Types of Parkinson's

Parkinsonism is a term that covers a range of conditions that have similar symptoms to Parkinson's.

Most people with a form of parkinsonism have idiopathic Parkinson's disease, also known as Parkinson's.

Idiopathic Parkinson's

Idiopathic Parkinson's disease - or Parkinson's - is the most common type of parkinsonism. Idiopathic means that the cause is unknown.

The main symptoms of idiopathic Parkinson's are tremor, rigidity (stiffness) and slowness of movement.

Doctors may diagnose idiopathic Parkinson's by seeing if there is a response to Parkinson's medication. If symptoms improve, your specialist may confirm an idiopathic Parkinson's diagnosis.

Find out more about how Parkinson's is diagnosed.

Vascular parkinsonism

Vascular parkinsonism (also known as arteriosclerotic parkinsonism) affects people with restricted blood supply to the brain - usually older people who have health issues such as diabetes.

Sometimes people who have had a mild stroke may experience this form of parkinsonism.

The common symptoms are walking difficulties, urinary incontinence and memory problems.

The symptoms of vascular parkinsonism are often the same as normal pressure hydrocephalus, which mainly affects the lower half of the body.

Some people with vascular parkinsonism may swing their arms less than those with Parkinson's.

Drug-induced parkinsonism

A small number (around 7%) of people diagnosed with parkinsonism develop symptoms following treatment with particular medication.

Neuroleptic drugs (used to treat schizophrenia and other psychotic disorders) which block the action of dopamine are thought to be the biggest cause of drug-induced parkinsonism.

The symptoms of drug-induced parkinsonism tend to be static. Only in rare cases do they change in the manner that the symptoms of Parkinson's do.

Most people will recover within months, and often within hours or days, of stopping the drug that is the cause.

Other types of parkinsonism

Multiple system atrophy (MSA)

Both multiple system atrophy and Parkinson's cause stiffness and slowness of movement in the early stages.

People with multiple system atrophy can also develop symptoms such as incontinence, difficulty with swallowing and dizziness. These symptoms are unusual in early Parkinson’s.

The condition used to be known as striatonigral degeneration, Shy-Drager syndrome, or olivopontocerebellar atrophy.

Progressive supranuclear palsy (PSP)

Progressive supranuclear palsy affects eye movement, balance, mobility, speech and swallowing. It is sometimes called Steele-Richardson-Olszewski syndrome.

Normal pressure hydrocephalus

The symptoms of normal pressure hydrocephalus mainly affect the lower half of the body.

The common symptoms are walking difficulties, urinary incontinence and memory problems.

Removing some cerebrospinal fluid 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 lumbar puncture) can help in the long term.

The following organisations offer help and support for people diagnosed with these conditions and their families:

Tremors, including essential tremor, dystonic tremor, indeterminate tremor and atypical tremor

You may be diagnosed with one of these conditions if tremor is your main symptom and it is not caused by Parkinson's.

How is parkinsonism diagnosed?

You should be referred to a Parkinson's specialist for diagnosis.

They will look at your medical history, carry out a detailed neurological interview and medical examination. 

Investigating symptoms

Differentiating between types of parkinsonism is not always easy, because:

  • 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 more specific diagnosis may only appear as your condition progresses
  • everyone with parkinsonism is different and has different symptoms

Response to Parkinson's drugs

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 might have Parkinson's, they will expect you to have a good response to Parkinson’s drugs, such as levodopa. 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, it will mean that your Parkinson's specialist will have to look again at your diagnosis.

Most people with forms of parkinsonism other than Parkinson's usually don't respond, or respond less well, to Parkinson's drugs.

But to confuse things, some people with forms of parkinsonism other than Parkinson's will show some response.

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 investigate further.

In this case, your specialist may use the terms 'atypical parkinsonism' or 'Parkinson's plus'. These terms are not a diagnosis, but they simply mean that you probably have something other than Parkinson's.

Specialist tests

Although they are not routinely available, there are specific tests that your specialist may wish to carry out to find out what is causing your symptoms.

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:

  • a dopamine transporter chemical scan, known as a Dat Spect Scan or DaTSCAN, or an FP-CIT scan
  • lumbar puncture (an operation to divert spinal fluid) or cerebrospinal fluid infusion testing (which tests the ability for cerebrospinal fluid to be absorbed)
  • MRI (magnetic resonance imaging) brain scanning
  • an electrical recording (EMG) of the urethral or anal sphincter. This test checks the health of the muscles and the nerves that control them
  • special recordings of pulse and blood pressure, known as autonomic function tests (AFTs). Dizzy spells and low blood pressure can be a sign of multiple system atrophy

Find out more about how Parkinson's is diagnosed.

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Last updated April 2017. 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].