Continue Learning About Parkinson’s Disease
Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.
Which Age Group Is Parkinsonism More Prevalent In
There is more data on the incidence of Parkinsons disease than there is for Parkinsonism. The incidence of Parkinsons disease increases with age, and the diagnosis is more likely in older populations.
About 4% of people with Parkinsons disease will be diagnosed before they turn 50 years old.
Is There A Proposed Mechanism Of Vascular Parkinsonism
Ischemic basal ganglia or subcortical white matter lesions disrupt interconnecting fiber tracts between the basal ganglia, thalamus, and motor cortex leading to disruption of sensory-motor integration as well as descending reticular pathways to major centers of the brain stem.
Infarctions affecting basal ganglia lacunae, including the thalamus, external globus pallidus, and putamen, that extend into the caudate and internal capsule, can mimic features of idiopathic PD. The second form with subcortical white matter lesions often produces clinical features resembling the classical lower body parkinsonism and has a more relentless rather than step-wise progression.
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Causes Of Parkinson’s Disease
Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.
Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.
Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.
Whats The Difference Between Multiple System Atrophy And Parkinsons
Parkinsons and MSA both affect the movement control system and the involuntary autonomic control system and early symptoms can make a differential diagnosis a challenge. MSA, however, tends to progress faster than Parkinsons balance problems and a stooped posture happen earlier and get worse more quickly with MSA and autonomic functions such as blood pressure, heart rate, breathing, sweating, bladder function, and sexual problems are more severe in people with MSA.
For more information on multiple symptom atrophy, read this fact sheet.
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Are There Caveats Of Diagnosing Vascular Parkinsonism
The diagnostic criteria for VP as suggested by Zijlmans et al., which is widely used, were based on a study that compared the brains of 17 patients with suspected VP to those of 10 age-matched controls who had hypertension and other vascular risk factors in life, but no evidence of parkinsonism. The study observed macroscopically visible lacunar infarcts or lacunae caused by enlarged perivascular spaces which were seen in the caudate, putamen, globus pallidus, and thalamus in 11 of the parkinsonian brains, compared to only one control brain. It was also noted that the severity of microscopic small-vessel disease pathology was substantially greater in the VP cohort compared to controls.
However, there are several commonitions, worth highlighting about these observations which include the following: severity of microscopic small-vessel disease did not differ between frontal, temporal, parietal, occipital, and striatal regions and suggest lack of regional specificity 12/17 patients had nigral cell loss suggestive of underlying neurodegenerative parkinsonism and proposed VP criteria could be acute, delayed, or insidious in onset, with unilateral or bilateral parkinsonism, with or without gait impairment, and with focal or diffuse lesions, located anywhere in the parenchyma. Such imprecise clinical and neuroimaging criteria have contributed to less defined diagnostic boundaries, resulting in misrepresentation of other entities as VP.
Are There Diagnostic Criteria For Vascular Parkinsonism
Zijlmans et al. proposed possible criteria for the clinical diagnosis of VP and they are as follows:
Parkinsonism, defined as bradykinesia, and at least one of the following: rest tremor, rigidity, or postural instability
Cerebrovascular disease, defined as evidence of relevant cerebrovascular disease by brain imaging or the presence of focal signs or symptoms consistent with stroke
A relationship between and : acute or delayed progressive onset of parkinsonism 1 year after stroke with evidence of infarcts on imaging in or near areas that increase the basal ganglion motor output or decrease the thalamocortical drive directly , or an insidious onset of parkinsonism with extensive subcortical white matter lesions, bilateral symptoms at the onset, and the presence of early shuffling gait or early cognitive dysfunction.
Based on the above criteria, two forms of VP are suggested: one with acute onset, related to basal ganglia infarcts, and another one with insidious progression, possibly associated with more diffuse subcortical white matter ischemia.
Winikates and Jankovic have also suggested a two-step process in identifying VP. Step 1 involves identifying the parkinsonian syndrome and requires the presence of at least two of the four cardinal signs of parkinsonism . Step 2 involves assigning a vascular score. Two points or more are essential to diagnose VP. The points are assigned as follows:
Two points: Pathologically or angiographically proven diffuse vascular disease
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Whats The Difference Between Vascular Parkinsonism And Parkinsons
As the name implies, vascular parkinsonism is caused by cerebrovascular disease which affects the blood supply to the brain. Vascular parkinsonism is caused by one or more small strokes, while Parkinsons is caused by a gradual loss of nerve cells. One major difference from Parkinsons is that its not progressive, while Parkinsons becomes worse with time. Another difference is that there are no tremors in vascular parkinsonism.
For more information on vascular parkinsonism, read this journal article.
What Is Parkinsonism Characterized By
Parkinsonism is characterized by the loss of dopamine, a neurotransmitter that helps regulate movement.
Without dopamine, a person will experience the symptoms of bradykinesia, rigidity, and tremors that are characteristic of Parkinsonism.
The exact cause of the damage to dopamine-producing cells is unknown and likely differs from person to person.
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How Is It Diagnosed
Diagnosing vascular Parkinsonism starts with a thorough review of your current symptoms and medical history, including your family medical history. A physical examination and a review of your current medications are also necessary.
To make sure your doctor gets an accurate diagnosis, brain imaging is critical. A 2019 scholarly review article suggests that an MRI of the brain can help determine whether your symptoms are caused by vascular Parkinsonism or PD. An accurate diagnosis is an important step in getting the most effective treatment.
Other brain imaging, such as a CT scan, can also be helpful for detecting signs of small strokes in the regions of the brain responsible for movement and muscle control.
What Is Vascular Parkinsonism
Vascular Parkinsonism is a condition in which areas of the brain that control movement have been damaged due to small strokes. This results in symptoms like muscle stiffness and balance problems, which are also common in PD.
Vascular Parkinsonism is one of several types of Parkinsonism. Parkinsonisms are conditions that cause symptoms that are similar to PD but are not PD. The other main types are:
The vascular damage is often the result of small strokes that have occurred over a period of several years. PD, on the other hand, is caused by the impairment or death of brain cells that produce the chemical dopamine, which plays a critical role in regulating body movement, among other important functions.
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Multiple System Atrophy Formerly Called Shy
As predicted by the name of this parkinsonism, multiple system atrophy affects multiple systems of the body. It affects both the motor skills movement system and the involuntary system of the body. Though the symptoms can often be treated with medications, there is no cure. In addition, there are no drugs that are able to slow the progress of MSA.
Symptoms Of Atypical Parkinsonism
The symptoms of atypical parkinsonism are similar to those seen in Parkinsons disease: muscle tremors while at rest, muscle stiffness, difficulty with balance and coordination while walking, and problems with fine motor control. Symptoms may be present only in the lower body or only on one side of the body, while Parkinsons disease symptoms are usually present on both sides of the upper and lower body.
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Imaging Of Striatal Dopamine Transporters In Vp
Several studies looked at dopamine transporters in VP using -CIT single-photon emission computed tomography and FP-CIT SPECT. Gerschlager et al. reported preserved or mild reduction in the striatal -CIT and putamen/caudate ratio in 13 patients with VP when compared to 20 PD cases. On the other hand, Zijlmans et al. found that the mean striatal FP-CIT uptake was significantly lower in 13 VP patients than in healthy controls. When compared with the PD group, only the mean asymmetry index was significantly lower in VP patients. They suggested that in the majority of VP patients, the pre-synaptic dopaminergic function is reduced and they proposed using the asymmetry index as a criterion for the clinical diagnosis of VP.
Lorberboym et al. studied 20 patients who developed VP in the course of cerebrovascular disease with FP-CIT SPECT and 20 healthy controls. Nine patients had normal striatal FP-CIT binding similar to that of controls. In contrast, 11 patients had significantly diminished striatal binding when compared with controls.
It is therefore difficult to reach any firm conclusion from available studies about the role of dopamine transporter imaging in VP. The lack of uniform clinical diagnostic criteria clearly contributes to difficulties of interpretation of the results, some of which are conflicting. Further research is needed.
The Association Between Vascular Disease And Pd
The association between ischaemic stroke and vascular risk factors on the one hand and PD on the other has been addressed in several studies. The incidence of ischaemic stroke among PD patients was lower than that of controls in one study , but an association was found in another . Cigarette smoking is recognised as protective for PD and a low incidence of both smoking and myocardial infarction is seen in PD patients . A retrospective case-control study of 178 patients with newly diagnosed PD, and 533 age- and sex-matched controls showed that diabetes, history of smoking, high blood pressure, high blood cholesterol and triglycerides were significantly less frequent in PD than controls . Another study looked at the frequency of cerebrovascular lesions in 617 patients with autopsy-proven idiopathic PD and 535 age-matched controls. It found that 44.0% of PD patients had vascular lesions, more than was seen in controls , while acute, often fatal ischaemic or hemorrhagic strokes were less frequent in parkinsonian patients . The study concluded that there is neither a protective effect of PD against stroke nor a greater susceptibility to death from stroke in the populations examined .
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Whats The Difference Between Progressive Supranuclear Palsy And Parkinsons
People with PSP generally progress more rapidly than people with Parkinsons. A person with Parkinsons tends to lean forward while a person with PSP tends to lean backward. Tremors are common in people with Parkinsons and rare in people with PSP. Speech and swallowing abnormalities are more severe and show up sooner in those living with PSP.
For more information on progressive supranuclear palsy, read this fact sheet and insights from the CurePSP organization website.
What Are The Clinical Features Of Vascular Parkinsonism
VP is classically described as an entity characterized by predominant lower-body parkinsonism, postural instability, shuffling or freezing gait, absence of rest tremor, absent or poor response to dopamine, and presence of corticospinal tract signs. Gait abnormalities predominate with VP the base is not always as narrow in lower-body parkinsonism as it is in idiopathic PD and posture is unstable, with postural responses to maintain balance being poor. The occurrences of dementia, pseudobulbar palsy, and incontinence are other recognized features.
Clinical features that resemble the pattern seen in idiopathic PD have also been described as being attributable to lacunar infarcts in the basal ganglia. Although the parkinsonism is often only clinically evident on the contralateral side of the body to the brain lesion, ipsilateral clinical features have also been reported.
Diagnosis is supported by the history of prior stroke and vascular risk factors, namely hypertension, diabetes mellitus, hypercholesterolemia, or carotid stenosis.
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The Proposed Mechanisms Of Vp
Various mechanisms have been discussed as explanation for VP. Ischaemic basal ganglion or white matter lesions disrupting the sensorimotor integration have been suggested . The gait disorder in Binswangers disease was attributed to diffuse vascular lesions disrupting basal ganglia/motor cortex connections and Winikates and Jankovic proposed it as a mechanism for VP.
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Apda In Your Community
APDANewsVascular Parkinsonism in the News
George H.W. Bush, the 41st President of the United States died on November 30, 2018, at the age of 94. He was diagnosed with vascular parkinsonism in 2012 which affected his walking and caused him to require a wheelchair for his mobility over the past few years. His passing puts a spotlight on this disease, which can be confused with Parkinsons disease .
Vascular parkinsonism is a brain disorder that mimics some of the features of PD, particularly the characteristic gait and balance symptoms. Vascular parkinsonism is thought to be due to an accumulation of small strokes in the parts of the brain that control movement. Lewy bodies, the key pathological hallmark of PD, are not present in vascular parkinsonism. People with vascular parkinsonism are less likely to be responsive to Levodopa and other PD meds than people with typical PD, but some are responsive, so it is common practice to try PD meds even if vascular parkinsonism is suspected. Treatment also focuses on preventing any further strokes with management of high blood pressure, high cholesterol, and diabetes and maximizing mobility with physical therapy.
A neurologist or movement disorder specialist can identify the distinctions between these diseases in order to make the proper Parkinsons diagnosis.
Whats The Difference Between Corticobasal Degeneration And Parkinsons
The main difference between CBD and Parkinsons is that it usually starts on one side with the gradual loss of use of one hand or leg , and there may be little flicks of involuntary muscle jerks. Walking and balance difficulties usually occur later in CBD than in Parkinsons. Also, in CBD, a person may have trouble with purposeful movements, such as buttoning a shirt or cutting food.
For more information on corticobasal degeneration, read this information page.
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What Are The Symptoms Of Vascular Parkinsonism
Most of the well-known symptoms of PD are also present in vascular Parkinsonism. With vascular Parkinsonism, muscle control challenges are more concentrated in the lower body, whereas with PD, they tend to affect the entire body.
While tremors are common in people with PD, it isnt a key symptom of vascular Parkinsonism. Some people with the vascular condition experience a resting tremor, but this usually occurs later in the course of disease.
The main symptoms of vascular Parkinsonism include:
How Is Parkinsonism Diagnosed
You should be referred to a Parkinsons specialist for the diagnosis of any parkinsonism. They may wish to explore different things before giving you a diagnosis.
Your specialist will look at your medical history, ask you about your symptoms and do a medical examination.
Telling the difference between types of parkinsonism isnt always easy, for the following reasons:
- The first symptoms of the different forms of parkinsonism are so similar.
- In many cases, parkinsonism develops gradually. Symptoms that allow your doctor to make a specific diagnosis may only appear as your condition progresses.
- Everyone with parkinsonism is different and has different symptoms.
Find out more: see our information on symptoms of Parkinsons, and diagnosing Parkinsons.
One of the most useful tests to find out what sort of parkinsonism you may have is to see how you respond to treatment.
If your specialist thinks you have idiopathic Parkinsons, theyll expect you to have a good response to Parkinsons drugs such as levodopa . A good response means that your symptoms will improve. Sometimes, it will only be clear that youve responded to medication when the drug is reduced or stopped, and your symptoms become more obvious again.
If you dont have any response to Parkinsons medication, your specialist will have to look again at your diagnosis.
Although not routinely available, your specialist may wish to carry out some of the tests below.
Current tests available include:
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