What are Parkinsons Plus Syndromes?

Parkinson’s plus syndromes, also called “atypical Parkinson’s,” are illnesses that attack your brain and nerve cells. As the name suggests, they’re linked to Parkinson’s disease and cause a lot of the same symptoms, but they can bring on other problems as well.

Your brain makes a chemical called dopamine that helps control your movement. “Parkinsonism” is the word doctors use to describe several conditions that can happen if you don’t make enough of it.

Parkinson’s disease is by far the most common of these, but about 15% of people who have a problem making dopamine will have one of the Parkinson’s plus syndromes.

Types

Parkinson’s plus syndromes are more serious and harder to treat than “classic” Parkinson’s disease. The four main types are:

Progressive Supranuclear Palsy (PSP)

This is the most common Parkinson’s plus syndrome. It causes some of the same issues with movement and your muscles as Parkinson’s disease, like stiffness and problems with walking or balance, but it doesn’t usually make your limbs shake. It also can make it harder to move your eyes -- it starts in the part of your brain that controls your eye muscles. Looking down can be especially hard. It can cause mood changes, affect your ability to think of words, and make it hard to swallow as well.

Dementia With Lewy Bodies

This is the second most common form of dementia after Alzheimer’s disease. Lewy bodies are clumps of protein that build up in your nerve cells. When that happens, it affects your ability to think clearly, speak, and remember things. It can make you confused and cause hallucinations (when you see things that aren’t there). The symptoms get worse over time.

Multiple System Atrophy

This affects what’s known as your autonomic nervous system, which controls things like your blood pressure and digestive system. Symptoms can include things like fainting, losing control of your bladder, and constipation. It also causes more typical Parkinson’s symptoms, like shaking, stiffness, and problems with balance or speech.

Corticobasal Degeneration

This is the rarest of the four main types. It kills brain cells in the cerebral cortex -- the wrinkly gray matter on the outside of your brain -- and causes the cortex to shrink. It also attacks what’s called the basal ganglia, a part of your brain that controls movement.

Its symptoms are like the ones caused by Parkinson’s disease, including the loss of muscle control, sometimes starting on only one side of your body. But it also can hurt your ability to think, see, and speak clearly. As the disease gets worse, it gets harder to walk and swallow.

Diagnosis

Parkinson’s plus syndromes can look a lot like other conditions that affect your nervous system, so it can sometimes take a while to find out for sure what’s going on.

If your doctor thinks you might have Parkinson’s or a Parkinson’s plus syndrome, they’ll recommend that you see a neurologist, a doctor who specializes in problems with the nervous system. Your neurologist will examine you and see how you move and follow directions. They then might suggest blood tests and a brain scan to rule out other conditions.

If those don’t show a reason for your symptoms, they may ask you to try a medication called carbidopa-levodopa. Your brain can turn that into dopamine. If your symptoms get better, that may be enough for your doctor to diagnose Parkinson’s disease. If it doesn’t help much or at all, or it helps for a while then stops working, that can be a sign of a Parkinson’s plus syndrome.

Other things that can point to a Parkinson’s plus syndrome rather than the classic form include:

• Early signs of dementia
• Falling often
• Trouble moving your eyes
• Your symptoms get worse then level off for a while

Treatment

Doctors don’t know exactly what causes any of the Parkinson’s plus syndromes, and there’s no cure for them. Treating them usually is about managing the symptoms. That can include the following:

• Medication can help some people move more easily and feel less stiff. Some drugs also can help with the problems caused by multiple system atrophy, like fainting or constipation.
• A cane or walker can help you get around.
• Speech therapy can help you communicate better.
• Exercise and physical therapy can make your muscles stronger and more flexible.
• Occupational therapy can help make everyday tasks easier.

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