Vascular parkinsonism: a case series of 17 patients

Abstract

Objective To report the clinical and neuroimaging findings in a case series of vascular parkinsonism (VP). Methods Seventeen patients with VP were evaluated with motor, cognitive, and neuroimaging standardized tests and scales. Results All patients had arterial hypertension. Ten patients were male and the mean age of the whole sample was 75.8±10.1 years. The mean age of parkinsonism onset was 72.2±10.0 years. Common clinical features were urinary incontinence (88.2%), lower limb parkinsonism with freezing of gait and falls (82.3%), and pyramidal signs (76.4%). The mean Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn-Yahr scores were 72.5±21.6 points and 3.3±0.9 points, respectively. Sixteen (94.1%) patients had freezing of gait and executive dysfunction. Twelve (70.5%) patients had probable vascular dementia. The mean dose of levodopa was 530.9 mg/day. Unresponsiveness to the drug was confirmed by a 6.9 mean point reduction in the UPDRS score after the “practically defined off” test. Conclusion This series provides a profile of VP with predominant lower-limb involvement, freezing of gait and falls, pyramidal signs, executive dysfunction, concomitant vascular dementia, and poor levodopa response.

Therapeutic Interventions for Vascular Parkinsonism: A Systematic Review and Meta-analysis

“…Figure 1 summarizes the study identification and selection process. Four different therapies were identified: 1 study investigated vitamin D therapy ( 24 ), 1 study assessed repetitive transcranial magnetic stimulation (rTMS) therapy ( 28 ), 1 study was focused on lumbar puncture as therapy ( 32 ) and 20 studies reported levodopa therapy ( 10 , 16 , 18 – 23 , 25 – 27 , 29 – 31 , 33 – 38 ). Clinical trials were not found for any therapeutic.…”

“…The majority of the studies used either Zijlmans et al’s criteria ( 1 ) (Table S1 in Supplementary Material) or Winikates’ criteria ( 16 ) (Table S2 in Supplementary Material). Zijlmans’ criteria was used for the diagnosis of VP in the vitamin D study ( 24 ) and in 10 of the levodopa studies ( 10 , 18 – 23 , 25 – 27 ) (Table S1 in Supplementary Material). Meanwhile, Winikates’ criteria were used for the diagnosis of VP in the rTMS and lumbar puncture studies ( 28 , 32 ) and in five of the levodopa studies ( 16 , 29 – 31 , 33 ) (Table S2 in Supplementary Material).…”

“…Finally, treatment with levodopa was evaluated in 14 cross-sectional studies ( 16 , 18 – 23 , 29 – 31 , 33 , 35 , 37 , 38 ), 2 case–control studies ( 25 , 27 ), 2 cohort studies ( 26 , 34 ), and 2 clinicopathological studies ( 10 , 36 ). Except for one clinicopathological study ( 10 ), no other study was specifically aimed at testing the levodopa response of VP subjects.…”

“…Four studies ( 18 , 20 , 23 , 27 ) measured the (%) of improvement on the UPDRS part 3 of VP subjects after levodopa therapy; respective sample sizes were: 13, 17, 5, and 15 subjects; reduction of motor symptoms ranged from 5.8 to 22.25%. Two studies ( 18 , 20 ) compared the UPDRS reduction to that of PD patients; VP subjects showed a reduction of 5.9–18.7% compared to 31.6–64.65% in PD subjects.…”

Cerebrovascular lesions in parkinsonian patients: when do they really matter?

“…The study of Vega et al 4 is welcomed since we need to understand how VP manifests and how should we mana ge these patients. Considering the importance of this issue and the need to identify true VP patients we need more stu dies addressing the point of how and where in the CNS the cerebrovascular abnormalities seen on MRI can induce parkinsonian features.…”