There are a number of degenerative syndromes less common than Parkinson's disease in which parkinsonism (the triad of rigidity, tremor and bradykinesia) occurs and for which care requires similar considerations. Each of these conditions may have a particular emphasis in its mix of symptoms. Patients with multiple system atrophy (MSA), for example, are more likely to have troublesome urinary incontinence compared with Parkinson's disease patients and MSA more often causes early erectile dysfunction. Other syndromes include progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), corticobasal degeneration (characterized by asymmetric parkinsonism) and Parkinson's disease with dementia (PDD). These conditions do not, on the whole, respond to therapy as well as does Parkinson's disease, and their ‘atypical’ nature may become clearer through a lack of response to levodopa (L-dopa).

The principal clinical feature of Parkinson's disease is bradykinesis, slowness of muscle contraction, along with muscle rigidity and tremor (mainly at rest). Muscle stiffness results in slowness of movement. Patients are forced to adopt a stooped posture, and proceed with shuffling short steps. There is imbalance and patients are prone to falls. The face is impassive, body movement may be suddenly frozen. Constipation and urinary symptoms more typical of prostatism occur.

THE SUPPORTIVE PHASE

The course of Parkinson's disease is commonly described as one of up to 5 years with acceptable control of symptoms, then increasing disability and difficulty for another 5 or more years.