3.30.16 – VA ambulatory report pearls – Vascular parkinsonism

Vascular Parkinsonism was first described by Dr. Critchley in 1929. There are currently no generally accepted clinical criteria to diagnose the condition, however, there are some key features that are thought to be consistent with Vascular Parkinsonism (VP).

Key features of VP versus idiopathic Parkinson’s Disease (PD) include the following:

  • Older patients – mean age at symptom onset is 4-10 years older than in patients with PD.
  • Key clinical signs and symptoms include symmetrical gait instability and other characteristic findings include lower extremity involvement with severe clinical features in the lower limbs (“lower body parkinsonism”), pyramidal signs, pseudobulbar palsy (inability to control facial muscles) and urinary incontinence.
    • Tremor is not a main feature of VP.
    • Patients with PD tend to have more hypokinesia or bradykinesia and rigidity.
  • Patients with VP are more prone to postural instability, falls, and dementia.
  • Patients with VP are less responsive to levodopa.
  • Brain imaging reveals white matter lesions and lacunar infarcts though, as we know, this is not specific to this disease process.

A systematic review in Movement Disorders in 2010 (attached here) reviews 24 studies that compare clinical findings and neuroimaging in VP versus PD and excluded secondary causes of parkinsonism (e.g., progressive supranuclear palsy). Some additional findings of interest include the following:

  • Risk factors for VP include HTN, CAD, HLD, DM, and h/o CVA.
  • Response rates to levodopa ranged from 20-38% for patients with VP versus 74-100% for patients with PD.
  • Structural neuroimaging is more likely to be abnormal in VP (90-100%) than in PD (12-43%).

Kalra, S., Grosset, D. G., & Benamer, H. T. (2010). Differentiating vascular parkinsonism from idiopathic Parkinson’s disease: A systematic review. Mov. Disord. Movement Disorders, 25(2), 149-156.

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