What is vascular parkinsonism and what are the other types of parkinsonism

Parkinsonism: What is it and the different types

Parkinsonism means a collection of symptoms that includes having unusually slow muscle movements (bradykinesia), and at least one of a shaking or trembling in part of your body when at rest (resting tremor), stiffness (rigidity), and walking and balance problems (postural instability). It is caused by damage to a particular area of the brain - called the substantia nigra, which is in the basal ganglia in the midbrain.

As well as Parkinson's disease (PD) - sometimes called idiopathic Parkinson's - other causes of parkinsonism include drug-induced parkinsonism and vascular parkinsonism (VP) - caused by loss of blood supply to part of the brain as happens with a stroke. Other rarer causes includes Wilson’s disease, an inherited condition where there’s too much copper in the body. People who have dementia with Lewy bodies may also develop Parkinson’s-like symptoms.

Patient picks for Movement problems

Brain and nerves

What worsens Parkinson's disease?

Parkinson's disease is a progressive loss of certain nerve cells (dopaminergic cells) within specific areas of the brain (the substantia nigra). It is not known exactly what causes Parkinson's disease but it seems to be a combination of genetic and environmental factors.

by Dr Colin Tidy, MRCGP

Brain and nerves

Tremors

Anxiety, fear, feeling generally unwell and fever can all make you feel trembly - the expression 'shaking in his boots' is one we all recognise. Of course, feeling shaky without knowing what's causing it can make you feel anxious - which can lead to a vicious cycle of shakiness.

by Dr Doug McKechnie, MRCGP

What are the main types of parkinsonism?

There are 3 main types of parkinsonism:
Parkinson’s disease
Most people with parkinsonism have PD. The cause is unknown but it is partly genetic as up to 1 in 5 people with PD have a parent, brother or sister who also has it. The symptoms of PD tend to gradually worsen over time.

Vascular parkinsonism
VP affects people with restricted blood supply (small strokes) affecting the area of the brain that controls movement (substantia nigra). People with vascular parkinsons have similar symptoms to Parkinson's disease, but may also have other symptoms such as problems with memory, sleep and mood.

Drug-induced parkinsonism
Some medicines can cause parkinsonism, such as those used to treat schizophrenia. Drug-induced parkinsonism only affects a small number of people, and most recover soon after stopping the medicine that’s causing it.

People with parkinsonism are usually referred to a nerve and movement disorders specialist (neurologist) for assessment and investigations - including brain imaging - to establish the cause of the symptoms.

What is vascular parkinsonism?

VP is the underlying cause for up to 12 out of 100 of all people with parkinsonism. People with VP tend to have a medical history of cardiovascular disease - such as angina, heart attack, stroke or peripheral artery disease. They may also have risk factors for cardiovascular disease - these include smoking, high blood pressure (hypertension), diabetes, high cholesterol, unhealthy diet and a low level of physical activity.

What are the symptoms of vascular parkinsonism?

The symptoms of VP may come on suddenly or may take weeks or months to develop. The symptoms don't tend to progress in the same way as happens with Parkinson's disease, but may still gradually get worse over time for some people with VP.

VP tends to affect the legs more than the upper body. The symptoms may include:

• Slow muscle movements (bradykineasia).

• Rigid muscles.

• Muscle weakness.

• Difficulty with balance.

• Difficulty walking.

• Frequent falls.

• Dementia.

• Incontinence.

Muscle tremors can also happen but these are not as common as in PD.

What causes vascular parkinsonism?

VP is caused by damage of cells in a region of the brain that controls muscle movement (substantia nigra). This damage is caused by poor blood supply to this area of the brain. When brain cells do not receive enough blood supply, they can be damaged or die.

VP can be compared to a stroke but the area of the brain that is damaged is different. It is thought that vascular parkinsonism is caused by multiple small strokes. The timing and severity of these small strokes varies and so the symptoms of vascular parkinsonism may start suddenly or come on gradually.

Some people with VP could have damage to more than one area of the brain meaning those people may have a history of strokes, with weakness affecting the body, or dementia as well.

Is vascular parkinsonism hereditary?

VP is not hereditary but some of the risk factors for the condition are - such as high cholesterol and high blood pressure.

How fast does vascular parkinsonism progress?

VP varies in how rapidly it starts and then progresses. The symptoms may start gradually and get worse over time, or they may appear immediately, or soon after the loss of blood supply to the area of the brain.

Can vascular parkinsonism be reversed?

VP cannot be reversed because the damaged or dead cells in the brain cannot be repaired. However, the symptoms and problems caused by VP can often be eased, such as by physiotherapy to help improve muscle function, and occupational therapy to help improve function with everyday activities.

The medicines that are used to treat PD don't tend to be as effective for VP. Also, these medicines only ease symptoms and do not cure PD.

It is also important to reduce the chance of further problems with the blood supply to your brain. You can do this by stopping smoking, eating a healthy diet, increasing daily activities, and, if necessary, taking regular medicines to help treat high blood pressure and high cholesterol.