Vascular Parkinsonism and cognitive impairment: literature review, Brazilian studies and case vignettes

Vale, Thiago Cardoso; Barbosa, Maira Tonidandel; Caramelli, Paulo; Cardoso, Francisco

doi:10.1590/S1980-57642012DN06030005

ABSTRACT

Vascular Parkinsonism (VP) is a form of secondary Parkinsonism resulting from cerebrovascular disease. Estimates of the frequency of VP vary greatly worldwide; 3% to 6% of all cases of Parkinsonism are found to have a vascular etiology. In a Brazilian community-based study on Parkinsonism, 15.1% of all cases were classified as VP, the third most common form, with a prevalence of 1.1% in an elderly cohort. Another Brazilian survey found a prevalence of 2.3% of VP in the elderly. VP is usually the result of conventional vascular risk factors, particularly hypertension, leading to strategic infarcts of subcortical gray matter nuclei, diffuse white matter ischaemic lesions and less commonly, large vessel infarcts. Patients with VP tend to be older and present with gait difficulties, symmetrical predominant lower-body involvement, poor levodopa responsiveness, postural instability, falls, cognitive impairment and dementia, corticospinal findings, urinary incontinence and pseudobulbar palsy. This article intends to provide physicians with an insight on the practical issues of VP, a disease potentially confounded with vascular dementia, idiopathic Parkinson's disease, dementia with Lewy bodies and other secondary causes of Parkinsonism.

Key words:
vascular parkinsonism; vascular cognitive impairment; vascular dementia; Parkinson's disease; diffuse white-matter lesions

RESUMO

Parkinsonismo vascular (VP) é a forma secundária da síndrome parkinsoniana resultante de doença cerebrovascular. Há grande variação das estimativas de frequência em estudos mundiais, sendo que em média 3% a 6% de todos os casos de parkinsonismo têm a etiologia vascular. Em um estudo brasileiro de base comunitária sobre parkinsonismo, 15,1% de todos os casos foram classificados como VP, que foi a terceira causa mais comum, com uma prevalência de 1,1% em uma coorte de idosos. Outro estudo brasileiro encontrou uma prevalência de 2,3% de VP também em idosos. VP usualmente resulta de fatores de risco vasculares como a hipertensão, levando a infartos estratégicos nos núcleos da base, lesões isquêmicas difusas da substância branca subcortical e menos comumente, infartos de grandes vasos. Os pacientes com VP geralmente são mais idosos e apresentam dificuldades para a marcha, envolvimento simétrico predominante em membros inferiores, resposta pobre à terapêutica com levodopa, instabilidade postural e quedas, comprometimento cognitivo e demência, sinais de acometimento corticoespinhal, incontinência urinária e paralisia pseudobulbar. Este artigo apresenta algumas informações práticas sobre o VP, uma condição neurológica potencialmente confundida com demência vascular, doença de Parkinson idiopática, demência com corpos de Lewy e com outras causas de parkinsonismo.

Palavras-chave:
parkinsonismo vascular; comprometimento cognitivo vascular; demência vascular; doença de Parkinson; lesões difusas de substância branca

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REFERENCES

Gupta D, Kuruvilla A. Vascular parkinsonism: what makes it different? Postgrad Med J 2011;87:829-836.
Critchley M. Arteriosclerotic parkinsonism. Brain 1929;52:23-83.
Fisher CM. Lacunes: Small, Deep Cerebral Infarcts. Neurology 1965; 15:774-784.
Critchley M. Arteriosclerotic pseudo-parkinsonism. London: Pitman Books Ltd; 1981.
Eadie MJ, Sutherland JM. Arteriosclerosis in Parkinsonism. J Neurol Neurosurg Psychiatry 1964;27:237-240.
Marttila RJ, Rinne UK. Arteriosclerosis, heredity, and some previous infections in the etiology of Parkinson's disease. A case-control study. Clin Neurol Neurosurg 1976;79:46-56.
Parkes JD, Marsden CD, Rees JE, et al. Parkinson's disease, cerebral arteriosclerosis, and senile dementia. Clinical features and response to levodopa. Q J Med 1974;43:49-61.
Thompson PD, Marsden CD. Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger's disease. Mov Disord 1987;2:1-8.
Hachinski VC, Potter P, Merskey H. Leuko-araiosis. Arch Neurol1987;44:21-23.
O'Sullivan M. Leukoaraiosis. Pract Neurol 2008;8:26-38.
FitzGerald PM, Jankovic J. Lower body parkinsonism: evidence for vascular etiology. Mov Disord 1989;4:249-260.
Winikates J, Jankovic J. Clinical correlates of vascular parkinsonism. Arch Neurol 1999;56: 98-102.
Zijlmans JC, Daniel SE, Hughes AJ, Revesz T, Lees AJ. Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord 2004;19:630-640.
de Lau LM, Giesbergen PC, de Rijk MC, Hofman A, Koudstaal PJ, Breteler MM. Incidence of parkinsonism and Parkinson disease in a general population: the Rotterdam Study. Neurology 2004;63:1240-1244.
Benito-Leon J, Bermejo-Pareja F, Rodriguez J, Molina JA, Gabriel R, Morales JM. Prevalence of PD and other types of parkinsonism in three elderly populations of central Spain. Mov Disord 2003;18:267-274.
de Rijk MC, Tzourio C, Breteler MM, et al. Prevalence of parkinsonism and Parkinson's disease in Europe: the EUROPARKINSON Collaborative Study. European Community Concerted Action on the Epidemiology of Parkinson's disease. J Neurol Neurosurg Psychiatry 1997;62:10-15.
Cardoso F, Camargos ST, Silva Junior GA. Etiology of parkinsonism in a Brazilian movement disorders clinic. Arq Neuropsiquiatr 1998;56:171-175.
Munhoz RP, Werneck LC, Teive HA. The differential diagnoses of parkinsonism: findings from a cohort of 1528 patients and a 10 years comparison in tertiary movement disorders clinics. Clin Neurol Neurosurg 2010;112:431-435.
Barbosa MT, Caramelli P, Maia DP, et al. Parkinsonism and Parkinson's disease in the elderly: a community-based survey in Brazil (the Bambui study). Mov Disord 2006;21:800-808.
Roriz-Cruz M R-CI, Prado RCP, Schuh AS, Bianchin MM, Chaves ML, Rieder CRM. Parkinsonian syndromes among the community-dwelling elderly: High prevalence of vascular parkinsonism in southern Brazil. Mov Disord 2010;25:S262-263.
van Zagten M, Lodder J, Kessels F. Gait disorder and parkinsonian signs in patients with stroke related to small deep infarcts and white matter lesions. Mov Disord 1998;13:89-95.
Chang CM, Yu YL, Ng HK, Leung SY, Fong KY. Vascular pseudoparkinsonism. Acta Neurol Scand 1992;86:588-592.
Zijlmans JC, Thijssen HO, Vogels OJ, et al. MRI in patients with suspected vascular parkinsonism. Neurology 1995;45:2183-2188.
Piccini P, Pavese N, Canapicchi R, et al. White matter hyperintensities in Parkinson's disease. Clinical correlations. Arch Neurol 1995;52:191-194.
Murrow RW, Schweiger GD, Kepes JJ, Koller WC. Parkinsonism due to a basal ganglia lacunar state: clinicopathologic correlation. Neurology 1990;40:897-900.
Yamanouchi H, Nagura H. Neurological signs and frontal white matter lesions in vascular parkinsonism. A clinicopathologic study. Stroke 1997;28:965-969.
Awad IA, Spetzler RF, Hodak JA, Awad CA, Carey R. Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. Stroke 1986;17:1084-1089.
Hughes AJ, Daniel SE, Blankson S, Lees AJ. A clinicopathologic study of 100 cases of Parkinson's disease. Arch Neurol 1993;50:140-148.
Fenelon G, Houeto JL. [Vascular Parkinson syndromes: a controversial concept]. Rev Neurol (Paris) 1998;154:291-302.
Bohnen NI, Albin RL. White matter lesions in Parkinson disease. Nat Rev Neurol 2011;7:229-236.
Baloh RW, Yue Q, Socotch TM, Jacobson KM. White matter lesions and disequilibrium in older people. I. Case-control comparison. Arch Neurol 1995;52:970-974.
Baezner H, Blahak C, Poggesi A, et al. Association of gait and balance disorders with age-related white matter changes: the LADIS study. Neurology 2008;70:935-942.
Lee SJ, Kim JS, Lee KS, et al. The severity of leukoaraiosis correlates with the clinical phenotype of Parkinson's disease. Arch Gerontol Geriatr 2009;49:255-259.
Slawek J, Wieczorek D, Derejko M, et al. The influence of vascular risk factors and white matter hyperintensities on the degree of cognitive impairment in Parkinson's disease. Neurol Neurochir Pol 2008;42:505-512.
Stern MB, Braffman BH, Skolnick BE, Hurtig HI, Grossman RI. Magnetic resonance imaging in Parkinson's disease and parkinsonian syndromes. Neurology 1989;39:1524-1526.
Zijlmans J, Evans A, Fontes F, et al. [123I] FP-CIT spect study in vascular parkinsonism and Parkinson's disease. Mov Disord 2007;22:1278-1285.
Lee SJ, Kim JS, Yoo JY, et al. Influence of white matter hyperintensities on the cognition of patients with Parkinson disease. Alzheimer Dis Assoc Disord 2010;24:227-233.
Rektor I, Rektorova I, Kubova D. Vascular parkinsonism--an update. J Neurol Sci 2006;248:185-191.
Inzelberg R, Bornstein NM, Reider I, Korczyn AD. Basal ganglia lacunes and parkinsonism. Neuroepidemiology 1994;13:108-112.
Antonini A, Vitale C, Barone P, et al. The relationship between cerebral vascular disease and parkinsonism: The VADO study. Parkinsonism Relat Disord 2012;18:775-780.
Colosimo C, Morgante L, Antonini A, et al. Non-motor symptoms in atypical and secondary parkinsonism: the PRIAMO study. J Neurol 2010;257:5-14.
Demirkiran M, Bozdemir H, Sarica Y. Vascular parkinsonism: a distinct, heterogeneous clinical entity. Acta Neurol Scand 2001;104:63-67.
Kalra S, Grosset DG, Benamer HT. Differentiating vascular parkinsonism from idiopathic Parkinson's disease: a systematic review. Mov Disord 2010;25:149-156.
Stenc Bradvica I, Janculjak D, Butkovic-Soldo S, Vladetic M. Cognitive dysfunction in idiopathic and vascular parkinsonism. Med Glas Ljek komore Zenicko-doboj kantona 2011;8:209-215.
Santangelo G, Vitale C, Trojano L, et al. Differential neuropsychological profiles in Parkinsonian patients with or without vascular lesions. Mov Disord 2010;25:50-56.
Rampello L, Alvano A, Battaglia G, Raffaele R, Vecchio I, Malaguarnera M. Different clinical and evolutional patterns in late idiopathic and vascular parkinsonism. J Neurol 2005;252:1045-1049.
Choi SM, Kim BC, Nam TS, et al. Midbrain atrophy in vascular Parkinsonism. Eur Neurol 2011;65:296-301.
Tzen KY, Lu CS, Yen TC, Wey SP, Ting G. Differential diagnosis of Parkinson's disease and vascular parkinsonism by (99m)Tc-TRODAT-1. J Nucl Med 2001;42:408-413.
Gerschlager W, Bencsits G, Pirker W, et al. [123I]beta-CIT SPECT distinguishes vascular parkinsonism from Parkinson's disease. Mov Disord 2002;17:518-523.
Contrafatto D, Mostile G, Nicoletti A, et al. [(123) I]FP-CIT-SPECT asymmetry index to differentiate Parkinson's disease from vascular parkinsonism. Acta Neurol Scand 2012;126:12-16.
Kagi G, Bhatia KP, Tolosa E. The role of DAT-SPECT in movement disorders. J Neurol Neurosurg Psychiatry 2010;81:5-12.
Zijlmans JC, Katzenschlager R, Daniel SE, Lees AJ. The L-dopa response in vascular parkinsonism. J Neurol Neurosurg Psychiatry 2004; 75:545-547.

Publication Dates

Publication in this collection
Jul-Sep 2012

History

Received
13 Feb 2012
Accepted
20 May 2012

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Gupta D, Kuruvilla A. Vascular parkinsonism: what makes it different? Postgrad Med J 2011;87:829-836.

[2] Critchley M. Arteriosclerotic parkinsonism. Brain 1929;52:23-83.

[3] Fisher CM. Lacunes: Small, Deep Cerebral Infarcts. Neurology 1965; 15:774-784.

[4] Critchley M. Arteriosclerotic pseudo-parkinsonism. London: Pitman Books Ltd; 1981.

[5] Eadie MJ, Sutherland JM. Arteriosclerosis in Parkinsonism. J Neurol Neurosurg Psychiatry 1964;27:237-240.

[6] Marttila RJ, Rinne UK. Arteriosclerosis, heredity, and some previous infections in the etiology of Parkinson's disease. A case-control study. Clin Neurol Neurosurg 1976;79:46-56.

[7] Parkes JD, Marsden CD, Rees JE, et al. Parkinson's disease, cerebral arteriosclerosis, and senile dementia. Clinical features and response to levodopa. Q J Med 1974;43:49-61.

[8] Thompson PD, Marsden CD. Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger's disease. Mov Disord 1987;2:1-8.

[9] Hachinski VC, Potter P, Merskey H. Leuko-araiosis. Arch Neurol1987;44:21-23.

[10] O'Sullivan M. Leukoaraiosis. Pract Neurol 2008;8:26-38.

[11] FitzGerald PM, Jankovic J. Lower body parkinsonism: evidence for vascular etiology. Mov Disord 1989;4:249-260.

[12] Winikates J, Jankovic J. Clinical correlates of vascular parkinsonism. Arch Neurol 1999;56: 98-102.

[13] Zijlmans JC, Daniel SE, Hughes AJ, Revesz T, Lees AJ. Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord 2004;19:630-640.

[14] de Lau LM, Giesbergen PC, de Rijk MC, Hofman A, Koudstaal PJ, Breteler MM. Incidence of parkinsonism and Parkinson disease in a general population: the Rotterdam Study. Neurology 2004;63:1240-1244.

[15] Benito-Leon J, Bermejo-Pareja F, Rodriguez J, Molina JA, Gabriel R, Morales JM. Prevalence of PD and other types of parkinsonism in three elderly populations of central Spain. Mov Disord 2003;18:267-274.

[16] de Rijk MC, Tzourio C, Breteler MM, et al. Prevalence of parkinsonism and Parkinson's disease in Europe: the EUROPARKINSON Collaborative Study. European Community Concerted Action on the Epidemiology of Parkinson's disease. J Neurol Neurosurg Psychiatry 1997;62:10-15.

[17] Cardoso F, Camargos ST, Silva Junior GA. Etiology of parkinsonism in a Brazilian movement disorders clinic. Arq Neuropsiquiatr 1998;56:171-175.

[18] Munhoz RP, Werneck LC, Teive HA. The differential diagnoses of parkinsonism: findings from a cohort of 1528 patients and a 10 years comparison in tertiary movement disorders clinics. Clin Neurol Neurosurg 2010;112:431-435.

[19] Barbosa MT, Caramelli P, Maia DP, et al. Parkinsonism and Parkinson's disease in the elderly: a community-based survey in Brazil (the Bambui study). Mov Disord 2006;21:800-808.

[20] Roriz-Cruz M R-CI, Prado RCP, Schuh AS, Bianchin MM, Chaves ML, Rieder CRM. Parkinsonian syndromes among the community-dwelling elderly: High prevalence of vascular parkinsonism in southern Brazil. Mov Disord 2010;25:S262-263.

[21] van Zagten M, Lodder J, Kessels F. Gait disorder and parkinsonian signs in patients with stroke related to small deep infarcts and white matter lesions. Mov Disord 1998;13:89-95.

[22] Chang CM, Yu YL, Ng HK, Leung SY, Fong KY. Vascular pseudoparkinsonism. Acta Neurol Scand 1992;86:588-592.

[23] Zijlmans JC, Thijssen HO, Vogels OJ, et al. MRI in patients with suspected vascular parkinsonism. Neurology 1995;45:2183-2188.

[24] Piccini P, Pavese N, Canapicchi R, et al. White matter hyperintensities in Parkinson's disease. Clinical correlations. Arch Neurol 1995;52:191-194.

[25] Murrow RW, Schweiger GD, Kepes JJ, Koller WC. Parkinsonism due to a basal ganglia lacunar state: clinicopathologic correlation. Neurology 1990;40:897-900.

[26] Yamanouchi H, Nagura H. Neurological signs and frontal white matter lesions in vascular parkinsonism. A clinicopathologic study. Stroke 1997;28:965-969.

[27] Awad IA, Spetzler RF, Hodak JA, Awad CA, Carey R. Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. Stroke 1986;17:1084-1089.

[28] Hughes AJ, Daniel SE, Blankson S, Lees AJ. A clinicopathologic study of 100 cases of Parkinson's disease. Arch Neurol 1993;50:140-148.

[29] Fenelon G, Houeto JL. [Vascular Parkinson syndromes: a controversial concept]. Rev Neurol (Paris) 1998;154:291-302.

[30] Bohnen NI, Albin RL. White matter lesions in Parkinson disease. Nat Rev Neurol 2011;7:229-236.

[31] Baloh RW, Yue Q, Socotch TM, Jacobson KM. White matter lesions and disequilibrium in older people. I. Case-control comparison. Arch Neurol 1995;52:970-974.

[32] Baezner H, Blahak C, Poggesi A, et al. Association of gait and balance disorders with age-related white matter changes: the LADIS study. Neurology 2008;70:935-942.

[33] Lee SJ, Kim JS, Lee KS, et al. The severity of leukoaraiosis correlates with the clinical phenotype of Parkinson's disease. Arch Gerontol Geriatr 2009;49:255-259.

[34] Slawek J, Wieczorek D, Derejko M, et al. The influence of vascular risk factors and white matter hyperintensities on the degree of cognitive impairment in Parkinson's disease. Neurol Neurochir Pol 2008;42:505-512.

[35] Stern MB, Braffman BH, Skolnick BE, Hurtig HI, Grossman RI. Magnetic resonance imaging in Parkinson's disease and parkinsonian syndromes. Neurology 1989;39:1524-1526.

[36] Zijlmans J, Evans A, Fontes F, et al. [123I] FP-CIT spect study in vascular parkinsonism and Parkinson's disease. Mov Disord 2007;22:1278-1285.

[37] Lee SJ, Kim JS, Yoo JY, et al. Influence of white matter hyperintensities on the cognition of patients with Parkinson disease. Alzheimer Dis Assoc Disord 2010;24:227-233.

[38] Rektor I, Rektorova I, Kubova D. Vascular parkinsonism--an update. J Neurol Sci 2006;248:185-191.

[39] Inzelberg R, Bornstein NM, Reider I, Korczyn AD. Basal ganglia lacunes and parkinsonism. Neuroepidemiology 1994;13:108-112.

[40] Antonini A, Vitale C, Barone P, et al. The relationship between cerebral vascular disease and parkinsonism: The VADO study. Parkinsonism Relat Disord 2012;18:775-780.

[41] Colosimo C, Morgante L, Antonini A, et al. Non-motor symptoms in atypical and secondary parkinsonism: the PRIAMO study. J Neurol 2010;257:5-14.

[42] Demirkiran M, Bozdemir H, Sarica Y. Vascular parkinsonism: a distinct, heterogeneous clinical entity. Acta Neurol Scand 2001;104:63-67.

[43] Kalra S, Grosset DG, Benamer HT. Differentiating vascular parkinsonism from idiopathic Parkinson's disease: a systematic review. Mov Disord 2010;25:149-156.

[44] Stenc Bradvica I, Janculjak D, Butkovic-Soldo S, Vladetic M. Cognitive dysfunction in idiopathic and vascular parkinsonism. Med Glas Ljek komore Zenicko-doboj kantona 2011;8:209-215.

[45] Santangelo G, Vitale C, Trojano L, et al. Differential neuropsychological profiles in Parkinsonian patients with or without vascular lesions. Mov Disord 2010;25:50-56.

[46] Rampello L, Alvano A, Battaglia G, Raffaele R, Vecchio I, Malaguarnera M. Different clinical and evolutional patterns in late idiopathic and vascular parkinsonism. J Neurol 2005;252:1045-1049.

[47] Choi SM, Kim BC, Nam TS, et al. Midbrain atrophy in vascular Parkinsonism. Eur Neurol 2011;65:296-301.

[48] Tzen KY, Lu CS, Yen TC, Wey SP, Ting G. Differential diagnosis of Parkinson's disease and vascular parkinsonism by (99m)Tc-TRODAT-1. J Nucl Med 2001;42:408-413.

[49] Gerschlager W, Bencsits G, Pirker W, et al. [123I]beta-CIT SPECT distinguishes vascular parkinsonism from Parkinson's disease. Mov Disord 2002;17:518-523.

[50] Contrafatto D, Mostile G, Nicoletti A, et al. [(123) I]FP-CIT-SPECT asymmetry index to differentiate Parkinson's disease from vascular parkinsonism. Acta Neurol Scand 2012;126:12-16.

[51] Kagi G, Bhatia KP, Tolosa E. The role of DAT-SPECT in movement disorders. J Neurol Neurosurg Psychiatry 2010;81:5-12.

[52] Zijlmans JC, Katzenschlager R, Daniel SE, Lees AJ. The L-dopa response in vascular parkinsonism. J Neurol Neurosurg Psychiatry 2004; 75:545-547.

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