Clinical correlates of vascular parkinsonism

Background: Parkinsonism may be due to other causes besides Parkinson disease (PD). Vascular parkinsonism (VP) has not been well defined and the clinical correlates of VP have not been clarified. Objectives: To seek evidence for or against the role of cerebrovascular disease in parkinsonism, and to identify clinical features that suggest a vascular origin. Design: Retrospective chart review of patients with parkinsonism. A vascular rating scale was used to identify 2 patient groups, 1 with strong evidence of cerebrovascular disease (VP), and 1 with idiopathic PD. Clinical features of parkinsonism were then compared between the 2 patient groups. Setting: A Movement Disorders Clinic, Baylor College of Medicine, Houston, Tex, a tertiary referral center. Patients: Three hundred forty-six patients, 69 with VP and 277 with PD. Results: The VP and PD groups were clearly differentiated in terms of evidence of cerebrovascular disease (P<.001 to P<.00001). Patients with VP were order, more likely to present with gait difficulty rather than tremor, and less likely to respond to the use of levodopa compared with patients with PD (P<.00001). Patients with VP were also significantly more likely to have predominant lower body involvement, postural instability, a history of falling, dementia, corticospinal findings, incontinence (P<.00001), and pseudobulbar effect (P<.05). Conclusions: These differences in clinical features suggest a different pathogenesis of parkinsonism in these 2 patient groups. The strong evidence of cerebrovascular disease in the VP group and the differences in clinical features support the concept of VP as a distinct clinical entity. We conclude that compared with PD, patients with parkinsonism associated with vascular disease are more likely to present with gait difficulty and postural instability rather than tremor, have a history of stroke and risk factors for stroke? and fail to respond to levodopa therapy.