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

Yes, yes there is! And before you start thinking this is going to be a dry medical lecture — don’t worry, we’ve got you. Think of this as your friendly, no-jargon guide to the Parkinson’s family tree. Spoiler: it’s a bigger family than most people realise.

Now, all types of Parkinson’s come back to one core problem — the brain isn’t processing things the way it should. But which part of the brain is affected, and why, is where things get interesting.

So let’s meet the family, shall we?

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Quick Answer:

How Many Types of Parkinson’s Disease Are There?

Great question — and one that even surprises a lot of people! There are three main types:

1. Idiopathic Parkinson’s Disease — the most common form, the one most people picture when they hear “Parkinson’s”

2. Early-Onset Parkinson’s Disease — the same condition, just showing up earlier to the party (before age 50)

3. Atypical Parkinsonism (Parkinson’s Plus) — the mysterious cousin that looks a lot like Parkinson’s but has its own distinct personality

At a Glance: Parkinson’s Types Compared

Because who doesn’t love a good summary table?

Feature	Idiopathic PD	Early-Onset PD	Atypical Parkinsonism
Typical age of diagnosis	60 years +	Under 50 years	Varies by condition
Primary cause	Unknown	Genetic mutations	Other neurological disease
Tremor	Yes — both sides over time	Yes — as per classic PD	May be absent or one-sided
Body side affected	Both sides over time	Both sides over time	Often one side or lower limbs only
Responds to Parkinson’s meds?	Yes, initially	Yes, as per classic PD	Usually poor response
How common?	Most common (~80–85%)	10–20% of PD cases	Rare

General information only — always check in with a neurologist or qualified health professional for diagnosis and treatment advice.

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

Common signs and symptoms of Parkinson's

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Type 1: Idiopathic Parkinson’s Disease

Your classic Parkinson’s — the one behind roughly 80–85% of all diagnoses

So What’s Actually Going On In There?

Deep in your brain lives a region called the substantia nigra — fancy Latin for “black substance,” which is exactly as dramatic as it sounds. Nerve cells here produce dopamine, the chemical that carries movement signals from one nerve to the next. Think of dopamine as the brain’s movement Wi-Fi.

In Parkinson’s, those nerve cells start to malfunction and die. Less dopamine means weaker signal. Weaker signal means movement becomes slower, stiffer, and harder to control. And because Parkinson’s is a slowly progressive condition, the signal keeps getting weaker over time as more dopamine depletes.

Now — idiopathic. What on earth does that mean? It literally means no known cause. Which is as frustrating as it sounds! Researchers believe it’s a combination of genetics and environmental factors, but no single culprit has been identified yet.

Who’s Most Likely to Get It?

•             Most commonly diagnosed in people aged 60 and over

•             More common in men than women (though researchers are still working out why)

•             Makes up approximately 80–85% of all Parkinson’s diagnoses

Signs & Symptoms — The Ones You Can See…

Motor (movement) symptoms — the ones a physio or doctor will likely spot first:

•             Involuntary tremors (often starting in one hand or limb)

•             Slowed movement — known as bradykinesia (there’s your medical term for the day)

•             Muscle rigidity or stiffness

•             Impaired balance and posture

…And the Ones You Can’t

Non-motor symptoms are sneaky. They’re often present long before the movement stuff kicks in, and they’re easy to miss:

•             Sleep disturbances

•             Constipation

•             Slurred or quieter speech

•             Mood changes, anxiety, or depression

•             Masked facial expression — reduced blinking and expressiveness

•             Loss of smell

Symptoms usually start on one side of the body and gradually work their way to both sides over time.

How Is It Diagnosed?

Here’s the tricky bit — there’s no single test for Parkinson’s Disease. Diagnosis comes down to a clinician’s assessment of symptoms and how well a person responds to dopamine-based medication. Because a lot of these symptoms overlap with normal ageing, it can take a while to get a confirmed diagnosis. Patience, unfortunately, is part of the process.

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Type 2: Early-Onset Parkinson’s Disease

Same disease, earlier arrival — diagnosed before the age of 50

What Makes It “Early-Onset”?

Biologically? It’s the same condition as idiopathic Parkinson’s. The difference is purely timing — Early-Onset Parkinson’s (EOP) is diagnosed under the age of 50, and accounts for about 10–20% of all Parkinson’s cases. At least half of those diagnosed with EOP are in their 40s. Yes, their 40s.

What Causes It?

This is where Early-Onset diverges from its idiopathic sibling — genetics takes centre stage. Several specific gene mutations have been linked to EOP, especially in people with a family history of Parkinson’s.

The main culprits include:

•             Alpha-synuclein (PARK1)

•             Parkin (PARK2)

•             PINK1

•             Leucine-rich repeat kinase 2 (LRRK2)

Signs & Symptoms

Same playbook as classic Parkinson’s — so you’ll recognise these:

•             Tremor

•             Small, cramped handwriting (micrographia — another one for your medical vocabulary)

•             Loss of smell

•             Difficulty sleeping

•             Stooped posture

•             Quieter voice

•             Constipation

•             Dizziness or fainting

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Type 3: Atypical Parkinsonism (Parkinson’s Plus)

The mysterious cousin — rarer, trickier to diagnose, and often mistaken for classic Parkinson’s

What Is It?

Right, so here’s where it gets interesting. Atypical Parkinsonism is actually an umbrella term for a group of conditions that walk, talk, and act a lot like Parkinson’s Disease — but are caused by other disorders that damage multiple parts of the brain, not just the substantia nigra.

Because the symptoms overlap so heavily, it’s frequently misdiagnosed as Parkinson’s in the early stages. Getting the right diagnosis usually requires extensive testing, including brain imaging. It’s rarer than classic Parkinson’s, but it’s worth knowing about.

How Do the Symptoms Differ?

You’ll still see tremor, slowed movement, and rigidity — but there are two tell-tale differences:

•             Symptoms are often one-sided, or show up only in the lower limbs

•             Standard Parkinson’s medications? They usually don’t work very well here

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Meet the Extended Family

Multiple System Atrophy (MSA) Think Parkinson’s, but with the autonomic nervous system dragged into the mix — things like blood pressure regulation and bladder control start playing up too. Caused by overproduction of alpha-synuclein protein, which leads to cell death across multiple brain regions.

Progressive Supranuclear Palsy (PSP) Looks very similar to Parkinson’s, but PSP has a few quirks of its own — early falls, difficulty moving the eyes up and down, and a tendency to stand tall with the head tilted back (the opposite of Parkinson’s forward stoop). Associated with a protein called tau clumping on nerve endings.

Corticobasal Ganglionic Degeneration (CBGD) Cell loss across multiple brain regions, with symptoms showing up on one side of the body only. Doesn’t respond to Parkinson’s medications.

Lewy Body Dementia (LBD) Protein clumps — Lewy bodies — form in the brain. Unlike classic Parkinson’s, the headline symptoms here are early dementia and visual hallucinations rather than movement problems. That said, Lewy bodies also show up in the later stages of Parkinson’s Disease, so the two are more connected than they might seem.

Vascular Parkinsonism Thought to be caused by a series of small strokes in the brain’s movement-control regions. Tends to only affect the lower limbs.

Drug-Induced Parkinsonism Some medications block dopamine receptors in the brain, reducing the dopamine available for nerve signalling — and producing very convincing Parkinson’s-like symptoms as a result. The good news? These often ease off when the medication is changed or stopped.

Essential Tremor (ET) Not technically Parkinson’s, but worth a mention because it gets confused with it regularly. Essential Tremor causes active trembling of the hands and arms during movement — and can spread to the head, voice, and legs. The key difference? It’s not caused by dopamine loss. A Dopamine Transporter (DaT) Scan can tell them apart.

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Want to Know More — Or Need Some Support?

Well, now you know there’s more than one type of Parkinson’s — and what to look out for with each of them.

How do we treat this disease of many stripes? Keep your eyes peeled — that’s coming in a future blog.

In the meantime, if you or someone you care for is navigating a Parkinson’s diagnosis, the team at Quest Physio in Chermside, Brisbane are here to help.

We have a special interest in neurological conditions such as Parkinson's, support NDIS participants and aged care recipients, and offer both clinic and home visit appointments.

Call us on (07) 3088 8035 or head to questphysio.com.au/parkinson to book.