With the recent passing of former President George H.W. Bush, whose cause of death was listed as “vascular parkinsonism”, many of my fighters are asking me, “What Is Vascular Parkinson’s?”
Vascular (or “multi-infarct”) Parkinson’s is a form of “atypical parkinsonism” in which Parkinson’s symptoms (slow movements, tremor, difficulty with walking and balance, stiffness, and rigidity) are produced by one or more small strokes, rather than by a gradual loss of nerve cells as seen in the more typical neurodegenerative Parkinson’s disease. Typical Parkinson’s is usually considered idiopathic or of unknown cause.
Diagnosis
Patients with vascular parkinsonism might have the same symptoms as those with typical Parkinson’s disease, although it often involves mostly the lower part of the body, along with the other characteristic findings. There may also be additional residual signs and symptoms from previous strokes, such as limb weakness, numbness, abnormal reflexes, or abnormal speech. CT and MRI scans of the brain are likely to be abnormal in 90 to 100 percent of people with vascular parkinsonism, often showing multiple small strokes in the deep portions of the brain.
Cause
There are many causes of vascular parkinsonism. By definition, a stroke is the loss of a distinct area of the brain (lesion) because of blockage of a blood vessel supplying blood to that brain region. The blockage of the blood vessel is usually caused by either:
- Thickening of the vessel wall due to uncontrolled high blood pressure.
- Build-up of fatty material in the walls of an artery “atherosclerosis”.
- Sudden lodging in the blood vessel of a clot which broke off from the inner lining of another blood vessel or the heart.
Stroke is similar to a heart attack; both are caused by a blocked blood vessel. When one or more strokes occur in the basal ganglia of one side of the brain, the patient can develop symptoms of parkinsonism on the opposite side of the body. If there are strokes affecting the basal ganglia on both sides of the brain, the patient can develop parkinsonism on both sides of the body.
Because strokes generally happen suddenly, the onset of symptoms can come on very quickly. Patients may have had several strokes in the past, but will not produce parkinsonism. However, when the strokes affect the basal ganglia, parkinsonism can result. Because each stroke is small, the symptoms may progress gradually and may resemble the progression of typical Parkinson’s disease, occasionally leading to misdiagnosis.
Treatment
Vascular parkinsonism does not respond well to the typical medications used to treat Parkinson’s disease. The treatment of vascular parkinsonism focuses on trying to lower the chance of having additional strokes in the future to control “stroke risk factors.” These “stroke risk factors” are essentially the same ones which are associated with increased risk of heart attack. They include smoking, high blood pressure, diabetes mellitus, high cholesterol, obesity, a sedentary lifestyle, and family history.
Resources:
Benamer HT, Grosset DG. Vascular parkinsonism: a clinical review. Eur Neurol. 2009;61(1):11-5.
Demirkiran M, Bozdemir H, Sarica Y. Vascular parkinsonism: a distinct, heterogeneous clinical entity. Acta Neurol Scand. 2001 Aug;104(2):63-7.
Kalra S, Grosset DG, Benamer HS. Differentiating vascular parkinsonism from idiopathic Parkinson’s disease: A systematic review. Mov Disord. 2010 Jan 30;25(2):149-56.
Korczyn AD. Vascular parkinsonism–characteristics, pathogenesis and treatment. Nat Rev Neurol. 2015 Jun;11(6):319-26.