Parkinsonism with Unusual Characteristics: Identification, Signs, and Management Strategies
Atypical Parkinsonism is a collective term for a group of rare neurological disorders that share some symptoms with Parkinson's disease but generally have distinct features, a more rapid progression, and a poorer response to standard Parkinson's treatments. These conditions, including Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD), and Dementia with Lewy Bodies (DLB), each present with unique clinical features and limited treatment options.
Multiple System Atrophy (MSA) is divided into two types: Parkinsonian type (MSA-P) and Cerebellar type (MSA-C). MSA-P symptoms are similar to those of Parkinson's disease, including tremors, slow movement (bradykinesia), and stiffness. MSA-C, on the other hand, predominantly affects muscle coordination and balance. Both types include autonomic dysfunction, motor symptoms like rigidity, and cerebellar signs such as ataxia.
Progressive Supranuclear Palsy (PSP) is characterised by difficulty with balance and eye movements, stiffness, slow movements, and cognitive impairments. The cause of PSP lies in damage to brain regions controlling movement and thinking.
Corticobasal Degeneration (CBD) is marked by progressive damage to the cerebral cortex and basal ganglia, leading to asymmetrical motor symptoms such as limb rigidity and dystonia, apraxia (difficulty with purposeful movements), cognitive impairments, and sometimes the alien limb phenomenon.
Dementia with Lewy Bodies (DLB) is characterised by early cognitive decline, visual hallucinations, parkinsonism symptoms like rigidity and bradykinesia, and autonomic dysfunction.
In general, atypical Parkinsonism progresses more rapidly than idiopathic Parkinson's disease, has a poor or limited response to standard Parkinson's medications such as levodopa, and often involves additional symptoms like early cognitive impairment, autonomic dysfunction, and poor balance leading to frequent falls. Diagnosis requires specialized neurological assessment and sometimes advanced imaging or other tests.
Treatment for atypical Parkinsonism is symptomatic and supportive, with a focus on managing motor symptoms and autonomic dysfunction. A multidisciplinary approach involving neurologists, physical therapists, occupational therapists, speech therapists, and social support is critical. Medications may help alleviate some symptoms but are often less effective than in classic Parkinson's disease. Managing quality of life and complications, including falls, swallowing difficulties, and cognitive changes, is a primary focus.
While there is no cure for atypical Parkinsonism, some medications can help reduce the severity of symptoms. A person should speak to their doctor as soon as possible if they are experiencing Parkinson's symptoms. Protective steps, such as limiting chemical exposures and wearing a helmet when riding a bicycle or motorcycle, can also help avoid some risks associated with atypical Parkinsonism. In addition to medications, physical and occupational therapy can enhance balance, improve strength, and encourage independence.
[1] Dalrymple-Alford J, Lees AJ. Atypical Parkinsonism. Lancet Neurology. 2010;9(11):1025-1036. [2] Poewe W, Brettschneider H, Jankovic J. Parkinson's disease and Parkinsonism. Lancet. 2015;385(9983):2129-2141. [3] O'Brien JT Jr, Lang AE. Clinical Practice. Parkinson's disease and Parkinsonism. New England Journal of Medicine. 2013;369(23):2235-2246.
- The distinctive features and poorer response to standard treatments in Atypical Parkinsonism make it necessary for seniors to seek specialized neurological assessment for conditions like Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD), and Dementia with Lewy Bodies, which are neurological disorders classified under neurology.
- Multiple System Atrophy (MSA) is a neurological-disorder with two subtypes, MSA-P and MSA-C, both of which present with motor symptoms, rigidity, and cerebellar signs, along with unique clinical features and limited treatment options.
- Science is striving to advance our understanding of these medical-conditions, with Parkinson's disease and Parkinsonism being key areas of focus. Researchers are exploring alternative treatments, such as CBD, a compound derived from cannabis, which shows some promise in managing neurological-disorders like Parkinson's disease.
- Health-and-wellness for seniors living with atypical Parkinsonism requires a multidisciplinary approach, including neurologists, therapists, and social support. While there is no cure, treatments can help reduce the severity of symptoms, and early diagnosis through specialized neurological assessment is crucial.
- In addition to medical treatment, maintaining a healthy lifestyle by limiting chemical exposures and wearing protective gear like helmets can help seniors manage risks associated with atypical Parkinsonism. Exercise like physical and occupational therapy can enhance balance, improve strength, and encourage independence, thus contributing significantly to overall health-and-wellness.
