There is often a lot of confusion about the types of Parkinson’s Disease and hopefully, the following will help you understand a little better what is meant by the terms idiopathic Parkinson’s, Early-onset Parkinson’s and Parkinson’s Plus, or Parkinsonism.
Idiopathic Parkinson’s Disease
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 Disease
What is it? Early-onset Parkinson’s can be described just as Parkinson’s Disease; however, it is diagnosed typically in people younger than 60 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.
Parkinson’s Plus or Atypical Parkinsonism
What is it? Atypical Parkinson’s is rarer than Parkinson’s Disease. The collective symptoms are often similar, but it is caused by other disorders. Because they are so similar, it is very difficult to diagnose initially.
What are the 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.
What are the symptoms? 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.
What are the symptoms? 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.
How is it diagnosed? 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.
What causes it? 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).
What causes it? 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.
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.
What is the treatment? Prescribing Levodopa is the gold standard for treating the symptoms of Parkinson’s Disease. Your Specialist will prescribe the medication they feel with best suit you, to manage your unique symptoms and remain compatible with other medical conditions you may have.
What is the treatment? Since the effects of Levodopa can wear off after several years, people with Early Onset Parkinson’s are not typically prescribed these drugs in the early years after diagnosis. The side effects of these drugs can create involuntary movements called dyskinesia and painful cramping called dystonia.
For this reason, people with EOP are usually started on anticholinergics, MAO -B inhibitors and dopamine agonists. Your Specialist will prescribe the medication they feel with best suit you, to manage your unique symptoms and remain compatible with other medical conditions you may have.
What is the treatment? Treatment depends on the diagnosis. For Drug-induced Parkinsonism, simply stopping the drugs can resolve the symptoms quickly.
There are a variety of drugs that help manage the tremors in Essential tremor.
Vascular Parkinsonism is managed by controlling blood pressure and other related conditions such as diabetes.
The other types are often treated with Parkinson’s drugs but generally respond poorly to a typical PD regime. Your Specialist will prescribe the medication they feel with best suit you, to manage your unique symptoms and remain compatible with other medical conditions you may have.
