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Vascular Parkinsonism Explained

Posted on July 06, 2022
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Andrew J. Funk, DC, DACNB

Vascular parkinsonism is a movement disorder and a type of atypical parkinsonism. Some of the symptoms are similar to those of Parkinson’s disease, but vascular parkinsonism is a separate condition.

Vascular parkinsonism usually affects people over the age of 70, and it affects men more often than women. It comprises around 4 percent to 12 percent of all parkinsonism cases. Scientists believe that one or more small strokes in the brain regions that manage body movement are responsible for causing vascular parkinsonism.

Despite vascular parkinsonism resembling Parkinson’s disease and some other types of atypical parkinsonism, the condition shows distinct signs and symptoms, which is why it stands out as a separate brain disorder.

“I have recently been diagnosed with vascular parkinsonism, which differs from Parkinson’s disease,” one MyParkinsonsTeam member wrote. Another said, “I was misdiagnosed with Parkinson’s disease — it turned out to be vascular parkinsonism.”

A neurologist, or another type of movement-disorder specialist, diagnoses vascular parkinsonism using an exam and a brain scan. Treatment for vascular parkinsonism involves stroke prevention, physical therapy, exercise, and sometimes medication.

Signs and Symptoms of Vascular Parkinsonism

Several signs and symptoms separate vascular parkinsonism from Parkinson’s disease and the other parkinsonian syndromes such as progressive supranuclear palsy, dementia with Lewy bodies, and multiple system atrophy.

The clinical features of vascular parkinsonism usually come on quickly and without warning. They typically include a combination of the following symptoms:

  • Wide-based slow walking with short steps and hesitations
  • Postural instability, or difficulty in keeping your balance while upright
  • Muscle tightness or spasticity, particularly in the legs
  • Muscle stiffness or rigidity, especially of the lower extremities
  • Pseudobulbar palsy, which results in difficulty with speech, trouble swallowing, tongue and face weakness, and regulating laughter and crying
  • Incontinence, or difficulty in controlling one’s bowels and/or bladder
  • Loss of memory, difficulty thinking clearly, or other cognitive impairments

Diagnosing Vascular Parkinsonism

Either a neurologist or a health care provider specializing in movement disorders typically diagnoses vascular parkinsonism. During the exam, they will check for and ask about the signs and symptoms you’re experiencing. If the exam points them toward vascular parkinsonism, they’ll also order brain imaging such as MRI or a CT scan.

In 90 percent to 100 percent of vascular parkinsonism cases, your health care team will see abnormalities on the MRI or CT scans. This can often mean they visualize small strokes in deeper brain areas, leading them to suspect a vascular parkinsonism diagnosis.

What Causes Vascular Parkinsonism?

The direct cause of vascular parkinsonism is usually multiple small strokes and/or white-matter lesions in the brain. However, there are several risk factors linked to vascular disease, which can later lead to developing vascular parkinsonism:

  • High blood pressure (hypertension)
  • Dyslipidemia (unhealthy levels of either cholesterol or triglycerides)
  • Heart disease
  • Diabetes
  • Sleep apnea
  • Smoking

How Does Vascular Parkinsonism Differ From Parkinson’s Disease?

Several differences distinguish Parkinson’s disease from vascular parkinsonism. Vascular parkinsonism occurs due to small strokes, affecting blood flow to the brain. In addition, Parkinson’s disease is progressive, which means it gets worse as time passes. Vascular parkinsonism, however, is not a progressive disease.

“Vascular parkinson’s is not Parkinson’s,” one MyParkinsonsTeam member wrote. “It only mimics and shows symptoms that are much like Parkinson’s. Basically, it is caused by small strokes.”

Vascular parkinsonism also differs from Parkinson’s disease in the following ways:

  • Vascular parkinsonism involves the lower body more often than Parkinson’s disease does.
  • People with vascular parkinsonism often have worse imbalance and more falls than those with Parkinson’s disease.
  • Vascular parkinsonism looks similar on both sides of the body more often than Parkinson’s disease.
  • Spasticity is more common in vascular parkinsonism than in Parkinson’s disease.
  • Pseudobulbar signs occur more often in vascular parkinsonism.
  • People with vascular parkinsonism have bladder incontinence more commonly than those with Parkinson’s disease.
  • Cognitive impairment is more common in people with vascular parkinsonism.
  • Levodopa is much less effective for vascular parkinsonism than for Parkinson’s disease. Those with vascular parkinsonism have a positive response to levodopa only about 30 percent of the time.

Treatments for Vascular Parkinsonism

Your health care team will work with you to create a treatment plan for addressing your vascular parkinsonism. The plan may include stroke prevention strategies, physical therapy, exercise, and sometimes medication.

Because small strokes lead to vascular parkinsonism, it is important to decrease the risk of further strokes by lowering high blood pressure, improving dyslipidemia, managing diabetes, and stopping smoking.

Physical therapy can help people with vascular parkinsonism lower their risk of falling. The therapy may include balance training and learning to use of canes and walkers to maintain steadiness while walking around. “I can’t walk very well owing to my vascular parkinsonism, so I use my mobility scooter,” one MyParkinsonsTeam member wrote.

Regular exercise can also help you reduce the chance of having another stroke. Moderate aerobic exercise helps to lower risk factors for stroke by decreasing inflammation in the body.

Although medication may not always help in managing vascular parkinsonism, levodopa may improve slowness of movement and muscle stiffness associated with the condition. Doctors will often prescribe a trial of levodopa to see if it can help improve symptoms of vascular parkinsonism.

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinson’s disease and their loved ones. On MyParkinsonsTeam, more than 88,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s disease.

Have you or a loved one been diagnosed with vascular parkinsonism? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Andrew J. Funk, DC, DACNB has held board certification in neurology with the American Chiropractic Neurology Board since 2015. Learn more about him here.

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