Types of Parkinson’s disease
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Parkinson’s disease is a neurological condition characterized by motor symptoms that include bradykinesia (slowed movement), tremor, rigidity, and problems with balance. These symptoms are caused by the progressive dysfunction and death of neurons, nerve cells that are responsible for making the chemical dopamine in the brain.
The term “parkinsonism” is used to describe any condition that is marked by motor symptoms similar to those seen in Parkinson’s disease. Parkinson’s disease is the most common form of parkinsonism, but there are other types, namely atypical and secondary parkinsonism.
Primary parkinsonism
Parkinson’s disease is known as primary parkinsonism. It’s also sometimes called idiopathic Parkinson’s, meaning it’s not clear what caused the disease to develop. Primary parkinsonism is caused by the death and dysfunction of dopamine-making cells in the brain.
Parkinson’s disease is by far the most common form of parkinsonism; about 80% of all instances of parkinsonism are due to Parkinson’s disease.
While the most commonly recognized symptoms of primary parkinsonism are those that affect movement and motor skills, nonmotor symptoms such as cognitive impairment, difficulty swallowing, gastrointestinal problems, anxiety and depression, loss of smell, and sleep issues are also common.
Treatment with levodopa and its derivates, which are medicines that work by providing the brain with more of the raw material needed to produce dopamine, is usually effective for easing Parkinson’s disease symptoms. Other forms of parkinsonism generally don’t respond as well to these treatments.
The disease can be divided further into subtypes, such as familial Parkinson’s and early-onset Parkinson’s.
Familial Parkinson’s
Most cases of Parkinson’s disease are sporadic, meaning that Parkinson’s affects only one person in a family. However, about 15% of Parkinson’s patients have a family history of the disease. When Parkinson’s runs in a family, it’s referred to as familial Parkinson’s disease.
Familial Parkinson’s disease is usually associated with certain genetic mutations that either can cause Parkinson’s outright, or they increase an individual’s risk of developing the disease. These mutations are passed from parents to their biological children, and that is thought to mainly explain why the disease runs in families.
The mode of inheritance in familial Parkinson’s depends on the specific mutation associated with the disease in a family. With almost all genes, everyone inherits two copies, one from each biological parent. With some genes, one mutated copy is sufficient to cause Parkinson’s, and this is called autosomal dominant inheritance. Other genes are inherited in an autosomal recessive pattern, meaning both copies need to be mutated to cause the disease.
Early-onset Parkinson’s
Parkinson’s disease usually develops in the later decades of life — most people with Parkinson’s first start to notice symptoms when they are age 60 or older. In about 10% to 20% of cases, however, Parkinson’s begins before a person turns 50. These cases are commonly referred to as early-onset or young-onset Parkinson’s.
Because Parkinson’s is more common in older adults, younger patients may have difficulty in getting a correct disease diagnosis.
Compared with those who develop the disease at older ages, people with early-onset Parkinson’s more often have a family history of the disease, and they tend to experience slower disease progression. People with early-onset Parkinson’s also are more likely to experience involuntary movement problems as a side effect of medications like levodopa, but they are less likely to experience memory loss, confusion, and balance problems.
While Parkinson’s symptoms are generally similar regardless of age, the disease tends to affect younger people differently. Younger patients are at a different stage in life, and Parkinson’s causes unique psychological and social challenges, such as having to coordinate medical care alongside adult responsibilities like work and children.
Atypical parkinsonism (Parkinson’s plus)
Atypical parkinsonism, also known as Parkinson’s plus, refers to a group of neurological conditions that cause motor symptoms similar to those seen in Parkinson’s disease. But atypical parkinsonism also is marked by other symptoms and biological changes that distinguish it from Parkinson’s.
Unlike Parkinson’s disease, atypical forms of parkinsonism generally don’t respond to treatment with levodopa and its derivatives. Atypical forms of parkinsonism also tend to progress faster, and they have a poorer overall prognosis than does Parkinson’s disease.
Dementia with Lewy bodies
Dementia with Lewy bodies (DLB) — sometimes also called Lewy body dementia (LBD) — is a form of dementia that is characterized by toxic clumps of protein in the brain called Lewy bodies. These toxic protein clumps are also a hallmark feature in Parkinson’s disease.
People with Parkinson’s may develop dementia, and those with DLB can experience motor symptoms similar to what’s seen in Parkinson’s. The main distinction is that, in DLB, cognitive problems become apparent before the development of motor symptoms, whereas in Parkinson’s disease, motor symptoms typically develop before cognitive issues.
Progressive supranuclear palsy
Progressive supranuclear palsy, or PSP, is a neurological disorder that can be characterized by some of the same symptoms seen in Parkinson’s disease, like rigidity, cognitive changes, and sleep problems. However, people with PSP tend to have additional symptoms, like abnormal eye movements and a tendency to lean backwards (axial rigidity). Problems with speech and swallowing also are more common and usually more severe in progressive supranuclear palsy than in Parkinson’s, whereas tremor is much less common.
Whereas Parkinson’s is marked by abnormal clumps of the protein alpha-synuclein in the brain, progressive supranuclear palsy is characterized by toxic clumps of another protein called tau.
Corticobasal degeneration
Corticobasal degeneration (sometimes called corticobasal syndrome) is marked by many of the same motor symptoms seen in Parkinson’s disease, such as rigidity, tremor, and balance problems. These motor issues tend to be characteristically asymmetrical, affecting one side of the body substantially more than the other.
Like progressive supranuclear palsy, corticobasal degeneration is marked by toxic clumps of the protein tau in the brain. There is notable clinical overlap between corticobasal degeneration and PSP; people with either of these conditions also may develop the other disease.
Multiple system atrophy
Multiple system atrophy (MSA), another form of atypical parkinsonism, can cause many of the same motor symptoms as seen in Parkinson’s disease. But people with MSA characteristically have more impairment of the autonomic nervous system — the branch of the nervous system that’s responsible for regulating unconscious bodily processes, like breathing, sweating, and digestion. Multiple system atrophy also usually progresses much faster than Parkinson’s disease.
Like Parkinson’s disease, multiple system atrophy typically is marked by toxic clumps of the protein alpha-synuclein in the brain. Formerly, multiple system atrophy has been known as Shy-Drager syndrome, olivopontocerebellar atrophy, or striatonigral degeneration.
Secondary parkinsonism
Several health conditions can cause Parkinson’s-like symptoms. People with such symptoms are said to have secondary parkinsonism, as their Parkinson’s symptoms occur secondary to other health problems.
Sometimes the term “secondary parkinsonism” also is used to refer to atypical forms of parkinsonism, but experts tend to make a distinction between atypical and secondary parkinsonism.
Drug-induced parkinsonism
Some medications can cause Parkinson’s-like symptoms as a side effect, which is known as drug-induced parkinsonism. Next to primary Parkinson’s disease, this is the most common type of parkinsonism.
Medications associated with the highest risk of drug-induced parkinsonism are antipsychotics, also known as neuroleptics, which are given to help control psychosis. A range of other medications, including some antidepressants, antibiotics, antihistamines, nausea treatments, anti-seizure therapies, and medications that help to regulate blood pressure or heart rate, have been associated with drug-induced parkinsonism in some cases, though the risk of this side effect is generally lower with most of these therapies.
Usually, symptoms of drug-induced parkinsonism will ease within a few weeks after a patient stops taking the problematic medication. In rare cases, however, symptoms can persist for months or even years after stopping the medication.
Vascular parkinsonism
Vascular parkinsonism arises when problems with blood flow in the brain lead to brain damage that mimics symptoms of Parkinson’s disease. Small strokes are the main cause of vascular parkinsonism. This form of parkinsonism usually affects the lower limbs more than the arms.
Normal pressure hydrocephalus
The brain and spinal cord are surrounded by fluid known as the cerebrospinal fluid or CSF. Normal pressure hydrocephalus develops when the CSF doesn’t drain properly, causing swelling in the brain that leads to problems with brain function. The result can be symptoms similar to what’s seen in Parkinson’s disease or in other neurological disorders like Alzheimer’s.
Normal pressure hydrocephalus typically is treated by a procedure to drain the CSF, relieving pressure on the brain.
Infections, toxins, and trauma
Several types of infections in the brain can cause Parkinson’s-like symptoms. Infections known to cause these symptoms include:
- influenza, which causes the flu
- Epstein-Barr virus, which causes infectious mononucleosis, or “mono,” as well as other nonspecific diseases
- Japanese encephalitis virus
- West Nile virus
- Herpes zoster, which causes chickenpox and shingles
- Human immunodeficiency virus (HIV).
Toxins that cause damage to the brain also may result in parkinsonism; for example, parkinsonism is a common complication of carbon monoxide poisoning. Tumors in the brain or physical injury to the brain also may cause Parkinson’s-like symptoms.
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FAQs about the types of Parkinson's
Parkinson’s disease refers to a specific neurological condition caused by the progressive death and dysfunction of dopamine-making cells in the brain, leading to characteristic motor symptoms including tremor, rigidity and bradykinesia or slowed movements. There also are several forms of atypical and secondary parkinsonism, where other health problems result in Parkinson’s-like symptoms.
Parkinson’s disease is highly variable, and it doesn’t affect any two people in the same way. Even among people with the same subtype of Parkinson’s, there can be variability in disease symptoms, the age at onset, and rate of disease progression. In general, atypical forms of parkinsonism progress more rapidly than Parkinson’s disease itself.
Parkinson’s disease manifests with a lot of variability, so that even people with the same Parkinson’s subtype can have considerably different experiences and life expectancies. Parkinson’s disease itself, also known as primary parkinsonism, usually is milder and progresses more slowly than the rarer atypical forms of parkinsonism.
Parkinson’s disease, also called primary parkinsonism, is the most common form of parkinsonism. Parkinson’s disease accounts for roughly 80% of all cases where people develop Parkinson’s-like symptoms. Other cases mainly are caused by atypical or secondary forms of parkinsonism, where symptoms develop as a byproduct of other health conditions.
About 15% of Parkinson’s patients have a family history of the disease. These cases, referred to as familial Parkinson’s, typically are caused by mutations in a disease-associated gene that can be passed by parents to their biological children. For most people with Parkinson’s, the disease does not run in families.
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