What Is Vascular Parkinsonism?

Parkinson’s disease (PD) is a disorder that affects muscle movement. It is caused by damage to certain areas of the brain. Symptoms of PD include muscle tremors, slowness, and difficulty walking. These symptoms can show up in other disorders. When this happens, it is called ‘parkinsonism.”¹

Vascular parkinsonism (VP) is one of these disorders. It accounts for anywhere from 4 to 12 percent of all parkinsonism cases. VP has a different cause than PD but it looks very similar so the two disorders can be confused.^2,3

What are the symptoms?

VP is often called 'lower body parkinsonism' because it affects the legs more than the upper body. People living with VP may experience:⁴

• Bradykinesia, or slow muscle movements
• Rigid muscles
• Muscle weakness
• Difficulty with balance
• Difficulty walking
• History of multiple recent falls
• Dementia
• Incontinence

Muscle tremors can also occur but these are not as common. While the symptoms usually affect the legs, some people living with VP may also experience these symptoms in their upper body.²

These symptoms may come on suddenly or may take weeks to months to develop. VP is not as progressive as PD but symptoms may also worsen over time in some people with VP.^3,4

What are the causes?

In PD, these symptoms are caused by the breakdown of neurons in the regions of the brain that control muscle movement. VP mimics PD because damage occurs to cells in the same areas of the brain. This damage, however, is caused by poor blood supply.²

A stroke occurs when an area of the brain does not receive enough blood. Strokes can last anywhere from a few seconds to minutes or even longer. When brain cells do not receive enough blood, they can be damaged or they can die. Many different symptoms can occur based on what area of the brain was damaged. These can be temporary or permanent.⁵

Researchers are still learning more about VP but they believe it is caused by multiple small strokes that occur in the 'motor cortex' of the brain. The motor cortex is an area of the brain that specifically controls your muscles. The timing and severity of these small strokes varies. This explains why VP symptoms may be sudden or gradual.¹

How is it diagnosed?

If your doctor suspects that you have VP, they will do a neurological exam. They will examine your movement, how you walk, and your muscle tone.

They also will order brain imaging, such as a CT scan or an MRI. This allows them to rule out other disorders that may look like VP.

VP diagnosis also requires a history of vascular disease or risk factors for vascular disease. These include:

• Tobacco use
• Hypertension or high blood pressure
• Diabetes
• High cholesterol
• Prior strokes
• Cardiovascular disease such as coronary artery disease

These risk factors increase your likelihood of having a stroke. You may also be diagnosed with VP if your symptoms developed within a year of a previous stroke.⁴

How is it treated?

Treatment for VP focuses on improving symptoms and reducing risk. Your doctor may prescribe levodopa but studies have shown that it may not be effective for most people living with VP.¹

Difficulty with walking and balance can increase your likelihood of falls so your doctor may recommend physical or occupational therapy. This can strengthen your muscles to reduce your fall risk.¹

Finally, your doctor will work with you to reduce your risk factors. Decreasing tobacco use, high blood pressure, and high cholesterol can improve your vascular health. Increasing your daily activity may also improve your vascular health and increase your muscle strength.¹

If you have been experiencing similar symptoms, talk to your doctor or a movement disorder specialist. The correct diagnosis is important to best manage your symptoms.