Vascular parkinsonism: what makes it different?

Abstract

Vascular parkinsonism (VP) accounts for 2.5-5% of all cases of parkinsonism in various population based and clinical cohort studies. VP develops as a result of ischaemic cerebrovascular disease, so aetiologically it is classified as secondary parkinsonism. It has been variably referred to in the literature as arteriosclerotic parkinsonism, vascular pseudo-parkinsonism, and lower body parkinsonism. The most important consideration while making a diagnosis of VP should be to differentiate VP from Parkinson's disease (PD) because of prognostic and therapeutic implications. The salient clinical features in VP which differentiate it from PD are presentation with postural instability and falls rather than with upper limb rest tremor or bradykinesia; short shuffling parkinsonian gait in VP is accompanied by a wider base of stance and variable stride length (parkinsonian-ataxic gait), absence of festination, frequent occurrence of pyramidal signs, and early subcortical dementia. In a patient where the clinical features are suggestive of VP the clinical diagnosis can be supported by demonstration of diffuse white matter lesions and/or strategic subcortical infarcts in the MRI of the brain. The therapeutic options in VP are limited to levodopa, and a poor or non-sustained response to levodopa is another differentiating feature between VP and PD.

Vascular parkinsonism: a case series of 17 patients

“…Because of prognostic and therapeutic implications, the most important consideration when making a diagnosis of VP is differentiating it from PD 4 . Based on a systematic review of seven clinical studies and 16 other comparative studies (which included an assessment of imaging data), patients with VP were older, had a shorter duration of the illness, presented with symmetrical gait difficulties, and were less res ponsive to levodopa.…”

“…In various population-based studies and clinical series, VP reportedly accounted for 2.5% to 5.0% of all cases of parkinsonism 4 . In Brazil, Cardoso et al 5 reported that VP was present in 4.7% of 338 patients who were followed up in a tertiary care specialized movement disorder unit.…”

Clinicoradiological comparison between vascular parkinsonism and Parkinson’s disease

“…In population-based studies and clinical series, VP accounts for 2.5–5% of parkinsonism cases 2. A systematic review identified only seven clinical studies addressing the characteristics distinguishing VP from PD 9.…”

Investigation of Anticipatory Postural Adjustments during One-Leg Stance Using Inertial Sensors: Evidence from Subjects with Parkinsonism

“…APAs prior to voluntary movement are known to improve with improvements in bradykinesia from levodopa replacement therapy in patients with iPD (2). In contrast, levodopa seldom improves lower body bradykinesia in FGD so the postural deficits in these two types of parkinsonism likely have different underlying mechanisms (9, 10). …”

“…However, it is not known how FGD affects APAs. The effects of different types of parkinsonism on APAs may differ because people with iPD stand and walk with a narrow base of support whereas people with FGD stand and walk with wider than normal base of support (8, 9). APAs prior to voluntary movement are known to improve with improvements in bradykinesia from levodopa replacement therapy in patients with iPD (2).…”