What Are Parkinson's Plus Syndromes?

Some neurological diseases mimic many Parkinson's disease symptoms. These disorders are called Parkinson's plus syndromes or atypical parkinsonian syndromes.

Parkinson's plus syndromes are related to Parkinson's disease because they all negatively affect the brain or spinal cord nerve cells, and they are progressive with no available cure.

This article provides an overview of the most common Parkinson's plus syndromes.

Early Signs of Multiple System Atrophy: Snail (slow movement), hand holding a mug and shaking (tremors), hand with lightning bolts around it (rigid muscles), hands stacking blocks (lack of coordination), person with a speech bubble and jumbled letters (impaired speech), a yellow drop (bladder control issues)

Verywell / Julie Bang

Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is an uncommon brain disorder. This disease is caused by nerve cell damage in the brain that leads to walking, balance, and eye movement problems. Over time, PSP worsens and leads to an inability to think and control movement properly.

PSP is caused by a buildup of a protein (Tau) in the brain's nerve cells. This protein is believed to degenerate and destroy other essential proteins within the brain's nerve cells.

While it's normal to have low levels of Tau in the brain, people with PSP do not break down Tau correctly, and it increases to high levels.

PSP signs and symptoms can mimic those of Parkinson's disease and may include:

  • Balance issues and falls
  • Eye problems and vision changes
  • Trouble with speech and swallowing
  • Memory issues
  • Emotional outbursts
  • Depression

Because these symptoms are similar to Parkinson's disease, it can take time to diagnose it properly.

Symptoms unique to PSP that do not usually occur in Parkinson's can include:

  • Being unable to move your eyes properly or downward
  • Falling backward
  • Lack of severe shaking or tremors

PSP Treatment

Unfortunately, there is no cure or effective treatment for PSP, though some patients will be treated with Parkinson's medications to help with balance issues. Patients may also use things like specialized glasses, walkers, and regular physical therapy to help improve their quality of life.

Cortical-Basal Ganglionic Degeneration

Cortical-basal ganglionic degeneration (CBGD) is a rare neurological disease in which nerve cells in the brain break down and die over time. Similar to Parkinson's disease, the most commonly impacted areas control body movement and thinking.

CBGD is progressive, which means it worsens slowly over time, and it usually occurs in people over the age of 60. The exact cause of CBGD is unknown. However, researchers believe there may be an environmental or genetic factor.

Difficulty moving a limb or one side of the body is usually the first sign of CBGD, but over time it may affect every limb.

Signs and symptoms of CBGD may include:

  • Slight tremor
  • Slow movement
  • Muscle spasms
  • Speech or language problems
  • Difficulty swallowing
  • Poor coordination
  • Inability to perform purposeful movements
  • Uncontrolled eye movement

There is no cure for CBDG, and there are currently no treatment methods to slow its progression. However, there are medications and other alternative treatments that can manage symptoms.

Some of the same medications used to treat Parkinson's disease are also used to treat CBDG.

Physical, occupational, and speech therapy may also be useful to help mitigate symptoms.

Multiple System Atrophy

Multiple system atrophy (MSA) is an uncommon neurological disease caused by the death of nerve cells in the brain and spinal cord. This is also a progressive disorder, meaning it becomes worse over time. MSA affects the involuntary (autonomic) nervous system and body movement.

Some of the involuntary body functions the autonomic nervous system is responsible for include:

  • Blood pressure
  • Breathing
  • Body temperature
  • Sleep
  • Digestion
  • Urination
  • Motor movement
  • Sexual function

The exact cause of MSA is unknown. However, it is known that a type of protein (alpha-synuclein) is found in larger amounts in the nerve-supporting cells of the brains of MSA patients.

This protein is responsible for making the outer portion of nerve cells, called the myelin sheath. The myelin sheath allows for the electrical transmission of information between the brain and body. The same protein also builds up in patients who have Parkinson's disease, but on the inside of nerve cells.

There are two types of MSA:

  • The parkinsonian type: Symptoms mimic those of Parkinson's disease, primarily including stiffness, tremor, and slow movement.
  • The cerebellar type: Symptoms involve balance and coordination problems.

Early signs and symptoms of MSA may include:

  • Slow movement
  • Tremors
  • Rigidity
  • Lack of coordination
  • Impaired speech
  • Bladder control problems
  • Orthostatic hypotension (when blood pressure drops due to standing up)

There is no cure for MSA, and there are currently no treatments designed to specifically treat it. Treatment is usually aimed at helping to provide symptom relief.

Disease Progression

MSA usually progresses more quickly than Parkinson's disease. Patients often require a walking aid within a few years of symptom onset.

Lewy Body Dementia

Lewy body dementia (LBD) is a type of dementia that progresses over time. LBD occurs when protein deposits called Lewy bodies occur in the brain's nerves cells. The affected nerve cells are responsible for memory, thinking, and motor movement.

Lewy bodies are also found in patients with other neurological diseases such as Parkinson's disease and Alzheimer's disease. This has led some researchers to believe there is a connection between the accumulation of proteins that cause buildup and plaque found in the brain with diagnostic imaging.

LBD is a less common type of dementia than Alzheimer's disease. However, it is progressive and results in a decline in mental abilities.

Symptoms of LBD are similar to those of Parkinson's and Alzheimer's and can include:

  • Rigid muscles
  • Slow movement
  • Balance and coordination issues
  • Tremors
  • Poor posture
  • Difficultly swallowing
  • Changes in alertness or attention
  • Visual hallucinations
  • Memory loss
  • Sleep problems
  • Changes in mood and behavior

There is no cure for LBD. However, some medications can help with symptom management, including sleep medications, antidepressants or antipsychotics, and medications approved to treat Alzheimer's.

Physical, occupational, and speech therapy are also beneficial for LBD patients.

Lewy Body Dementia and Alzheimer's

The memory loss in Lewy body dementia is less severe than it is with Alzheimer's. However, delusions and hallucinations are more common in the early stages of LBD. Sleep disturbances are also more likely in LBD.

A Word From Verywell

Distinguishing between Parkinson's disease and the various Parkinson's plus syndromes can be challenging and make for a difficult diagnosis. Be very clear and descriptive with your healthcare provider about the symptoms you are experiencing to ensure an accurate diagnosis. While there are no cures for these Parkinson's plus syndromes, there are medications and therapies that can help mitigate symptoms.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. National Institute of Neurological Disorders and Stroke. Progressive supranuclear palsy fact sheet.

  3. National Organization for Rare Disorders. Progressive supranuclear palsy.

  4. Johns Hopkins Medicine. Progressive supranuclear palsy.

  5. National Organization for Rare Disorders. Corticobasal degeneration.

  6. Reich SG, Grill SE. Corticobasal degenerationCurr Treat Options Neurol. 2009;11(3):179-185. doi:10.1007/s11940-009-0021-9

  7. Multiple System Atrophy Coalition. What is multiple system atrophy?

  8. National Institute of Neurological Disorders and Stroke. Multiple system atrophy fact sheet.

  9. National Institute on Aging. What is lewy body dementia? Causes, symptoms, and treatments.

  10. Alzheimer's Association. Lewy body dementia.

  11. National Institute of Neurological Disorders and Stroke. Lewy body dementia: hope through research.

By Sarah Jividen, RN
Sarah Jividen, RN, BSN, is a freelance healthcare journalist and content marketing writer at Health Writing Solutions, LLC. She has over a decade of direct patient care experience working as a registered nurse specializing in neurotrauma, stroke, and the emergency room.