If you or a loved one are living with Parkinson’s disease, you’ve likely heard the term “parkinsonism” — but you may not know how it differs from Parkinson’s. “Getting very confused about the difference between Parkinson’s and parkinsonism,” wrote one MyParkinsonsTeam member.

Parkinson’s disease is a brain condition that advances slowly over time in the majority of people. The condition involves the loss of brain cells (neurons) in a part of the brain called the substantia nigra. The substantia nigra makes a chemical called dopamine, which plays a role in body functions including memory, movement, and pleasure. As these dopamine-producing neurons decrease in number, Parkinson’s symptoms begin to appear.

Parkinsonism is a broad term referring to several neurological conditions with movement issues — including Parkinson’s disease. Types of parkinsonism other than Parkinson’s disease are sometimes referred to as “Parkinson’s plus” or “atypical Parkinson’s disease.” Around 85 percent to 90 percent of diagnosed cases of parkinsonism are types other than Parkinson’s disease.

Despite their differences, the various types of parkinsonism — including Parkinson’s disease — share some common signs and symptoms. As a result, they sometimes can be misdiagnosed as a different type.

What Are the Different Types of Parkinsonism?

Each of the most common types of parkinsonism are typically characterized by muscle stiffness, slow movement, and difficulty with balance and walking. However, doctors look for several signs of each type of parkinsonism to distinguish them from one another.

Drug-Induced Parkinsonism

Drug-induced parkinsonism (DIP) is caused by certain medications that alter the levels of dopamine in the brain. DIP is the second most common type of parkinsonism in older people — just behind Parkinson’s.

Researchers and neurologists believe medications that block the effect of dopamine are the main cause of DIP. Health care providers prescribing these types of medications should monitor people for signs of DIP and other movement disorders.

Examples of medicines that may cause DIP include:

• Aripiprazole (Abilify)
• Haloperidol (Haldol)
• Metoclopramide (Reglan)

Within four days to one month after starting a medication, a person with DIP may develop symptoms of parkinsonism.

DIP can be difficult to distinguish from Parkinson’s disease. People with DIP may experience less severe resting tremors and balance difficulties. The biggest difference between the two conditions, however, is that Parkinson’s progresses and worsens over time while DIP does not.

Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) generally appears in people in their early 60s. The disease is caused by clumps of a protein called tau that builds up in specific parts of the brain. This tau protein can lead to a slow loss of neurons.

PSP symptoms usually worsen at a faster rate than those of Parkinson’s. Although resting tremors are common in Parkinson’s, they are rare in PSP. Speech and swallowing difficulties appear earlier and are often more severe in people with PSP.

Symptoms of PSP can include:

• Having difficulty walking
• Falling backward
• Slurring one’s speech
• Having difficulty swallowing
• Experiencing trouble moving one’s eyes up or down, leading to blurry vision and trouble with reading
• Losing one’s memory and having difficulty processing thoughts
• Feeling depressed
• Lacking motivation

Multiple System Atrophy

Multiple system atrophy (MSA) includes a group of neurological disorders that affect movement. MSA involves the autonomic nervous system, which is responsible for regulating digestion and controlling blood pressure.

Symptoms of MSA can include:

• Muscle stiffness
• Slowness while walking
• Difficulties with balance
• Lack of coordination
• Slurred speech
• Low blood pressure
• Constipation and bladder issues
• Sleep problems, including rapid eye movement sleep behavior disorder (physically acting out one’s dreams)
• Difficulty breathing, particularly during the night

Vascular Parkinsonism

Vascular parkinsonism usually results from several small strokes that lead to clotting in the brain. The main symptoms of vascular parkinsonism include movement issues with the lower body, such as a shuffling gait and unsteadiness while walking. Tremors aren’t a symptom of vascular parkinsonism as they are with Parkinson’s disease.

Dementia With Lewy Bodies

Dementia with Lewy bodies (DLB) is the second most common contributor to dementia in older people. People with DLB may also experience the typical symptoms of Parkinson’s, which makes the condition especially difficult to distinguish from Parkinson’s. However, several characteristics make DLB stand out.

Among them, dementia is the first sign of DLB, which can include inattentiveness, decreased alertness, memory loss, and visual hallucinations. People with DLB usually start to experience dementia and movement issues around the same time or less than one year apart. People with DLB generally don’t experience tremor, and if they do, it’s slight.

Corticobasal Degeneration

Corticobasal degeneration is the least common type of parkinsonism. The condition usually occurs in people over 60. Symptoms of corticobasal degeneration typically include:

• Slow movement
• Muscle stiffness
• Muscle tightness that causes unusual positions of body parts (dystonia)
• Automatic and jerky movements of an arm or leg
• Difficulty with speech
• Loss of concentration
• Difficulty with language

How Do Parkinson’s Symptoms Differ From Those of Other Types of Parkinsonism?

Differences in signs and symptoms distinguish Parkinson’s from other types of parkinsonism.

Symptoms of Parkinson’s Disease

Some symptoms of Parkinson’s affect a person’s ability to move. These symptoms are often called motor symptoms, and they include:

• Stiffness of muscles
• Tremor of an arm or leg while at rest (resting tremor)
• Slow movement
• Unstable posture

Other symptoms of Parkinson’s don’t affect a person’s movement. These nonmotor symptoms may include:

• Depression
• Decreased sense of smell
• Digestive problems, such as constipation
• Cognitive changes, such as loss of attention, difficulty solving problems, memory loss, and trouble with language

Parkinson’s symptoms may take several years to appear. A majority of people with Parkinson’s live for many years with the condition.

Symptoms of Other Types of Parkinsonism

Parkinson’s disease and other types of parkinsonism share some common symptoms, such as stiffness, tremors, and slow movement. However, other types of parkinsonism tend to progress more quickly than Parkinson’s, and people with other types generally start experiencing balance issues sooner. Additionally, people with other types of parkinsonism show only a short-term response — if any — to levodopa, a common medication for Parkinson’s.

How Is Each Type of Parkinsonism Diagnosed?

There is no test to definitively diagnose each type of parkinsonism. Doctors will always take a complete medical history. They may order a variety of movement tests. In the end, diagnosis of each type of parkinsonism is largely based on observation by a health care professional.

Drug-Induced Parkinsonism

DIP is diagnosed when a doctor or health care provider notices signs of parkinsonism connected with a certain medication that can reduce the effect of dopamine in the brain.

Progressive Supranuclear Palsy

The PSP symptoms which differ most from Parkinson’s are:

• Difficulty focusing one’s eyes, leading to blurry vision
• Loss of balance, which can lead to falling backward
• Posture that prompts the person to lean backward

A health care provider can make note of these symptoms and use them to make a PSP diagnosis.

Multiple System Atrophy

A doctor can distinguish MSA from Parkinson’s disease by noticing the following differences:

• MSA often progresses faster than Parkinson’s.
• Balance difficulty and poor posture often occur at an earlier age with MSA.
• Autonomic system problems such as low blood pressure, bladder dysfunction, and difficulty breathing are usually more severe in those with MSA.

Vascular Parkinsonism

There are several signs and symptoms a health care provider will look for to distinguish vascular parkinsonism from Parkinson’s disease:

• Vascular parkinsonism symptoms can often appear suddenly, while Parkinson’s is usually gradual.
• Vascular parkinsonism affects the lower body more commonly than Parkinson’s does.
• People with vascular parkinsonism usually do not have tremors.

Dementia With Lewy Bodies

Several key symptoms set DLB apart from Parkinson’s:

• Dementia always occurs first in DLB.
• Visual hallucinations that occur in DLB are rare in Parkinson’s.
• Movement symptoms common to Parkinson’s appear later in people with DLB.

Corticobasal Degeneration

Signs and symptoms of corticobasal degeneration that set it apart from Parkinson’s include the following:

• A person with corticobasal degeneration will slowly lose use of just one hand or leg (apraxia).
• They will develop small, automatic muscle jerks.
• Walking difficulties and loss of balance develop later with corticobasal degeneration than they do in Parkinson’s.
• A person with corticobasal degeneration will have difficulty with purposeful body motions, like cutting food or zipping up a jacket.

How Do Treatments for Parkinsonism Differ?

Since parkinsonism is an umbrella term for many types of conditions, medical treatment often varies. Once a health care provider has diagnosed a specific type of parkinsonism, they will typically start a treatment plan for that type.

Drug-Induced Parkinsonism

Usually, the quickest treatment for DIP is to halt or slowly lower the dosage of the drug causing the symptoms. It’s important to work with your neurologist when making changes to any medication.

All symptoms of DIP may completely go away once a person stops the specific medication involved. However, a person may need up to 18 months for all their DIP symptoms to resolve.

Progressive Supranuclear Palsy

People with PSP do not usually respond well to medication. For this reason, health care professionals often prescribe the following therapies:

• Stretches to promote movement of the joints
• Glasses to help with vision trouble
• Weighted walkers to decrease backward falling

Multiple System Atrophy

Parkinson’s medications usually aren’t effective for MSA. However, doctors can treat symptoms, such as low blood pressure and bladder issues, that accompany MSA. Currently, there are no medications to slow the overall progression of this condition.

Vascular Parkinsonism

Treatment for vascular parkinsonism may or may not include levodopa. Some people with vascular parkinsonism respond well to the medication, while others do not.

The main focus of vascular parkinsonism treatment is lowering the risk of having more strokes. This entails controlling the risk factors for stroke, including:

• Stopping or decreasing smoking
• Medically managing high blood pressure, diabetes, and high cholesterol
• Following a weight-loss plan, when needed
• Adopting an active lifestyle
• Eating a diet with a lower fat and salt intake

Dementia With Lewy Bodies

The treatment of DLB sometimes involves using levodopa to address motor symptoms. However, the movement disorder symptoms of DLB may not respond to levodopa.

Currently, no cure for DLB exists, nor are there any therapies to slow the progression of the disease. Medicine may help with the mental symptoms of DLB. Maintaining a safe home environment and providing assistive equipment can make daily living easier.

Corticobasal Degeneration

At this time, no specific treatment for corticobasal degeneration exists. Regardless, medical management of the condition frequently involves one or all of the following:

• Physical therapy
• Occupational therapy
• Speech therapy

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinson’s disease and their loved ones. On MyParkinsonsTeam, more than 89,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s disease.

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