Parkinson's-plus disorders (atypical Parkinsonism)

Multiple system atrophy (MSA) is a rare degenerative condition. In MSA, more widespread neurological damage occurs than with Parkinson’s. This includes damage to the autonomic nervous system – the part of the nervous system that involves involuntary functions.

MSA involves a number of areas of the brain. Different MSA have different names, depending on which area of the brain is most affected. They include the following.

Olivopontocerebellar atrophy (OPCA)
OPCA has some symptoms that overlap with Parkinson's disease. Other particularly noticeable symptoms include progressive clumsiness and balance problems, trouble coordinating arm movements, unsteady and staggered walking and slurred speech.

Striatonigral degeneration
Symptoms are very similar to Parkinson's, though tremor is rare in this condition. It progresses more rapidly than Parkinson's disease and may be signaled by failure to respond to levodopa.

Shy-Drager syndrome
This condition often is mistaken for Parkinson's in its early stages, but as it evolves, other symptoms appear. These symptoms may include severe dizziness when standing, a loss of sweating and a loss of bowel or bladder control.

A small number of patients respond to levodopa treatment, but its benefits fade over time.  Other medications can support blood pressure, bladder and bowel function. Physical, occupational and speech therapy are helpful. Education and support can improve quality of life for the patient, family and caregivers.

PSP often resembles Parkinson's disease. Its unique features include early development of a severe loss of balance, unsteady walking and frequent falls. People with PSP also may develop blurred vision and impaired eyesight, especially the inability to look downward. Other symptoms include a gradual but significant impairment in speech and swallowing. Apathy, depression and a reduced ability to think are common among patients with PSP. 

No medication has been found to treat this disorder. Currently, treatment aims to help with specific problems with balance, eating and swallowing. Support, counseling and education for patients and care partners can improve their quality of life.

Symptoms of diffuse Lewy body disease (DLBD) are similar to Parkinson's, but changes in thinking and memory may be more noticeable and progress faster than other typical Parkinson's symptoms. People with DLBD often have an increased sensitivity to Parkinson's medications.

CBD is a movement disorder that usually starts after age 60. First, symptoms often appear on one side of the body and spread to the other side. They include stiffness, rigidity, slowness, tremor, jerky movements and loss of sensation. Later, patients can develop problems with walking and maintaining balance, dementia, memory loss and “alien limb” phenomenon (a condition in which a limb appears to move on its own).

Depression and other emotional changes also can develop.

Levodopa treatment is rarely successful. Other medicines may help manage specific symptoms. Physical, occupational and speech therapy can help patients cope with the illness. Education and support can improve quality of life.

Lewy bodies are abnormal protein deposits found in brain cells. In Parkinson’s disease, Lewy bodies form in only one area of the brain. In DLB, these deposits are found in many areas of the brain.

Symptoms of DLB are similar to Parkinson’s and Alzheimer’s diseases. In addition, patients can have repeated visual hallucinations, and experience varying levels of alertness and mental ability. Depression, apathy, anxiety and delusional thoughts also are common. Some patients develop a sleep disorder years before developing DLB that causes them to violently and loudly act out their dreams.

Treatment with levodopa and Alzheimer medications can be helpful. Support, education and counseling for the patient and family are important.