What Is Vascular Parkinson’s Disease

By Jasmine S

September 16, 2021

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Whats The Difference Between Dementia With Lewy Bodies And Parkinsons

Vascular Parkinsonism

In dementia with Lewy bodies, dementia always appears first. There can also be changes in alertness as well as visual hallucinations. However, because of the presence of Lewy bodies throughout the entire brain, characteristics of this disease not only include cognitive characteristics, but also physical, sleep, and behavioral changes. As the disease progresses, the motor symptoms common to Parkinsons such as tremor, slowness, stiffness, and walking and balance problems will appear.

For more information on dementia with Lewy bodies, visit www.lbda.org.

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.

How Parkinsonism Differs From Parkinsons Disease

Parkinsons disease is one of many types of parkinsonism. Its caused by a loss of cells in the part of your brain that produces the neurotransmitter dopamine.

Parkinsons disease and the different types of parkinsonism progress in different ways. Some may progress more rapidly than Parkinsons disease. Others, like secondary parkinsonism, may be reversible.

The conditions also respond differently to treatments. For instance, someone who has a type of parkinsonism may not respond to the drug levodopa, which is commonly used for Parkinsons disease.

It can be hard to tell the difference between types of parkinsonism. Heres a look at some of the identified categories of parkinsonism with their typical symptoms and treatments.

involuntary muscle contractions

Treatment

No treatment has been found to slow the progression of corticobasal syndrome. Parkinsons drugs are generally ineffective but may help manage stiffness in some people.

Diet Advice Parkinsons Disease

Some people with Parkinsons disease may experience constipation . This are improving by increasing the amount of fiber in your diet and making sure you drink enough water. The natural fiber is present in fruits, vegetables, and grains. You should drink six to eight glasses of water every day.

Another common problem is orthostatic or postural hypotension. This is low blood pressure causes by changing body posture, especially after standing up on ones own. If you have orthostatic hypotension, your doctor may advise you to increase the amount of salt and water in your diet.

Observing the following also helps with hypotension:
Avoiding Caffeine Consumption in the Evening
Eating small, frequent meals instead of large amounts
Abstaining from alcohol
About 50% of people with Parkinsons disease experience unintentional weight loss. Your doctor may refer you to a dietician .

Treatment Of Vascular Parkinsonism

The most commonly used medications for vascular Parkinsonism are L-dopa and amantadine. However, some people with Parkinsonism do not experience significant improvement with medication. Some stroke survivors who have vascular Parkinsonism can experience better muscle control with physical therapy. Often, safety measures need to be taken to avoid falls.

If you have already had recurrent strokes resulting in vascular Parkinsonism, you may be at risk of experiencing more strokes over the coming years if no action is taken to reduce your risk. Therefore, if you have been diagnosed with vascular Parkinsonism, it is particularly important to follow up with your doctor in order to prevent additional strokes. You should expect to have testing for stroke risk factors and medical treatment to reduce your risk of stroke.

There are also a number of lifestyle factors that can help reduce stroke risk, such as getting regular moderate exercise and quitting smoking if you smoke. Eating a healthy diet is also important.

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Whats The Difference Between Drug

Parkinsons is a progressive disorder, which will become worse over time, while DIP does not. In DIP, Parkinson-like symptoms can begin within four days to one month of starting the medication. However, all the symptoms could completely subside once the effecting medication is stopped, though it may take up to 18 months for all the symptoms to subside.

For more information on drug-induced parkinsonism, read this journal article and/or information sheet.

Parkinson’s Disease And Parkinsonism

There is also another similar disease called Parkinsonism, which is a condition in which people have some of the symptoms of Parkinson’s disease, but do not have Parkinson’s disease itself. Parkinsonism occurs when one or more of the regions of the brain that are responsible for Parkinson’s disease become damaged.

One of the early symptoms of Parkinson’s disease is a loss of the sense of smell, which can happen years before other symptoms appear. The symptoms of Parkinson’s disease and Parkinsonism also include a fine tremor, which is very noticeable in the hands and arms and happens when the hands and arms are at rest.

Beyond loss of sense of smell and tremor, Parkinson’s is associated with several other physical symptoms, including slowness of movement , rigidity and postural instability. These symptoms can make walking or generally moving around extremely difficult and can lead to abnormal body posture. Additionally, people who have Parkinson’s disease or Parkinsonism often have very little facial expression, which is typically called a “masked face.”

The areas of the brain involved in Parkinson’s disease and Parkinsonism are called the substantia nigra and the basal ganglia. Parkinson’s disease is normally caused by slowly progressive degeneration of these two areas, which control the rhythm and smoothness of our movements and the tone of our muscles. As the substantia nigra and the basal ganglia degenerate, the typical symptoms of Parkinson’s disease begin to emerge.

What Are The Different Forms Of Parkinsonism

There are three main forms of parkinsonism, as well as other related conditions.

Most people with parkinsonism have idiopathic Parkinsons disease, also known as Parkinsons. Idiopathic means the cause is unknown.

The most common symptoms of idiopathic Parkinsons are tremor, rigidity and slowness of movement.

Vascular parkinsonism affects people with restricted blood supply to the brain.;Sometimes people who have had a mild stroke may develop this form of parkinsonism.

Common symptoms include problems with memory, sleep, mood and movement.

Some drugs can cause parkinsonism.

Neuroleptic drugs , which block the action of the chemical dopamine in the brain, are thought to be the biggest cause of drug-induced parkinsonism.

The symptoms of drug-induced parkinsonism tend to stay the same only in rare cases do they progress in the way that Parkinsons symptoms do.

Drug-induced parkinsonism only affects a small number of people, and most will recover within months and often within days or weeks of stopping the drug thats causing it.

Are There Caveats Of Diagnosing Vascular Parkinsonism

Ask the MD: Is parkinsonism the same as Parkinson’s disease?

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.

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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:

What Doctors Look For When Diagnosing Parkinsons

Certain physical signs and symptoms noticed by the patient or his or her loved ones are usually what prompt a person to see the doctor. These are the symptoms most often noticed by patients or their families:

Shaking or;tremor: Called resting tremor, a trembling of a hand or foot that happens when the patient is at rest and typically stops when he or she is active or moving
Bradykinesia: Slowness of movement in the limbs, face, walking or overall body
Rigidity: Stiffness in the arms, legs or;trunk
Posture instability: Trouble with balance and possible falls

Once the patient is at the doctors office, the physician:

Takes a medical history and does a physical examination.
Asks about current and past medications. Some medications may cause symptoms that mimic Parkinsons disease.
Performs a neurological examination, testing agility, muscle tone, gait and balance.

Also Check: How Do People Get Parkinsons Disease

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Learn More About Parkinsons Disease

Parkinsons Disease: The Essentials

If youre new to Parkinsons disease and would like a good overview to help you better understand the disease, please view our Parkinsons Disease: The Essentials presentation. Its a great place to get started with reliable and concise information.

Causes

The exact cause of Parkinsons is still unknown, but there is an enormous amount of research being done to learn more. This research has led scientists to formulate a number of theories on the cause of this disease.

Diagnosing

While there is no definitive test that can be taken to determine whether a person has Parkinsons disease, movement disorder specialists look for symptoms and use brain imaging technology to accurately diagnose Parkinsons.

Symptoms

Even though Parkinsons is classified as a movement disorderand its motor symptoms are the most discussed and well-knownthere are many non-motor symptoms that display in people with Parkinsons as well.

Treatments

As of today, there is no cure for Parkinsons disease. But there are many ways in which the disease can be treated to make symptoms more manageable.

Living With Parkinsons

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.

The Role Of Mri And Datscan In Vascular Parkinsonism: A Case Report

A. Tran, M. Amin, R. Burns

Location: Exhibit Hall C

Objective: The role;of MRI and DAT scan in Vascular Parkinsonism: A Case Report

Background: DaTscan has become a widely used clinical tool to help clinicians with challenging diagnoses. DaTscan can help distinguish idiopathic Parkinson Disease from secondary forms of Parkinsonism such as vascular Parkinsonism .; The integrity of the nigrostriatal dopamine pathway can be assessed using single photon emission computed tomography with dopamine transporter radioligands. DaTscan would be abnormal in PD and normal in VD.; While a meta-analysis by Brigo showed high sensitivity and specificity in differentiating PD and VD using DaTscan,;reliance on DaTscan alone may be misleading in certain cases.

Methods: Case study

: Although DaTscan has been shown to have high sensitivity and specificity by many studies, the test has limitations because in most studies the gold standard used is the clinical diagnosis made by a movement disorders neurologist and not a neuropathological confirmation.;;;Therefore, the true diagnosis is unknown; false positive or false negative scans can occur, which ;highlights the needs for integration of various clinical findings and imaging tools . This case illustrates an abnormal DaTscan in a patient with VD.;;

References: Brigo F, et al. FP-CIT SPECT may be a useful tool to differentiate between Parkinsons disease and vascular or drug-induced parkinsonisms: A meta-analysis. Eur J Neurol 2014;21:1369-1376.

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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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.

Environmental Factors And Exposures

Ask the MD Is parkinsonism the same as Parkinson’s disease

Exposure to pesticides and a history of head injury have each been linked with PD, but the risks are modest. Never drinking caffeinated beverages, are also associated with small increases in risk of developing PD. Although smokers are at a reduced risk of developing PD, tobacco smoking has overwhelmingly negative effects on health and as many as half of people who use tobacco die from complications of tobacco use.

Low concentrations of urate in the blood is associated with an increased risk of PD.

Drug-induced parkinsonism

Different medical drugs have been implicated in cases of parkinsonism. Drug-induced parkinsonism is normally reversible by stopping the offending agent. Drugs include:

Phenothiazines

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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.

Apda In Your Community

APDA NewsVascular 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.

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Living With Parkinsons Disease

As Parkinsons develops, a person who has it may slow down and wont be able to move or talk quickly. Sometimes, speech therapy and occupational therapy are needed. This may sound silly, but someone who has Parkinsons disease may need to learn how to fall down safely.

If getting dressed is hard for a person with Parkinsons, clothing with Velcro and elastic can be easier to use than buttons and zippers. The person also might need to have railings installed around the house to prevent falls.

If you know someone who has Parkinsons disease, you can help by being a good friend.

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It Mimics Parkinsons Disease But Is A Very Different Condition

Former President George H.W. Bush went skydiving to celebrate his 85th birthday in 2009. Less than three years later, his son Jeb revealed that he was confined to a wheelchair .;

The reason? AParkinsons disease-like condition known as vascular parkinsonism . The movement issues from VP are caused by small strokes in a section of the brain called the basal ganglia, which controls movement, among other functions.;

VP versus Parkinsons; While the two conditions share a number of symptoms, there are important differences. Parkinsons typically progresses gradually, but becausestrokes can happen suddenly, VP can appear or worsen suddenly. VP most often affects the lower body. There may be other signs of stroke with VP, such as slurred speech or cognitive impairment, and sometimes incontinence.;

Risk factors; Because VP is essentially a series of strokes, risk factors for VP are the same asrisk factors for stroke. They include:;

Older age;
Obesity;

Diagnosis and treatment of VP; Both Parkinsons and VP can be difficult to diagnose, as there areno blood testsfor either. However, unlike Parkinsons, evidence of VP can often be detected by an imaging test like a CT scan or MRI. Abnormal brain scans are present in nearly all VP cases, and will often show evidence of multiple small strokes in the basal ganglia.;

Image credit:;Ytoyoda, Wikimedia Commons;