<unk>  is characterized by the following, which can be present in any combination: * autonomic dysfunction * parkinsonism (muscle rigidity +/ tremor and slow movement) * cerebellar ataxia (Poor coordination/unsteady walking, double vision) A variant with combined features of<unk>  and dementia with Lewy bodies may also exist. There have also been occasional instances of frontotemporal lobar degeneration associated with<unk> . Initial presentation The most common first sign of<unk>  is the appearance of an "akinetic-rigid syndrome" (i.e. slowness of initiation of movement resembling Parkinson's disease) found in 62% at first presentation. Other common signs at onset include problems with balance (cerebellar ataxia) found in 22% at first presentation, followed by genito-urinary symptoms (9%): both men and women often experience urgency, frequency, incomplete bladder emptying, or an inability to pass urine (retention). About 1 in 5<unk>  patients experience a fall in their first year of disease. For men, the first sign can be erectile dysfunction. Women have also reported reduced genital sensitivity. Progression As the disease progresses one of three groups of symptoms predominates. These are: # Parkinsonism - slow, stiff movement, writing becomes small and spidery # Cerebellar dysfunction - difficulty coordinating movement and balance # Autonomic nervous<unk>  dysfunction - impaired automatic body functions, including one, some, or all of the following: * postural or orthostatic hypotension, resulting in dizziness or fainting upon standing up * urinary incontinence or urinary retention * impotence * constipation * vocal cord paralysis * dry mouth and skin * trouble regulating body temperature due to sweating deficiency in all parts of the body * loud snoring, abnormal breathing or inspiratory stridor during sleep * other sleep disorders including sleep apnea, REM behavior disorder * double vision * muscle twitches * Cognitive impairment
Multiple system atrophy
Pure autonomic failure
Progressive supranuclear palsy
Tropical ataxic neuropathy
Low pressure hydrocephalus
Spinal and bulbar muscular atrophy
Lewy body dementias
Amyotrophic lateral sclerosis