What are the signs and symptoms of Parkinson-plus syndromes?

Updated: Sep 24, 2018
  • Author: Stephen M Bloomfield, MD; Chief Editor: Selim R Benbadis, MD  more...
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In addition to lack of response to carbidopa/levodopa (Sinemet) or dopamine agonists in the early stages of the disease, other clinical clues suggestive of Parkinson-plus syndromes include the following:

  • Early onset of dementia

  • Early onset of postural instability

  • Early onset of hallucinations or psychosis with low doses of carbidopa/levodopa or dopamine agonists

  • Ocular signs, such as impaired vertical gaze, blinking on saccade, square-wave jerks, nystagmus, blepharospasm, and apraxia of eyelid opening or closure

  • Pyramidal tract signs not explained by previous stroke or spinal cord lesions

  • Autonomic symptoms such as postural hypotension and urinary incontinence early in the course of the disease

  • Prominent motor apraxia

  • Alien-limb phenomenon

  • Marked symmetry of signs in early stages of the disease

  • Truncal symptoms more prominent than appendicular symptoms

  • Absence of structural etiology such as a normal-pressure hydrocephalus (NPH)

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