Parkinson Plus Syndromes, also known as atypical Parkinson’s, describe several neurological conditions that share some symptoms with Parkinson’s disease but also have features that make them distinct. These conditions can affect movement, balance, cognition, speech, and swallowing in different ways. Learning about these differences helps people and their Care Partners understand the diagnosis with clarity.

A diagnosis of a Parkinson Plus Syndrome may feel unexpected. Many people search for answers, wonder how symptoms will progress, or feel uncertain about what the diagnosis means. As each of these conditions is complex, it’s essential to recognize that individuals with them can benefit from SPEAK OUT!^® Therapy. Read below to learn more about the symptoms of each and how INTENT can make a positive difference. 

Parkinson Plus Syndromes Defined

Parkinson Plus Syndromes include:

• Progressive Supranuclear Palsy (PSP)
  
• Multiple System Atrophy (MSA)
  
• Corticobasal Degeneration (CBD)
  
• Lewy Body Dementia (LBD)

These conditions are less common than Parkinson’s and involve changes in brain regions responsible for movement planning, coordination, attention, autonomic function, and communication. While Parkinson’s primarily affects the substantia nigra and dopamine pathways, Parkinson Plus Syndromes involve broader neurological networks. This is why symptoms can appear differently and may progress more quickly.

The four cardinal symptoms of Parkinson’s are:

• Resting Tremor
• Slowness of Movement (Bradykinesia)
• Rigidity
• Postural Instability

Parkinson Plus Syndromes have some overlap of these symptoms. 

Although these conditions share stiffness, slowness, and changes in balance, people often notice key differences early. Now, let’s explore each disorder more closely to have a better understanding of how symptoms present.

Progressive Supranuclear Palsy (PSP)

Similar to Parkinson’s, PSP symptoms include slowness of movement, rigidity, and postural instability, but tremors are rare. Symptoms usually begin in the early 60’s, but they may start as early as the 40s. It is slightly more common in men than in women. It progresses more quickly than Parkinson’s. People are often misdiagnosed with Parkinson’s initially. 

Symptoms

• Supranuclear gaze palsy
  • Impaired voluntary eye movement, primarily up and down. This impacts functional activities such as going up or down stairs, walking on sidewalks, reading, and seeing food on a plate. 
• Blepharospasm
  • Involuntary eyelid closing. There can also be eyelid apraxia. This means once the eyelids close, the person has difficulty opening them. 
• Gait and balance disturbances, and backward falls (retropulsion).
• Slowed movement with bilateral involvement. 
• Reduced facial expression and difficulty maintaining eye contact. 

• Poor insight with increased impulsivity.
• Depression may be worse than other Parkinson Plus Syndromes.

Multiple System Atrophy (MSA)

Like Parkinson’s, MSA symptoms include slowness of movement, rigidity, postural instability, and tremors. However, the tremor usually occurs when the limb is in use, as opposed to at rest, as in Parkinson’s. While movement and coordination are affected, the autonomic nervous system is most notably affected. The average age of onset is typically younger than the age of onset for PSP. 

Symptoms

• Significant autonomic body function changes – blood pressure fluctuations, issues with urination, constipation, and sweating. Hypertension may occur while lying down. 
• Sometimes breathing is affected. Changes can include irregular breathing or temporary stopping of breathing while sleeping. A sleep study may be recommended to properly diagnose and treat these symptoms. 
• Myoclonus – sudden, involuntary muscle jerks of the arms, legs, or trunk. 
• Exaggerated reflexes and muscle tone may be spastic. 
• Dystonia – involuntary muscle spasms in the face, jaw, neck, trunk, or limbs. This results in abnormal, painful movements and postures. It may be treated with Botox injections. 
• Inspiratory stridor – strained vocalized inspiration. It is due to the paralysis of the muscles responsible for vocal fold abduction. 
• Cerebellar ataxia – changes in the cerebellum may cause a staggering gait, poor balance, discoordinated movements, and slurred speech. 

Corticobasal Degeneration (CBD)

CBD occurs slightly more often in women than men, with the age of onset ranging from 60 to 80 years of age. Due to the overlapping features with PSP, Alzheimer’s, and other disorders, it is often difficult to diagnose. A stroke or brain tumor can also mimic the symptoms of CBD. 

The motor symptoms can include the four cardinal symptoms of Parkinson’s. There is often an asymmetry of the symptoms, which means it usually starts on one side of the body. 

 Symptoms

• “Alien limb syndrome” – the limb seems to have a mind of its own, performing actions involuntarily. 
• Exaggerated tendon reflexes.
• Oculomotor dysfunctions – the same as PSP with blepharospasms, supranuclear gaze palsy, and eyelid apraxia. 
• Cognitive changes – short-term memory problems characterized by repeating questions and misplacing things. Difficulty with complex information and following instructions. Difficulty paying attention or concentrating. 
• Frontotemporal dementia – may be characterized by apathy, antisocial behavior, personality change, irritability, disinhibition, impulsivity, and repetitive compulsive behavior. 

Lewy Body Dementia (LBD)

Lewy body dementia is the second most common form of degenerative dementia. LBD describes the presence of Lewy bodies, abnormal deposits of a protein called alpha-synuclein, in the brain. LBD presents initially in three different manners. 

Some begin with a diagnosis of Parkinson’s and then develop dementia. This is Parkinson’s disease dementia. Others present with a cognitive impairment that may be incorrectly diagnosed as Alzheimer’s. Over time, additional features develop that lead to dementia with Lewy bodies (DLB) diagnosis. Finally, a smaller number of people present with neuropsychiatric symptoms that also lead to the DLB diagnosis. 

People with LBD may exhibit Parkinson’s type movement symptoms, including slowness of movement, rigidity, postural instability, and tremors. 

Symptoms 

• Visual hallucinations.
• Excessive daytime sleepiness.
• REM sleep behavior disorder (RBD) – people physically act out their dreams. 
• Autonomic body function changes – blood pressure control, temperature regulation, and bladder and bowel function. 
• Cognitive fluctuations – unpredictable changes in concentration and alertness. Communication may not flow well or may seem unclear or illogical at times. 

How SPEAK OUT! Therapy Helps

The SPEAK OUT! Therapy Program, developed by Parkinson Voice Project, helps people with Parkinson’s and related disorders REGAIN and RETAIN their speech and swallowing. The program can improve volume, articulation, breath support for speech, vocal quality, intonation, and facial expression.

A Certified SPEAK OUT! Provider can tailor the therapy program for individuals with Parkinson Plus Syndromes by simplifying tasks and reducing session length to accommodate fatigue. The Care Partner plays a critical role in understanding and using the best cue to enhance the use of INTENT. 

Therapy typically begins at Level One in the SPEAK OUT! Booklet, progressing only when mastery is achieved, as the levels form a hierarchy of speech tasks that gradually increase in complexity — counting sequences become longer, and reading exercises expand in sentence length. Vocalizations are particularly important for maintaining both speech and swallowing, and may be paired with head nods or other signals when appropriate to reinforce communication. Daily practice is essential to maintain swallowing function. 

In summary, SPEAK OUT! Therapy can be adjusted to meet the unique needs of people with Parkinson Plus Syndromes, and consistent exercise of the swallowing muscles is vital for preserving function.

Your Next Step

People with Parkinson Plus Syndromes and their families can take meaningful steps to support their speech and swallowing. Early therapy intervention creates a foundation that helps people and their Care Partners move forward with INTENT.

Find a SPEAK OUT! Provider near you. Start speaking with INTENT today.