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A Parkinson’s diagnosis is not one-size-fits-all. In fact, there are a variety of types of Parkinson’s or Parkinson’s-like conditions that affect different age groups and bring differing symptoms.
At least 80 percent of diagnoses are idiopathic Parkinson’s, which means they have no known cause.
Other forms are considered atypical Parkinson’s disorders. “They can start out looking like idiopathic Parkinson’s, but in the first few years people start to have different symptoms,” she says. “These atyptical forms of Parkinson’s have a worse prognosis. The course is more quickly progressive, and patients get disabled more quickly. These are the forms of Parkinson’s that might shorten someone’s life, and they don’t respond very well to our medications.”
People who develop Parkinson’s at a young age — under 40 — are less likely to develop an atypical form, along with those who develop it later in life, during their late 70s and early 80s. The average onset for the atypical forms of the disease is in the 60s, Dent says.
What to expect with different types of Parkinson's
Here’s what to expect with the different types of Parkinson’s:
In this form, also known as primary Parkinson’s, the onset of symptoms is asymmetrical, affecting one side of the body months or years before the other side. Symptoms can include tremors or rigidity, which respond well to certain medications, especially Levodopa. “The progression is very slow, occurring over months to years,” Dent says. About one-third of people with idiopathic Parkinson’s will not have the classic tremor.
These forms of Parkinson’s usually affect both sides of the body, and symptoms can include loss of motion, rigidity, orthostatic hypotension (when your blood pressure quickly drops as you stand, causing dizziness), severe loss of bladder control and constipation. “GI symptoms in general can be a red flag,” Dent says. “The hard part is many people with idiopathic Parkinson’s will have these symptoms, too, but people with atypical Parkinson’s will have more.” People with atypical Parkinson’s do not have the classic tremor. Atypical forms of the disease include the following:
Multiple system atrophy (MSA)
“Some people with MSA will show signs of cerebral dysfunction,” she says. “They will have a more of a slurring to their speech and they’ll be less coordinated. Instead of having a Parkinson’s shuffling, it’ll be more of a staggering gait."
Progressive supranuclear palsy (PSP)
“These patients will have classically axial rigidity (in the neck and trunk), and they’ll fall a lot early on in the disease,” she says. “They’ll ultimately have vertical eye movement abnormalities. They might have more speech difficulties.”
“That one is very, very rare,” Dent says. “People can have a lot of unilateral rigidity and unusual muscle spasms. They might resemble someone who has had a stroke.”
Dementia with Lewy bodies
“If we see movement signs of Parkinson’s, such as slowness and stiffness and tremors, and within a year or two, someone starts developing significant cognitive or memory problems, we might consider dementia with Lewy bodies,” Dent says. “Sometimes people with Lewy bodies will hallucinate very easily, and hallucinations can develop pretty early on. There can also be signs of orthostatic hypotension.”
Mention any new symptoms to your movement specialist, but try not to stress about whether you or not you have an atypical form of the disease. “These are diseases that any good movement disorders neurologist will monitor for,” Dent says. “I tell my patients that it’s my job to worry about that for them.”