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Parkinson's - Types? There's more than one??

Yes, there are multiple types of Parkinson's disease - it all has to do with how the brain processes (or lack thereof) responsible for Parkinson's are damaged.

But first, a nice little image to show the main signs and symptoms a Dr. or allied health professional (Think Physiotherapist, OT or Nurse) would notice that would make them question whether you have Parkinson's Disease.

Now these are by no means all the signs or symptoms that a person with Parkinson's will have, but it could be considered your go to A-Lister's guide to inform a health professional whether you have idiopathic Parkinson's or another of it's lesser known cousins.

Idio...what you say, well thankfully my dear readers I have a lovely little table to show the main types of Parkinson's disease with symptoms and known causes.

Idiopathic Parkinson's

Early onset Parkinson's

Atypical or Parkinson's Plus

What is it??

  • A condition that affects the brain causing loss of coordinated movement. Nerve cells in the region of the brain called the substantia Nigra, start to malfunction or die. These nerve cells produce a neurotransmitter called dopamine, which allows signals to pass from one nerve to the next. Without dopamine, movement is diminished.

  • Parkinson’s is a slowly progressive condition, meaning that symptoms will get worse over time as more dopamine is depleted.

  • Parkinson’s is usually diagnosed in people over the age of 60 years old.

  • Parkinson’s Disease is more common in men than it is in women.

Early-onset Parkinson’s can be described just as Parkinson’s Disease; however, it is diagnosed typically in people younger than 50 years of age. About 10-20% of all Parkinson’s cases are early-onset and at least half of those diagnosed with EOP are in their 40s.

Atypical Parkinson’s is rarer than Parkinson’s Disease. The collective symptoms are often similar, but it is caused by other disorders that have damaged more parts of the brain. Because they are so similar, it is very difficult to diagnose initially. Conditions include: - Multiple systems atrophy - Progressive Supranuclear Palsy - Corticobasal syndrome - Dementia with Lewy bodies - Vascular Parkinsonism

Signs & Symptoms

The symptoms of Parkinson’s disease can vary, but the most common identifying symptoms include involuntary tremors, slowed movement (bradykinesia), rigidity or stiffness, and impaired balance. Parkinson’s disease also can cause a range of non-motor or “invisible” symptoms, such as sleep problems, constipation, slurred speech, and mood disorders.

Symptoms may start in one limb but usually progress to affect both sides of the body and both upper and lower limbs in some way.

Early-onset Parkinson’s presents just as Parkinson’s Disease. Typical symptoms include, tremor, small handwriting, loss of smell, trouble sleeping, difficulty with moving, stooped posture, quiet voice, constipation, masked face, dizziness, or fainting.

The symptoms are very similar to those of PD, tremor, bradykinesia, rigidity, and balance concerns; however, symptoms are usually only on one side of the body or only found in the lower limbs.

How is it diagnosed?

There is no test to diagnosed Parkinson’s Disease, it is usually diagnosed depending on a person’s clinical symptoms and how they respond to treatment. As many of these symptoms are typical of the aging process, it can be difficult to diagnose.

Parkinsonism can easily be miss diagnosed as Parkinson’s Disease and requires extensive diagnostic testing.

What causes it?

The term idiopathic means there is no known cause. Parkinson’s is believed to be a combination of underlying genetic predisposition and exposure to environmental pathogens.

Genetics is thought to be a more important factor in the cause of Early-onset Parkinson’s. There appear to be certain genetic mutations in the cells of people who have both Early-onset Parkinson’s and a family history of PD. These include mutations in:

  • Alpha-synuclein (Park1).

  • Parkin (Park2

  • Pink1

  • Leucine-rich repeat kinase 2 (LRRK2).

Unlike Parkinson’s Disease, a cause can be identified as there are several diseases that can cause Atypical Parkinson’s:

  • Drug-induced Parkinsonism. There are some medications that block dopamine receptors in the brain so less dopamine is available to carry nerve signals.

  • Essential Tremor (ET) is a more common condition, that results in an active tremor of the hands and arms occurring with focused activity. It can spread to the head, trunk, legs and voice. A scan called a Dopamine Transporter Scan can diagnose the difference between PD and ET.

  • Vascular Parkinsonism. Thought to be caused by a series of small strokes occurring in the part of the brain that controls movement. Symptoms usually only occur in the lower limbs.

  • Multiple System Atrophy (MSA). This is like PD in its early stages but seems to affect the autonomic nervous system more (affecting blood pressure and bladder control). It occurs due to overproduction of the alpha-synuclein protein in the brain causing atrophy of brain cells in multiple areas of the brain.

  • Lewy Body Dementia. Proteins clump together in the brain to form Lewy Bodies. The overriding symptoms are early-onset dementia and visual hallucinations as opposed to the movement disorder of PD, although Lewy Bodies do also form in the latter stages of PD.

  • Progressive supranuclear Palsy (PSP). Symptoms are very similar to PD though people with PSP are prone to falls in the early stages of this disease and they have difficulty with moving their eyes up and down. It is associated with the clumping of a protein called tau on the nerve endings. Unlike PD, people with PSP often stand in extension with their heads up and tend to fall backward.

  • Corticobasal ganglionic degeneration (CBGD). Occurs due to cell loss and atrophy (shrinking) in multiple parts of the brain. This is very similar to PD, but symptoms are only found on one side of the body. They do not respond to Parkinson’s medications.

There you have it, multiple types of Parkinson's disease - and what symptoms to keep an eye out for. How to treat this disease of many'll have to keep your eyes peeled as this will be in a few blogs time.

In the meantime another pretty infographic showing that the main signs and symptoms used to diagnose someone with Parkinson's disease are but the tip of the iceberg.

Written by

Julius Alpay (Physiotherapist)

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