Atypical Parkinsonism (Parkinson’s Plus)

What is Atypical Parkinsonism?

Atypical parkinsonism, also known as “Parkinsonism plus syndrome”, is a term used to describe a group of neurodegenerative disorders that share some clinical features with Parkinson’s disease but also have distinct characteristics and progression patterns. These conditions are called “atypical” because they go beyond the typical symptoms of idiopathic Parkinson’s disease (PD) and are generally more challenging to diagnose and manage.

The term parkinsonism refers to the appearance on exam similar to Parkinson’s disease, but Parkinson’s disease is not the only cause of parkinsonism.

Atypical parkinsonism is often referred to as “Parkinson’s-plus” because the conditions have parkinsonism plus another symptom.

Causes of Parkinsonism Other than Parkinson’s Disease Include:

Multiple System Atrophy (MSA)

MSA, not to be confused with multiple sclerosis (MS), is a group of disorders with parkinsonism, autonomic dysfunction (problems with nervous control of the internal organs), and cerebellar ataxia (lack of coordination).

Dementia with Lewy Bodies (DLB)

Patients with DLB have memory and cognitive changes plus parkinsonism, and typically also have visual hallucinations and fluctuations in the level of alertness.

Progressive Supranuclear Palsy (PSP)

PSP causes parkinsonism, dementia, eye movement abnormalities, and frequent falls.

Corticobasal Degeneration (CBD):

Corticobasal degeneration is a rare cause of atypical parkinsonism, and is manifested by dementia, unilateral parkinsonism, unilateral abnormal involuntary movements, and apraxia (lack of function).

Types of Atypical Parkinsonism

VASCULAR PARKINSONISM

This refers to shuffling gait, imbalance, and stooped posture due to multiple small strokes. These strokes may not have been apparent to the patient but as they accumulate the gait, balance and often memory are affected.

DRUG-INDUCED PARKINSONISM:

Drug-induced parkinsonism refers to the appearance of parkinsonism in patients who are taking certain psychiatric or nausea medications such as Haldol (haloperidol), Abilify (aripiprazole) and Reglan (metoclopramide). These patients do not have Parkinson’s disease or a neurodegenerative condition. Treatment for drug-induced parkinsonism is slowly tapering off the offending medications. However, sometimes the medications cannot be stopped; DaTscan can be useful to differentiate between drug-induced and degenerative parkinsonism.