Understanding Parkinson's Disease Types and Movement Symptoms

Understanding the Different Types of Parkinson's Disease

Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.

Parkinson's disease symptoms worsen over time. Although a cure for Parkinson's disease is still being researched, medications might significantly improve your symptoms.

Parkinson's disease has several different types, each affecting movement in slightly different ways. Understanding the different types of Parkinson's can help you better manage your symptoms and find the right treatments.

Primary Parkinsonism

The most common type of Parkinsonism is primary Parkinson's disease. This type occurs for unknown reasons, although genetics and environmental factors appear to play a role.

In people with primary Parkinson's, clumps of alpha-synuclein protein develop in certain neurons. These clumps, called Lewy bodies, damage neurons over time, leading to reduced production of dopamine. Dopamine helps transmit signals within the brain.

As dopamine levels fall, communication between the substantia nigra and corpus striatum brain regions becomes impaired. These two areas of the brain help regulate movement. Loss of dopamine leads to the motor symptoms of Parkinson's.

Young-Onset Parkinson's Disease

Parkinson's disease typically develops after age 60. But in some people, symptoms start before age 50. This early-onset type is called young-onset Parkinson's disease.

Symptoms of young-onset Parkinson's often resemble those of late-onset Parkinson's. They include tremor, slow movements, rigid muscles, imbalance, and walking problems. It's just that they start earlier in life.

Because this type of Parkinson's occurs during a patient's working years, the symptoms can be especially disruptive. Patients may still be working and caring for children. The early loss of independence can cause great difficulties.

Vascular Parkinsonism

Vascular parkinsonism occurs when brain injuries from strokes or other vascular causes produce Parkinson's-like symptoms such as tremor, slow movement and muscle stiffness. Many vascular risk factors have been linked to this type.

In vascular parkinsonism, symptoms often arise suddenly after one or several strokes. Early signs may affect only one side of the body and progress from there. The symptoms tend to be milder than in typical Parkinson's disease.

Patients with vascular parkinsonism often walk with very small steps. Loss of balance is common. Dementia frequently occurs as part of the disorder.

Drug-Induced Parkinsonism

Many medications can induce parkinsonian side effects, producing symptoms similar to Parkinson's disease. Drug-induced parkinsonism may arise from medications used to treat mood disorders, nausea, heart disease, or psychosis.

Some examples of medications linked to drug-induced parkinsonism include:

• Dopamine receptor blocking drugs like antipsychotics or antinausea drugs
• Lithium
• Calcium channel blockers like those that treat high blood pressure
• Antidepressants including tricyclics or SSRIs

Drug-induced parkinsonism can appear within days or weeks of starting a new medication known to have this side effect. When detected early, the condition usually improves after stopping the medication.

Parkinsonism-Plus Syndromes

Parkinson's-plus syndromes exhibit the traditional Parkinson's symptoms of tremor, rigidity, and bradykinesia. But they also have additional neurological features that help define the specific syndrome.

Some examples of Parkinson's-plus syndromes include:

• Multiple system atrophy (MSA): This progressive disorder causes Parkinson's symptoms along with impaired control of blood pressure, heart rate and bladder function.
• Progressive supranuclear palsy (PSP): Besides Parkinson's symptoms, this disorder causes balance and vision problems along with dementia.
• Corticobasal degeneration (CBD): This rare disorder involves Parkinson's motor dysfunction, along with symptoms like muscle twitching, gait problems, numbness, paralysis and dementia.
• Lewy body dementia: In addition to Parkinson's symptoms, this syndrome involves memory loss, confusion, and behavioral changes.

Secondary Parkinsonism

Sometimes Parkinson's-like symptoms develop as a secondary consequence of an underlying condition. This is known as secondary parkinsonism. Some examples of causes include:

• Head trauma
• Stroke
• Brain tumor
• Multiple sclerosis
• Certain toxins

Secondary parkinsonism may be partially reversible if the underlying condition can be successfully treated.

How Parkinson's Affects Movement

While types of Parkinson's differ, most involve four primary movement problems:

Tremor

Tremor is by far the most common early sign, occurring in around 70 percent of people with Parkinson's. Often starting in one hand, it takes the form of a pill-rolling tremor in the fingers or hand shaking when it is at rest.

Tremor typically begins on one side of the body. But over time, the tremor often spreads to affect both sides. Stress, fatigue, or strong emotions can worsen tremor.

Rigid Muscles

Parkinson's disease causes increased muscle tone and stiffness in the limbs and trunk. This rigidity can produce a resistance to movement that makes simple tasks difficult.

Daily activities like rising from a chair, walking, buttoning a shirt or rolling over in bed require great effort. Rigidity often begins mildly on one side of the body before progressing.

Slowness of Movement

Bradykinesia refers to the abnormally slow movements seen in Parkinson's. Affected people display slowed motions, reduced swinging of the arms when walking, loss of spontaneous movement, and problems performing sequential tasks.

Activities require concentrated effort. Patients report that routine tasks like buttoning a shirt feel exhausting. Walking speed and amplitude frequently decline.

Impaired Balance and Coordination

Parkinson's disease frequently causes balance problems and unsteady gait. Patients lean forward while walking, take tiny shuffling steps, and can freeze mid-step. Quick pivoting movements also grow difficult.

Loss of reflexes, decreased arm swing, and rigidity all contribute. Falls become more likely. Parkinson's patients often cannot perform tandem gait motions like walking toe-to-toe in a straight line.

Other Parkinson's Movement Symptoms

Beyond the four primary symptoms, Parkinson's can cause additional involuntary movement problems:

Freezing

Freezing involves a sudden, temporary inability to move, especially when trying to initiate or change a motion. It's like the feet are glued to the floor. This often causes falls.

Freezing most commonly happens when starting to walk - as when trying to walk through a doorway. Turning and reaching for objects can also trigger it. Anxiety tends to worsen it.

Dystonia

Dystonia refers to sustained, involuntary muscle contractions that force certain parts of the body into abnormal, contorted postures. Examples include a bent spine, twisted neck, or foot curled under.

Dystonia may affect just one limb or the entire body. Common triggers include attempting movement or extreme emotions. Relaxing the affected muscle can help straighten it out.

Dyskinesia

Dyskinesia consists of jerky, involuntary movements. This often emerges as a side effect of levodopa, a common Parkinson's medication. The face, arms, legs and trunk may begin moving in random, dance-like ways.

Dyskinesia appears when levodopa levels peak in the blood, then fades as the medication wears off. Reducing the medication dosage often minimizes these movements.

Shuffling Gait and Festination

Parkinson's often produces a distinctive, shuffling walk. Patients lean forward, take short, quick steps, and have reduced arm swing. This pattern is called festination.

Festination can build into a forward propulsion where the patient leans so far forward they can't avoid running forward a few steps. Some compare it to the gait of a drunken toddler.

Stooped Posture and Dropped Head

Many Parkinson's patients gradually develop a stooped, forward-leaning posture. The head droops downward and the spine bows forward. This bowed posture makes the neck extremely rigid.

Trying to walk in this position leads to severe imbalance. Some people cannot lift the chin up to look straight ahead. Poor posture worsens over time.

Mask-like Expression

The face may become fixed in a stare, appearing stiff, flat and devoid of expression. This mask-like facial appearance results from rigid facial muscles.

The lack of normal spontaneous blinking can make the stare appear intense or angry. Opening the eyes wide and infrequent blinking add to the mask-like look.

Soft Speech

Many Parkinson's patients have speech difficulties. Their voice may become very soft and difficult to hear. Speech lacks normal expression, trailing off to a whisper at the ends of sentences.

Swallowing problems, weak respiratory muscles, and poor breath support contribute to the diminished voice volume. Patients report great effort needed to speak up.

Micrographia

Micrographia refers to abnormally small, cramped handwriting. Parkinson's interferes with the fine motor dexterity needed for normal penmanship.

Handwriting shrinks progressively smaller. Sentences crowd together and words take on an angular, saw-tooth appearance. The condition worsens with fatigue.

Treatment Options for Parkinson's Symptoms

While no current treatment can slow or stop the progression of Parkinson's disease, medications and therapies can greatly improve the symptoms.

The main drug treatments aim to increase brain dopamine levels. The most common options include:

• Carbidopa-levodopa - Standard oral medication that elevates dopamine.
• Dopamine agonists - Mimic dopamine effects; come in oral and patch forms.
• MAO-B inhibitors - Prevent dopamine breakdown.
• Anticholinergics - Block acetylcholine activity to rebalance dopamine.

Beyond medications, deep brain stimulation is an electical stimulation therapy that can minimize symptoms. Physical, occupational, and speech therapies also help people better manage Parkinson's symptoms in daily life.

While living with Parkinson's presents many challenges, treatments and lifestyle changes can often significantly improve quality of life.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.