Objective: To define the clinical features of vascular parkinsonism (VP) and compare it to idiopathic Parkinson’s disease (iPD).

Background: The main differential diagnosis of VP has been said to be iPD, but little is known about the clinical heterogeneity of VP[1].

Methods: In this cross-sectional retrospective study, we included VP historic cases from our clinical data file and consecutive iPD patients attending our clinic. All cases were diagnosed according to previously published diagnostic criteria[2]. We recorded demographic data, cardiovascular risk factors, prior acute cerebrovascular events and clinical description. Neuroimaging was available for all VP cases.

Results: We identified 22 patients with VP (19 men; age at onset 69.86±12.64 years) and 6.27±4.23 years of disease duration. We defined two clinical subgroups according to vascular lesions patterns: 1) bilateral lacunar infarcts and symmetric parkinsonism with predominant lower body affection (n=14), 2) territorial infarcts and combined gait disturbances with asymmetric parkinsonism (n=5). Over time, three patients of the first group showed an involvement of supranuclear eye movements, qualifying for a diagnosis of probable progressive supranuclear palsy (PSP). Compared to 22 patients with iPD (18 men; age at onset 69.04±11.36 years) and 5.63±2.57 years of disease duration, both groups did not significantly differ in age (p=0.60), sex (p=1.00) and disease duration (p=0.55), nor in arterial hypertension (59.10% vs. 63.64%; p=0.55). Major disability (defined by the need of wheelchair or nursing home placement at last assessment) was greater in VP than in iPD (59.10% vs. 13.64%; p<0.01). By contrast, there were no differences regarding insidious onset (86.36% vs. 100%; p=0.23) and cognitive complaints (18.18% vs. 31.82%; p=0.49). Although rest tremor was more frequent in iPD (72.73% vs. 40.91%; p=0.07), it was present in nine VP patients. Four of them had presynaptic nigrostriatal degeneration in dopamine imaging and response to levodopa.

Conclusions: VP patients had a worse prognosis than iPD. Rest tremor and asymmetrical parkinsonism raise the question of either iPD co-pathology or strategic vascular lesions resulting in PD-like presynaptic nigrostriatal dysfunction. Lack of levodopa response and postural instability (as well as eye movement abnormalities in a few cases) raise the same question with regard to PSP.

References: 1 Vizcarra JA, Lang AE, Sethi KD, et al. Vascular Parkinsonism: Deconstructing a Syndrome. Mov Disord 2015;30:886–94. doi:10.1002/mds.26263. 2 Zijlmans JCM, Daniel SE, Hughes AJ, et al. Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord 2004;19:630–40. doi:10.1002/mds.20083.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/vascular-parkinsonism-clinical-features-and-comparison-with-parkinsons-disease/