What are the different forms of parkinsonism?
There are three main forms of parkinsonism, as well as other related conditions.
Vascular parkinsonism (also known as arteriosclerotic parkinsonism) affects people with restricted blood supply to the brain. Sometimes people who have had a mild stroke may develop this form of parkinsonism.
Common symptoms include problems with memory, sleep, mood and movement.
Some drugs can cause parkinsonism.
Neuroleptic drugs (used to treat schizophrenia and other psychotic disorders), which block the action of the chemical dopamine in the brain, are thought to be the biggest cause of drug-induced parkinsonism.
The symptoms of drug-induced parkinsonism tend to stay the same – only in rare cases do they progress in the way that Parkinson’s symptoms do.
Drug-induced parkinsonism only affects a small number of people, and most will recover within months – and often within days or weeks – of stopping the drug that’s causing it.
Multiple system atrophy (MSA)
Like Parkinson’s, MSA can cause stiffness and slowness of movement in the early stages.
However, people with MSA can also develop symptoms that are unusual in early Parkinson’s, such as unsteadiness, falls, bladder problems and dizziness.
Progressive supranuclear palsy (PSP)
PSP affects eye movement, balance, mobility, speech and swallowing. It’s sometimes called Steele-Richardson-Olszewski syndrome.
Normal pressure hydrocephalus
Normal pressure hydrocephalus mainly affects the lower half of the body. The common symptoms are walking difficulties, urinary incontinence and memory problems. Removing some cerebrospinal fluid through a needle in the lower back can help with these symptoms in the short term. If there is improvement after this procedure, an operation to divert the spinal fluid permanently (known as ventricular drainage) can help in the long term.
Various tremors, including essential tremor
While these are not parkinsonian disorders, you may be diagnosed with one of these conditions if tremor is your only symptom.
Rarer causes of parkinsonism
There are several other, much rarer, possible causes of parkinsonism.
These include rare conditions like Wilson’s disease, an inherited disorder where there’s too much copper in your body’s skin and muscles.
How is parkinsonism diagnosed?
You should be referred to a Parkinson’s specialist for the diagnosis of any parkinsonism. They may wish to explore different things before giving you a diagnosis.
Your specialist will look at your medical history, ask you about your symptoms and do a medical examination.
Telling the difference between types of parkinsonism isn’t always easy, for the following reasons:
- The first symptoms of the different forms of parkinsonism are so similar.
- In many cases, parkinsonism develops gradually. Symptoms that allow your doctor to make a specific diagnosis may only appear as your condition progresses.
- Everyone with parkinsonism is different and has different symptoms.
Find out more: see our information on symptoms of Parkinson’s, and diagnosing Parkinson’s.
One of the most useful tests to find out what sort of parkinsonism you may have is to see how you respond to treatment.
If your specialist thinks you have idiopathic Parkinson’s, they’ll expect you to have a good response to Parkinson’s drugs such as levodopa (co-careldopa or co-beneldopa). A good response means that your symptoms will improve. Sometimes, it will only be clear that you’ve responded to medication when the drug is reduced or stopped, and your symptoms become more obvious again.
If you don’t have any response to Parkinson’s medication, your specialist will have to look again at your diagnosis.
If you have both unusual symptoms and no response to Parkinson’s drugs, this doesn’t automatically mean you have another form of parkinsonism. But it will make your specialist want to reconsider your diagnosis.
In this case, your specialist may use the terms ‘atypical parkinsonism’ or ‘Parkinson’s plus’. These terms are not a diagnosis, they simply mean that you probably have something other than Parkinson’s, perhaps one of the conditions mentioned in this information. Your specialist will be able to tell you more.
Although not routinely available, your specialist may wish to carry out some of the tests below.
None of these tests alone can make a definite diagnosis, but sometimes they can rule out a particular condition. Sometimes (used alone or combined with other tests) they may help strengthen a case for a particular diagnosis, but only when put together with your medical history and the results from your medical examination.
Current tests available include:
- magnetic resonance imaging (MRI) brain scanning
- dopamine transporter chemical scan, known as a Dat Spect Scan, DaTSCAN or FP-CIT scan
- metaiodobenzylguanidine (MIBG) scan of your heart
- lumbar puncture – a simple procedure to test the spinal fluid that surrounds the brain
- electrical recording (EMG) of the urethral or anal sphincter – to check the health of the muscles and the nerves that control them
- special recordings of your pulse and blood pressure, known as autonomic function tests (AFTs)
Drug-induced parkinsonism: Norma's story
"I consider myself a very strong person. I was absolutely determined to get my bipolar in remission and I hope for the same with my drug-induced parkinsonism."
Norma has lived with bipolar disorder since she was 26. In 2015 she was told she had Parkinson’s, a diagnosis that was later adjusted to drug-induced parkinsonism. Here, she shares her story.
Getting diagnosed with Parkinson's: Daxa's story
"Getting a diagnosis wasn’t easy, but I’m learning more every day and gradually adapting to life with Parkinson’s."
Daxa shares the 3-year journey she had to receive a Parkinson's diagnosis – and how she's gradually learning to adapt to the challenges.
Last updated March 2019. We review all our information within 3 years. If you'd like to find out more about how we put our information together, including references and the sources of evidence we use, please contact us at [email protected]