Internet diagnosis can be confusing

Q. My 73-year-old husband has been diagnosed with vascular Parkinson's (progressive supranuclear palsy).

After the neurologists' diagnosis, I did research on the Internet and found that my husband has every symptom, both physical and mental. His falls started several years ago. His movements are now painfully slow, his thinking is impaired, he has trouble swallowing, spills food, requires help getting up and down, has great trouble walking even with a walker, has lost weight, is very weak, spends 15-plus hours in bed a day, and has a blank stare and reduced eye movement (says he can't see). He has not accepted that there is no cure and asked that I write for your opinion on the best place to seek help.

A. I believe you may have misunderstood the diagnosis, since vascular Parkinsonism and progressive supranuclear palsy are two separate, yet similar, disorders.

VP is caused by small strokes within either or both of the basal ganglia portions of the brain. Symptoms include resting tremor, rigidity, slowness of movement and difficulty walking. Some patients may experience sudden onset of symptoms as well as a strokelike event. Others may be completely unaware of the strokes and develop gradual worsening of symptoms.

Diagnosis can be difficult since it closely resembles typical Parkinson's disease and is often misdiagnosed as such in the early stages. Brain scans will show evidence of strokes. Treatment is primarily aimed at eliminating future strokes.

Progressive Supranuclear Palsy is also a Parkinson-like disorder but differs in several small ways. Like VP, it is often misdiagnosed as Parkinson's disease in the early stages. The symptoms are caused by deterioration of nerve cells in several tiny areas of the brainstem.

Symptoms include loss of balance while walking, stiffness, unexplained falls (usually backward), awkward gait, irritability, forgetfulness, loss of interest, impaired thinking, sudden laughing or crying, apathy, problems controlling eye movement, blurred vision, inability to maintain eye contact during conversation, slurred speech, trouble swallowing solids or liquids and more.

Based on the symptoms of each disorder, your husband appears to match closely those of PSP rather than VP.

I urge both of you to return to his neurologist to discuss treatment options.

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