Parkinson’s Syndrome Vs Disease

Lewy Body Dementia: A Common Yet Underdiagnosed Dementia

While its not a household word yet, Lewy body dementia is not a rare disease. It affects an estimated 1.4 million individuals and their families in the United States. Because LBD symptoms can closely resemble other more commonly known disorders like Alzheimers disease and Parkinsons, it is often underdiagnosed or misdiagnosed. In fact, many doctors or other medical professionals still are not familiar with LBD.

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Difference Between Parkinsons Disease And Als Signs And Symptoms

Parkinsons disease typically begins with tremors, followed by muscle stiffness, difficulty standing or walking, changes in speech, slow movements, impaired posture and balance, loss of automatic movements, and writing changes.

Signs and symptoms of ALS include slurred speech, hoarseness, difficulty swallowing, emotional liability , loss of tongue muscle contour, excess saliva, difficulty breathing, limp muscles or flaccid weakness, muscle wasting, and twitching.

In the early stages of the disease, ALS patients may notice that performing regular everyday tasks has become more challenging. For example, they may experience difficulty climbing steps or getting up from a chair. Symptoms may first begin on one side of the body, but as the condition progresses, they spread to both sides.

As you can see, ALS and Parkinsons disease share symptoms associated with the negative impact of both conditions on movement and muscle function.

Diagnostic Parameters For The Main Clinical Diagnoses

Overall, 122 out of 143 cases were clinically diagnosed correctly, giving an overall positive predictive value of 85.3% . Other than vascular parkinsonism, which was based on two cases, the clinical diagnosis of IPD showed the best overall sensitivity and positive predictive value , followed by MSA and then PSP. The figures for CBD and vascular parkinsonism are based on very small numbers. The specificity for all the major diagnoses was extremely high with little difference for any of the groups, indicating that these neurologists were extremely good at correctly ruling out these specific diagnoses.

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How Do Doctors Diagnose Parkinsonism

No single test exists for doctors to diagnose Parkinsonism.

A doctor will start by taking a persons health history and review their current symptoms. They will ask for a medication list to determine if any medicines could be causing the symptoms.

A doctor will likely also order blood testing to check for underlying potential causes, such as thyroid or liver problems. A doctor will also order imaging scans to examine the brain and body for other causes, such as a brain tumor.

Doctors can perform a test that tracks the movement of dopamine in the brain. This is known as the DaT-SPECT test.

The test uses radioactive markers designed to track dopamine in the brain. This allows a doctor to watch the release of dopamine in a persons brain and identify the areas of the brain that do or do not receive it.

Because Parkinsonism does not respond to typical treatments and can have a variety of symptoms, doctors can have difficulty coming to a quick diagnosis. It may take time for doctors to rule out other conditions and begin to make treatment recommendations.

Whats The Difference Between Corticobasal Degeneration And Parkinsons

The main difference between CBD and Parkinsons is that it usually starts on one side with the gradual loss of use of one hand or leg , and there may be little flicks of involuntary muscle jerks. Walking and balance difficulties usually occur later in CBD than in Parkinsons. Also, in CBD, a person may have trouble with purposeful movements, such as buttoning a shirt or cutting food.

For more information on corticobasal degeneration, read this information page.

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Parkinsonism Vs Parkinsons: Whats The Difference

If you or a loved one are living with Parkinsons disease, youve likely heard the term parkinsonism but you may not know how it differs from Parkinsons. Getting very confused about the difference between Parkinsons and parkinsonism, wrote one MyParkinsonsTeam member.

Parkinsons disease is a brain condition that advances slowly over time in the majority of people. The condition involves the loss of brain cells in a part of the brain called the substantia nigra. The substantia nigra makes a chemical called dopamine, which plays a role in body functions including memory, movement, and pleasure. As these dopamine-producing neurons decrease in number, Parkinsons symptoms begin to appear.

Parkinsonism is a broad term referring to several neurological conditions with movement issues including Parkinsons disease. Types of parkinsonism other than Parkinsons disease are sometimes referred to as Parkinsons plus or atypical Parkinsons disease. Around 85 percent to 90 percent of diagnosed cases of parkinsonism are types other than Parkinsons disease.

Despite their differences, the various types of parkinsonism including Parkinsons disease share some common signs and symptoms. As a result, they sometimes can be misdiagnosed as a different type.

Who Does It Affect

Parkinsonism overall is usually an age-related disease. Its slightly more common in people assigned male at birth than in those assigned female at birth. The most common forms of parkinsonism are more likely to happen after age 60.

But some forms can happen at a much earlier age. The average age when juvenile parkinsonism starts is 17. That form of parkinsonism is also four times more common in assigned males than assigned females.

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How Can I Prevent This Condition Or Reduce My Risk Of Developing It

Parkinsonism happens unpredictably in most cases, so it’s usually impossible to prevent it or reduce your risk of developing it. However, there are specific types of secondary parkinsonism that you can reduce the risk of developing. These are:

• Toxin-induced parkinsonism. Its possible to reduce your risk of developing this type of parkinsonism by avoiding toxins or substances that can cause it or by using safety equipment to reduce your exposure to these substances when you cant avoid them.
• Post-traumatic parkinsonism. You can reduce your risk of developing this by using safety equipment to protect yourself from head injuries.
• Vascular parkinsonism. Reducing your risk of developing this involves taking care of your circulatory health, especially the circulation in your brain. Managing this involves maintaining a weight that’s healthy for you, eating a balanced diet and staying physically active.

Symptoms Of Parkinsons Disease

Some symptoms of Parkinsons affect a persons ability to move. These symptoms are often called motor symptoms, and they include:

• Stiffness of muscles

Other symptoms of Parkinsons dont affect a persons movement. These nonmotor symptoms may include:

• Digestive problems, such as constipation
• Cognitive changes, such as loss of attention, difficulty solving problems, memory loss, and trouble with language

Parkinsons symptoms may take several years to appear. A majority of people with Parkinsons live for many years with the condition.

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What Are Atypical Parkinsonian Disorders

Atypical Parkinsonian disorders are progressive diseases that present with some of the signs and symptoms of Parkinsons disease, but that generally do not respond well to drug treatment with levodopa. They are associated with abnormal protein buildup within brain cells.

The term refers to several conditions, each affecting particular parts of the brain and showing a characteristic course:

• Dementia with Lewy bodies, characterized by an abnormal accumulation of alpha-synuclein protein in brain cells
• Progressive supranuclear palsy, involving tau protein buildup affecting the frontal lobes, brainstem, cerebellum and substantia nigra
• Multiple system atrophy, another synucleinopathy that affects the autonomic nervous system , substantia nigra and at times the cerebellum
• Corticobasal syndrome, a rare tauopathy that typically affects one side of the body more than the other and makes it difficult for patients to see and navigate through space

Understanding The Differences Between Parkinsonism And Parkinson Plus Syndromes

Parkinsonism means looks like Parkinsons disease. To neurologists this means that the person has a somewhat flexed posture, moves slowly, is stiff and usually walks slowly, with small steps and reduced or no arm swing. We call the syndromes atypical because they usually differ from Parkinsons Disease in a few ways:

Very often when the condition is mild, at the earliest stages, we cant tell whether it is Parkinsons Disease or atypical Parkinsons Disease and we treat it as if it is Parkinsons Disease because we dont have treatments for the atypical Parkinson disorders. Sometimes they respond to the usual Parkinsons Disease medications, but usually they dont. And when they do, the response is not as good as it is with PD.

Parkinson plus syndromes refer to syndromes which look like atypical PD, but also include additional abnormalities that are not seen in PD. These include: abnormalities of eye movements, gait ataxia , dystonia , severe problems with low blood pressure on standing, or changes on the neurological exam that are only detected by the neurologist in the form of abnormal reflexes.

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Motor Circuit In Parkinson Disease

The basal ganglia motor circuit modulates the cortical output necessary for normal movement .

Signals from the cerebral cortex are processed through the basal ganglia-thalamocortical motor circuit and return to the same area via a feedback pathway. Output from the motor circuit is directed through the internal segment of the globus pallidus and the substantia nigra pars reticulata . This inhibitory output is directed to the thalamocortical pathway and suppresses movement.

Two pathways exist within the basal ganglia circuit, the direct and indirect pathways, as follows:

• In the direct pathway, outflow from the striatum directly inhibits the GPi and SNr striatal neurons containing D1 receptors constitute the direct pathway and project to the GPi/SNr

• The indirect pathway contains inhibitory connections between the striatum and the external segment of the globus pallidus and between the GPe and the subthalamic nucleus striatal neurons with D2 receptors are part of the indirect pathway and project to the GPe

The STN exerts an excitatory influence on the GPi and SNr. The GPi/SNr sends inhibitory output to the ventral lateral nucleus of the thalamus. Dopamine is released from nigrostriatal neurons to activate the direct pathway and inhibit the indirect pathway. In Parkinson disease, decreased striatal dopamine causes increased inhibitory output from the GPi/SNr via both the direct and indirect pathways .

Treatment Of Atypical Parkinsonism

While no current therapy can slow or stop progression, treatment can ease symptoms of atypical parkinsonisms. Because symptoms overlap across these conditions, treatments overlap, too.

For movement symptoms, such as stiffness and slowness, doctors may prescribe levodopa. Unfortunately, if this medication does ease symptoms, its benefit may not be significant or long-lasting. In people who have dementia with Lewy bodies, levodopa may worsen hallucinations, so doctors prescribe it cautiously. For dystonia in CBD, botulinum toxin injections such as Botox or Myobloc into the muscles may be an option. For walking and balance problems, as well as falls, occupational and physical therapy are helpful. Canes and walkers may provide extra stability, though in some cases wheelchairs may be necessary.

Memory and thinking problems may be treated with medications such as Exelon , Aricept , Razadyne or Namenda . In DLB, these drugs also may help with behavioral changes and hallucinations.

Speech therapy treats speech and swallowing problems. Therapists may recommend exercises to strengthen speech and swallowing muscles, as well as diet adjustments and behavioral strategies to improve swallowing. If swallowing problems lead to weight loss or recurrent pneumonia , doctors may consider a feeding tube.

Doctors can use a variety of medications to ease mood, behavioral and sleep problems.

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Whats The Outlook For People With Parkinsons Plus

Although there currently isnt a treatment to halt the progression of Parkinsons plus syndrome, there are treatments that can help you manage your symptoms and improve your quality of life.

The exact outlook for Parkinsons plus syndrome depends on the person and the specific condition they have. Someone who is otherwise healthy when theyre diagnosed will typically have a longer life expectancy than someone who is already facing other health conditions when theyre diagnosed. Your doctor will monitor your condition over time and can let you know how its progressing.

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What Are The Current Treatment Options

While there is no specific cure for Parkinsons plus syndrome, there are treatments that can control your symptoms. A doctor can develop a plan for your overall health and to treat your specific symptoms. Medications that treat the symptoms of Parkinsons disease often do not work as well for Parkinsons plus syndrome.

Treatment options might include:

• Walking and balance assistance. You might receive physical and occupational therapy to help keep you moving. Therapists can help you build strength and prevent falls. They can also help you learn to use canes, walkers, and other mobility aids, if needed.
• Swallowing and speech assistance. A speech therapist can help you adjust to changes that might make it hard to swallow and speak. They can help you communicate and can recommend foods and beverages that are easier to swallow.
• Medications for cognitive issues. Your doctor might prescribe a variety of medications that can help with your focus and memory. Many of these medications are also used for conditions such as Alzheimers or dementia.
• Medications for trouble with movement. You might be prescribed medications that can help you control your muscles and movement. These medications might also address stiffness and balance problems.
• Medications to help with mood symptoms. If youre experiencing depression, anxiety, or other mood-related concerns, your doctor might prescribe medications that can help with these symptoms.

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Environmental Factors And Exposures

Exposure to pesticides and a history of head injury have each been linked with PD, but the risks are modest. Never drinking caffeinated beverages is also associated with small increases in risk of developing PD.

Low concentrations of urate in the blood is associated with an increased risk of PD.

Drug-induced parkinsonism

Different medical drugs have been implicated in cases of parkinsonism. Drug-induced parkinsonism is normally reversible by stopping the offending agent. Drugs include:

The Clinical Translation: Subtypes

The diagnostic concept of Parkinsons disease is changing and an ongoing revision of its diagnostic criteria by the International Movement Disorders Society has included a range of non-motor symptoms as part of the core parameters . This would suggest that there is a greater awareness of the clinical heterogeneity of PD, which is no longer viewed as a disease with motor features alone. The recognition mixed motor and non-motor phenotypes have been well documented in the literature and many initial studies attempted to understand these variances through a matched groups approach with classifications based on predetermined patient attributes, such as age of disease-onset, cognitive performance, motor phenotype, and disease severity. However, all of these approaches suffer from the limitations arising from the prospective assumptions about the classification, namely the arbitrary division of patients based on the criteria adopted. To avoid this, more recent work has sought to utilize data-driven methodologies, such as cluster analysis.

It has been suggested that NMS subtypes may be more stable over time compared to the motor subtypes PD as the former is underpinned by specific patterns of neurotransmitter pathway dysfunction . A proposed example is offered in Fig. 6.

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Changes In Cognition And Parkinsons Disease

Some people with Parkinsons may experience changes in their cognitive function, including problems with memory, attention, and the ability to plan and accomplish tasks. Stress, depression, and some medications may also contribute to these changes in cognition.

Over time, as the disease progresses, some people may develop dementia and be diagnosed with Parkinsons dementia, a type of Lewy body dementia. People with Parkinsons dementia may have severe memory and thinking problems that affect daily living.

Talk with your doctor if you or a loved one is diagnosed with Parkinsons disease and is experiencing problems with thinking or memory.

How Is Parkinsonism Treated

The treatments for parkinsonism depend on the condition itself and what caused it. Most forms of parkinsonism are treatable, and some can stop entirely .

Some examples of treatable conditions include:

In general, your healthcare provider is the best person to provide more information about whether or not your condition is treatable or curable. Thats because so many different conditions fall under parkinsonism, many of which are very different from person to person. Your provider can tell you more about if your condition is treatable and what your treatment options are with your specific case and circumstances.

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When Its Not Parkinsons Disease

In those cases where Levodopa doesnt help with Parkinsons symptoms, its usually because the symptoms arent caused by neuron death in the brain but by external factors. These factors include any of the following:

• Medications prescribed for psychosis, psychiatric disorders, or nausea
• Exposure to environmental toxins
• Metabolic disorders, chronic liver failure, or Wilsons disease

What Is The Difference Between Parkinsonism Vs Parkinsons Disease

What is the difference between Parkinsonism vs Parkinsons disease? In simple terms, Parkinsons is a disease whereas Parkinsonism is a range of symptoms that are usually seen in patients with Parkinsons disease, but sometimes occurring as a result of other neurodegenerative disorders.

Unless you are a medical professional, there might appear to be very little difference between Parkinsons disease and Parkinsonism.

On the surface, they appear to be exactly the same condition: both are characterized by tremors, stiffness, balance issues, and slowness of movement, but this is where the similarities end.

Whereas Parkinsonism encompasses the four main movement problems seen in patients suffering from Parkinsons disease, Parkinsons disease itself is a progressive and highly degenerative disorder that causes many other symptoms as well as those seen in Parkinsonism.

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