Understanding the differences between Parkinsonism and Parkinson Plus syndromes

“Parkinsonism” means “looks like Parkinson’s 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 Parkinson’s Disease in a few ways:

1. there is usually no tremor
2. the two sides are usually affected about equally
3. the response to L-Dopa and the other medications used in Parkinson’s Disease is not very good
4. deep brain stimulation surgery is of no value

Very often when the condition is mild, at the earliest stages, we can’t tell whether it is Parkinson’s Disease or atypical Parkinson’s Disease (APD) and we treat it as if it is Parkinson’s Disease because we don’t have treatments for the atypical Parkinson disorders. Sometimes they respond to the usual Parkinson’s Disease medications, but usually they don’t. 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” (wide based walking that looks like the walk of someone who is drunk or walking on a boat), dystonia (abnormal postures), 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.

The problems caused by APD are the same as those caused by PD: slowness, difficulty with movements, balance problems, speech problems and falls. There are many of these disorders and it is often difficult, or even impossible to be sure of the correct name to attach to the condition until autopsy. The reasons for this are that the disorders often share many of the same features, and that they occasionally lack certain symptoms that we count on for the clinical diagnosis.