buildup of a protein called tau in certain brain cells. When the tau protein forms clumps in these cells, the cells die. The reasons behind the buildup of the tau protein are not well understood.1

Corticobasal degeneration

CBD is the least common type of atypical Parkinsonism. The first signs of CBD are usually movement symptoms that only impact 1 side of the body. Like PSP, CBD is also caused by the buildup of the tau protein in brain cells.1,2

Symptoms of CBD include:1-3

  • Slowness and stiffness
  • Difficulty paying attention
  • Trouble speaking
  • Difficulty remembering how to perform simple motor tasks
  • Being unable to recognize that your limbs belong to your body (alien limb phenomenon)
  • Holding a limb in an unusual way, like an inward-turned hand (dystonia)

CBD typically progresses faster than PD. In most cases, common PD drugs do not help with CBD.2

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