“I read that some patients with PD actually have a condition known as vascular parkinsonism (VP). My wife, who has been diagnosed with having PD has shown most of the symptoms described in an earlier PD UPDATE newsletter. The article briefly described VP. My wife and I would like ot know what further information is available by answering the following:
1. Is VP treated differently than PD?
2. What medications, if any, are available for VP?
3. Are there any other sources of information that we could (or should) contact to discuss further?
My wife is under the care of a neurologist at the Dent Neurologic Institute, Buffalo, NY. We have not discussed VP with him as of this date.”
H. G., Orchard Park, NY
Dr. Sanchez-Ramos said...
Patients with vascular parkinsonism (VP) are usually older, 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. Patients with VP are also significantly more likely to have predominant lower body involvement. This means that difficulty with rising and walking is much worse than any motor difficulties in the use of the hands. They also have worse postural instability, a history of falling, dementia or decline in intellectual functions, evidence of spasticity, and incontinence. They are more likely to have a pseudobulbar affect, which refers to the phenomenon of inappropriate emotional responses, such as crying over events that normally wouldn’t evoke such a response.
In response to your first question, patients with VP generally respond poorly to levodopa or dopamine agonist therapy. We still recommend a trial of levodopa to as high a dose as tolerated by the patient. Although the response may be far from optimal, we have noticed that some levodopa in these patients is usually better than no levodopa at all.
For the second question, there are no specific medications available for treatment of vascular parkinsonism. The problem of VP resides in the small blood vessels which fail to deliver blood to regions of brain that connect higher cortical levels to basal ganglia and brainstem. If there were a way to maintain good cerebral blood flow in elderly patients, perhaps there would be less likelihood of devleoping VP. If the patient suffers from hypertension or diabetes as the background for development of small blood vessel disease, then it is important to control blood pressure and blood sugars with the appropriate medications.
An important modality of treatment is physical therapy with a focus on gait and balance. Although this therapeutic approach does not solve all problems, both patient and caregiver learn ways to improve mobility and to avoid dangerous situations that might result in falls.
The best resource for more information about specific treatment for your wife is likely to be your own neurologist who is able to conduct a physical examination , perfrom neuroimaging studies and obtain a lot more data regarding the particulars of her case.