Very brief overview of five Parkinsonian syndromes

On Kaiser’s website, there’s a very brief overview of five Parkinsonian syndromes – progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), multiple system atrophy (MSA), dementia with Lewy bodies (DLB), and vascular parkinsonism.  The first four are the focus on Brain Support Network’s local support group and educational materials.

I’ve copied the short overview below.  It’s odd that there’s so little on PSP yet there’s a lot on CBD, which is quite rare.
Parkinsonian Syndrome
Kaiser Northern California Website

Up to 20 percent of patients with clinical features resembling Parkinson’s disease actually have a Parkinsonian syndrome. They can be referred to as “atypical Parkinson’s” or “Parkinson’s plus.” These syndromes are clinically differentiated from “classic” Parkinson’s disease because they respond less reliably to medications and tend to progress more quickly.

Symptoms and Diagnosis
We might suspect that you have atypical Parkinson’s if you:

* Do not respond robustly to levadopa or dopamine agonists.
* Do not have a significant tremor.
* Experience early loss of balance.
* Have disproportionate rigidity.
* Experience prominent early speech difficulty and/or difficulty swallowing.
* Exhibit symptoms that progress rapidly.

We make a diagnosis based on your history, symptoms and physical examination. There are no tests or imaging studies to confirm a diagnosis.

Progressive supranuclear palsy (PSP)
PSP is characterized by early onset of balance problems, frequent falls, and (eventually) eye movement problems.

Corticobasal degeneration (CBD)
People with corticobasal degeneration experience nerve cell loss and shrinkage (atrophy) throughout the brain.  CBD is a rare progressive disorder marked by the following symptoms:

* Rigidity.
* Cramping and spasms of limbs that lead to painful unnatural positions.
* Uncontrolled movement of limbs combined with a feeling that the limb does not belong to you.
* Sudden muscle jerking.
* Early cognitive impairment.

Multiple system atrophy
Multiple system atrophy (MSA) is a neurodegenerative disease characterized by a variety of symptoms affecting movement, blood pressure, and other body functions.  Hence the label “multiple system” atrophy. All patients will exhibit some motor symptoms similar to Parkinson’s disease. However, most patients will develop additional symptoms.

In the Shy-Drager form of MSA, the most prominent symptoms are blood pressure control and urinary dysfunction. The Striatonigral Degeneration form of MSA is characterized by severe rigidity and may not respond to typical dopamine medications. The Olivopontocerebellar Atrophy form of MSA causes increased lack of muscle coordination, balance problems and speech difficulties.

Dementia with Lewy bodies
Lewy bodies are abnormal collections of protein that develop inside nerve cells. In Parkinson’s disease, patients do have Lewy body formations but only in select areas of the brain. When Lewy bodies are found throughout the brain, the patient is given the diagnosis of Dementia with Lewy Bodies.

Lewy bodies can only be confirmed by a post-mortem biopsy of the brain. For this reason, we use the patient’s clinical history to make a diagnosis. Symptoms we look for include fluctuating confusion, visual hallucinations, rapid cognitive decline and some motor symptoms of Parkinson’s disease. Patients with Dementia with Lewy Bodies do not respond to dopamine medication.

Vascular Parkinsonism
Multiple small strokes deep within the brain can cause symptoms that are similar to Parkinson’s disease. Patients with this disorder are more likely to experience difficulties with walking rather than tremor and they are more likely to have symptoms that are worse in the lower extremities than upper extremities.

Treatment focuses on preventing further strokes. Anti-platelet agents, such as aspirin, anti-cholesterol medications, along with treatment of high blood pressure, healthy diet and exercise, and cessation of smoking can significantly reduce the risk of future strokes.