What is Atypical Parkinsonism?

Subtle Signs, Not PD: A Quick Guide to Atypical Parkinsonism

Atypical Parkinsonism includes neurodegenerative disorders mimicking Parkinson’s Disease (PD) but with distinct features, faster progression, and poor levodopa response. Below are four key types—PSP, MSA, CBD, and DLB—with symptoms and subtle clues to aid early recognition. Supported by the CCF Coleen Cunningham Foundation, serving Canada, USA, UK, Australia, and India.

Progressive Supranuclear Palsy (PSP)

  • About: A tauopathy affecting balance, eye movement, and cognition. Onset in 60s, progresses 5-7 years.
  • Key Symptoms: Backward falls early on, trouble looking up/down (gaze palsy), stiffness, slurred speech.
  • Subtle Signs, Not PD: “Surprised” wide-eyed look, slight tilting posture, unexplained clumsiness.

Multiple System Atrophy (MSA)

  • About: A synucleinopathy impacting movement and autonomic functions. Onset in 50s-60s, progresses 6-10 years.
  • Key Symptoms: Stiffness or unsteady gait, blood pressure drops (dizziness), noisy breathing (stridor).
  • Subtle Signs, Not PD: Cold hands/feet, sighing breaths, early erectile dysfunction.

Corticobasal Degeneration (CBD)

  • About: A tauopathy with one-sided movement and cognitive issues. Onset after 60, progresses 6-8 years.
  • Key Symptoms: Asymmetric stiffness/jerking, “alien limb,” trouble with skilled tasks (apraxia).
  • Subtle Signs, Not PD: Misjudging distances, odd sensations (tingling), irritability or obsession.

Dementia with Lewy Bodies (DLB)

  • About: A synucleinopathy blending parkinsonism with dementia. Onset after 65, progresses 2-20 years.
  • Key Symptoms: Fluctuating alertness, visual hallucinations, tremor, acting out dreams.
  • Subtle Signs, Not PD: Daytime drowsiness, antipsychotic sensitivity, staring spells.

Why It Matters

These aren’t PD—each has unique signs (falls in PSP, autonomic issues in MSA, asymmetry in CBD, hallucinations in DLB) that demand early detection. Benefits include tailored care, safety planning, and global support via the CCF Coleen Cunningham Foundation. Look beyond PD—these subtle signs could unlock the right diagnosis.

Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice. Consult a healthcare provider for diagnosis and treatment. The CCF Coleen Cunningham Foundation does not provide medical services.

Atypical Parkinsonism Disorders

Atypical Parkinsonism disorders are progressive conditions that mimic some Parkinson’s disease symptoms but typically respond poorly to levodopa treatment. These disorders, linked to abnormal protein buildup in brain cells, include Progressive Supranuclear Palsy (PSP), Multiple System Atrophy (MSA), and Corticobasal Degeneration (CBD). Below are their descriptions and symptoms.

Progressive Supranuclear Palsy (PSP)

Progressive Supranuclear Palsy (PSP) affects movement, vision, speech, and cognition, typically emerging in a person’s 60s. Most individuals survive 5-9 years post-diagnosis, though some live longer. Early signs include loss of balance and frequent falls, progressing to slow movements (bradykinesia), clumsiness, and trunk stiffness, often requiring wheelchair use over time.

A hallmark feature is abnormal eye movements, such as restricted vertical gaze, difficulty with eyelids, and a staring gaze, leading to blurred vision and light sensitivity. Speech becomes slow and slurred (dysarthria), swallowing difficult (dysphagia), and personality changes like apathy emerge, alongside cognitive challenges in attention and planning.

PSP affects 3-6 per 100,000 people worldwide (about 20,000 Americans), far rarer than Parkinson’s disease. First identified in 1964 as distinct from Parkinson’s, it’s sometimes called Steele-Richardson-Olszewski syndrome. No cure exists, but some symptoms may be managed with medication or therapy.

Quick Facts:

  • No known cause or cure
  • Affects balance, coordination, eye movement, speech, swallowing, and thinking
  • Prevalence: 5-6 per 100,000
  • Onset typically in early 60s, occasionally 40s
  • Slightly more common in men, no racial or occupational preference

Symptoms:

  • Loss of balance
  • Personality changes
  • Weak downward eye movements
  • Weakened mouth, tongue, and throat movements
  • Slurred speech
  • Difficulty swallowing

Multiple System Atrophy (MSA)

Multiple System Atrophy (MSA) impacts movement and the autonomic nervous system, controlling blood pressure, digestion, and other involuntary functions. Its cause is unknown, but it involves alpha-synuclein protein clumps in glial cells, a focus of ongoing research to slow or stop the disease.

Symptoms:

  • Slowness, stiffness, walking, and balance issues
  • Clumsiness and incoordination
  • Slurred speech
  • Low blood pressure, constipation, bladder problems
  • Inappropriate laughing or crying
  • Acting out dreams (REM sleep behavior disorder)
  • Breathing difficulties, especially at night

Corticobasal Degeneration (CBD)

Corticobasal Degeneration (CBD) affects movement, cognition, and behavior, often starting in one limb before spreading. It’s caused by tau protein buildup in brain cells, though the exact mechanism is unclear and under investigation.

Symptoms:

  • Slowness and stiffness
  • Dystonia (abnormal postures)
  • Myoclonus (rapid jerks)
  • Difficulty concentrating or cognitive changes
  • Language issues (trouble finding words)
  • Behavioral changes (e.g., crude actions)

When affecting an arm, CBD may cause "alien limb syndrome," where the limb moves involuntarily despite retained strength, complicating tasks like combing hair or unlocking doors. Walking and balance issues may develop later.

For more resources and top PSP/MSA/CBD links, visit our Resource Links!

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