Most patients (about 80–85%) diagnosed with Parkinson’s disease have what is called primary parkinsonism or idiopathic Parkinson’s disease (meaning that the disease has no known cause). This type tends to respond well to drugs that work by increasing or substituting dopamine molecules in the brain.
Secondary parkinsonism (parkinsonian syndrome or atypical parkinsonism)
The remaining types of Parkinson’s are termed secondary or atypical parkinsonism or Parkinson’s Plus. In these cases, the cause of the disease is generally known and although it is very difficult to differentiate idiopathic Parkinson’s disease and secondary parkinsonism, a key difference is that patients with secondary parkinsonism do not respond well to dopaminergic medications such as levodopa.
Secondary parkinsonism includes drug-induced parkinsonism, vascular parkinsonism, normal pressure hydrocephalus (NSA), corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), and multiple system atrophy (MSA).
Certain medications, such as antipsychotics, can result in the patient developing the symptoms of Parkinson’s disease. Drug-induced parkinsonism may be difficult to distinguish from Parkinson’s disease, but the symptoms of tremors and postural instability will generally improve in the weeks or months after use of the medication has stopped.
Also called cerebrovascular disease, this type of parkinsonism is caused by a series of small strokes, resulting in the death of parts of the brain, leading to the Parkinson’s disease-like symptoms. The condition often only displays symptoms in the lower half of the body (walking difficulties and urinary incontinence) and memory loss. It tends to be less responsive to typical Parkinson’s disease medication especially as it progresses. Vascular parkinsonism becomes more common with age, especially in people with diabetes.
Normal pressure hydrocephalus (NSA)
The symptoms of NSA are very similar to those seen in vascular parkinsonism. The condition can be treated by removing spinal fluid in the short term or by lumbar puncture to permanently divert the spinal fluid as a long-term treatment.
Corticobasal degeneration (CBD)
CBD is caused by a build-up of proteins called tau, which damage parts of the brain. The condition tends to start on one side of the body and slowly spread to other areas over time. This is the least common of the atypical parkinsonisms.
Progressive supranuclear palsy (PSP)
PSP is one of the more common forms of secondary parkinsonism. As with idiopathic Parkinson’s disease, progressive supranuclear palsy has a late age of onset, but the symptoms tend to progress far more rapidly once they appear. However, dementia tends to have a later onset as the disease progresses. The cause of PSP is a build-up of the protein tau, as in CBD.
Multiple system atrophy (MSA)
MSA is caused by an overproduction of a protein called alpha-synuclein in the brain, leading to damage in multiple areas of the brain. This results in symptoms that are similar to idiopathic Parkinson’s disease, but with a much faster progression.
In addition, some infections can cause symptoms of parkinsonism, such as encephalitis and AIDS. Other causes such as exposure to toxins (like carbon monoxide), brain trauma, tumors, hypoxia (a lack of oxygen) in the brain, and some metabolic disorders have been shown to lead to parkinsonism-like symptoms.
There are also several conditions associated with Parkinson’s disease. One such condition is dementia with Lewy bodies (DLB), or Lewy Body Dementia (LBD), which is a particular form of dementia associated with Parkinson’s disease. DLB is caused by Lewy bodies (clumps of alpha-synuclein protein) forming in the brain. The condition tends to occur early in the progression of the disease and leads to a progressive deterioration of cognitive functions such as thinking, memory, and judgment.
Parkinson’s disease psychosis is another condition associated with Parkinson’s disease. It is a condition that more than half of Parkinson’s disease patients develop over the course of the disease, with the primary symptom being hallucinations and delusions.
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