Abstract
Objective
The aim of this study was to examine the clinical picture of Parkinson’s disease (PD) and vascular parkinsonism (VP) in the elderly, in an attempt to differentiate the clinical history, symptoms, signs and response to therapy.
Material and methods
Thirty–two elderly patients with late onset PD and 45 with VP were enrolled and the clinical features of two groups were compared. All patients underwent brain MRI and were scored using the Unified Parkinson’s Disease Rating Scales (UPDRS) –II, –III.
Results
Patients with PD had a younger age at onset and a longer duration of the disease as compared to patients with VP. Nearly all PD patients showed a good response to levodopa therapy, while only 29% of patients with VP were responsive to levodopa treatment. Vascular risk factors as well as postural tremor, gait disorders and pyramidal signs with lower body predominance, were more frequent in patients with VP. Ninety–three % of PD patients had normal MRI, whereas all patients with VP had cerebral vascular lesions. UPDRS–II, –III scores at baseline were higher in VP than in PD patients and their increases throughout the follow–up period were more marked in VP than in PD patients.
Conclusions
Clinical history, symptoms, signs, response to therapy, and brain imaging help to differentiate PD and VP as two clinical entities with different clinical, prognostic and therapeutic implications, even if the coexistence of PD and a cerebral vascular disease in elderly patients is not infrequent and can make the diagnosis difficult.
Similar content being viewed by others
References
Chang CM, Yu YL, Leong SY, Fong KY (1992) Vascular pseudoparkinsonism. Acta Neurol Scand 86:588–592
Crithely M (1929) Arteriosclerotic parkinsonism. Brain 52:23–83
Demirkiran M, Bozdemir H, Sarica Y (2001) Vascular parkinsonism: a distinct, heterogeneous clinical entity. Acta Neurol Scand 104:63–67
Eadie MJ, Sutherland JM (1964) Arteriosclerosis in parkinsonism. J Neurol Neurosurg Psychiatry 27:237–240
Elble RJ, Cousins R, Leffler K, Hughes L (1996) Gait initiation by patients with lower half parkinsonism. Brain 119:1705–1716
Fitzgerald P, Jankovic J (1989) Lower body parkinsonism: evidence for vascular etiology. Mov Disord 4:249–260
Homer S, Niederkorn K, Ni SK, Fischer R, Fazekas F, Schmidt B, Ott E (1997) Evaluation vaskulärer Risikofaktoren bei Patienten mit Parkinson–Syndrom. Nervenarzt 68:967–971
Hughes AJ, Daniel SS, Kilford L (1992) Accuracy of clinical diagnosis of Parkinson’s disease: a clinico–pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184
Hurtig HI (1993) Vascular parkinsonism. In: Stem MB, Koller WC (eds) Parkinsonian syndromes. New York: Marcel–Dekker, pp 81–93
Ikeda K, Kotabe T, Kanbashi S, Kinoshita M (1996) Parkinsonism in lacunar infarcts of the basal ganglia. Eur Neurol 36:248–249
Inzelberg R, Bornstein NM, Reider I, Korczyn AD (1994) Basal ganglia lacunes and parkinsonism. Neuroepidemiology 13:108–112
Jellinger KA (2001) The pathology of Parkinson’s disease. Adv Neurol 86:55–72
Jellinger KA (2002) Vascular parkinsonism – neuropathological findings. Acta Neurol Scand 105(5):414–415
Mark MH, Sage R, Walters AS, Duviosin RD, Miller DC (1995) Binswanger’s disease presenting as levodopa responsive parkinsonism: clinicopathologic study of three cases. Mov Disord 10:450–454
Meara J, Koller WC (2000) Parkinson’s disease and parkinsonism in the elderly. Cambridge University Press
Murrow RW, Schweiger GD, Kepes JJ, Koller WC (1990) Parkinsonism due to a basal ganglia lacunar state. Neurology 40:897–900
Papapetropoulos S, Ellul J, Argyriou AA, Talelli P, Chroni E, Papapetropoulos T (2004) The effect of vascular disease on late onset Parkinson’s disease. Eur J Neurol 11(4):231–235
Peters S, Eising EG, Przuntek H, Müller T (2001) Vascular Parkinsonism: a case report and review of the literature. J Clin Neurosci 8(3):268–271
Piccini P, Pavese N, Canapicchi R, Paoli C, Del Dotto P, Puglioli M, Rossi G, Bonuccelli U (1995) White matter hyperintensities in Parkinson’s disease: clinical correlations. Arch Neurol 52:191–194
Quinn N (1995) Parkinsonism – Recognition and differential diagnosis. BMJ 310:447–452
Reider–Groswasser I, Bornstein NM, Korczyn AD (1995) Parkinsonism in patients with lacunar infarcts of the basal ganglia. Eur Neurol 35:46–49
Riley DE, Lang AE (1996) Non Parkinson akinetic rigid syndromes. Curr Opin Neurol 9:321–326
Sibon I, Fenelon G, Quinn NP, Tison F (2004) Vascular parkinsonism. J Neurol 251:513–524
Sibon I, Tison F (2004) Vascular parkinsonism. Curr Opin Neurol 17(1):49–54
Thompson PD, Marsden CD (1987) Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger’s disease. Mov Disord 2:1–8
Tolosa ES, Santamaria J (1984) Parkinsonism and basal ganglia infarcts. Neurology 34:1516–1518
Trenkwalder C, Paulus W, Krafczyk S, Hawken M, Oertel WH (1995) Postural stability differentiates “lower body” from idiopathic parkinsonism. Acta Neurol Scand 91:444–452
Trenkwalder C, Schwarz J, Gebhard J, Ruland D, Trenkwalder P, Hense HW, Oertel WH (1995) Starnberg trial on epidemiology of Parkinsonism and hypertension in the elderly. Prevalence of Parkinson’s disease and related disorders assessed by a door–to–door survey of inhabitants older than 65 years. Arch Neurol 52(10):1017–1022
Van Zagten M, Loder J, Kessels F (1998) Gait disorder and parkinsonian signs in patients with stroke related to small deep infarcts and white matter lesions. Mov Disord 13:89–95
Winikates J, Jankovic J (1999) Clinical correlates of vascular parkinsonism. Arch Neurol 56:98–102
Yamanouchi H, Nagura H (1997) Neurological signs and frontal white matter lesions in vascular parkinsonism. A clinicopathologic study. Stroke 28:965–969
Zijlmans JC, Daniel SE, Hughes AJ, Revesz T, Lees AJ (2004) Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord 19(6):630–640
Jellinger KA (2003) Prevalence of cerebrovascular lesions in Parkinson’s disease. A postmortem study. Acta Neuropathol (Berl) 105:415–419
Zijlmans JCM, Thijssen HOM, Vogels OJM, Kremer HP, Poels PJ, Schoonderwaldt HC, Merx JL, van ‘t Hof MA, Thien T, Horstink MW (1995) MRI in patients with suspected vascular parkinsonism. Neurology 45:2183–2188
Peralta C, Werner P, Holl B, Kiechl S, Willeit J, Seppi K, Wenning G, Poewe W (2004) Parkinsonism following striatal infarcts: incidence in a prospective stroke unit cohort. J Neural Transm 111:1473–1483
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rampello, L., Alvano, A., Battaglia, G. et al. Different clinical and evolutional patterns in late idiopathic and vascular parkinsonism. J Neurol 252, 1045–1049 (2005). https://doi.org/10.1007/s00415-005-0811-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-005-0811-2