Parkinson-plus syndromes are a group of neurological
conditions that are similar to
Parkinson’s disease but have unique characteristics.
These syndromes can be hard to diagnose because the symptoms mimic other
conditions. Following are the four most common types of Parkinson-plus
Progressive supranuclear palsy (PSP)
PSP is a rare
disorder that, like Parkinson’s disease, causes problems with balance and
stability when a person is walking or standing. Rigid and stiff muscles,
especially those of the neck and spine, make body movement difficult. The
symptom that most distinguishes PSP from Parkinson’s disease and other
neurologic conditions is problems with eye movement that occurs in addition
to the body movement problems.
Problems with speech and
swallowing are more common and become worse in PSP than they do in Parkinson’s
disease. Depression and emotional difficulties are also more prominent. Unlike
Parkinson’s disease, PSP rarely causes tremors. PSP progresses more quickly
than Parkinson’s and often leads to disability within 5 to 10 years.
While there is currently no cure for PSP, some symptoms may be controlled
with medicines. Symptoms of depression that are related to PSP may improve
with antidepressant medications, and some movement problems may respond to
antiparkinson medicines such as levodopa.
Multiple system atrophy (MSA)
MSA is a series of
three related disorders that slowly but progressively affect the
nervous system. One disorder (called
olivopontocerebellar atrophy, or OPCA) causes problems with balance,
coordination, and speech. A second disorder (called striatonigral degeneration)
causes slow body movement and stiff muscles similar to Parkinson’s disease. The
third disorder (called Shy-Drager disease) interferes with automatic body
functions that are controlled by the
autonomic nervous system, such as breathing, heart
rate, digestion, and blood pressure.
Parkinson-like symptoms of
MSA include stiff and rigid muscles and limbs, loss of balance and coordination
when walking, difficulty swallowing and speaking, blurred vision, constipation
and urination problems, and
erectile dysfunction. Both MSA and Parkinson’s disease
can cause dizziness when standing up (orthostatic hypotension) due to a drop in blood pressure, which, in MSA, may be
severe enough to cause brief blackouts. There is no effective way to stop the
nerve degeneration that occurs with MSA, but medicines can help relieve
Cortical-basal ganglionic degeneration (CBGD)
is a rare neurological disorder that, over time, causes many areas of the brain
to shrink. Initial symptoms may appear on only one side of the body but
eventually affect both sides as the disease progresses. Some symptoms of CBGD
are similar to Parkinson’s disease, such as stiff, rigid movements,
tremor, problems with balance and coordination,
difficulty speaking and concentrating, and progressive problems with moving,
thinking, and remembering.
Gradually, problems with understanding
spoken or written language may develop. A phenomenon called “alien limb” can
occur in which the person has trouble controlling the movement of a
Although there is no cure for CBGD, medications are
available to treat its symptoms. Treatment can improve a person’s daily
functioning and quality of life.
Dementia with Lewy bodies (DLB)
DLB is a brain
disease that causes progressive changes with movement or thinking. In DLB,
abnormal structures called Lewy bodies form in certain areas of the brain.
Sometimes the symptoms of DLB resemble those of Parkinson’s disease-such as a
shuffling gait, tremor, and problems with movement. In other cases, symptoms
of DLB (such as confusion and memory loss) may mimic the symptoms of
Alzheimer’s disease. Often a combination of both
Parkinson’s and Alzheimer’s symptoms appear together. These symptoms may occur
in DLB because the structures in the brain affected by DLB are similar to those
affected by Parkinson’s disease or Alzheimer’s disease. Some experts think that
DLB may be a form of Parkinson’s disease or Alzheimer’s disease.
The progression of DLB is slow. Although there is no cure for DLB, treatment is
available to reduce symptoms of the disease.
Primary Medical Reviewer Anne C. Poinier, MD – Internal Medicine
Specialist Medical Reviewer G. Frederick Wooten, MD – Neurology
Current as ofOctober 9, 2017