The clinical features of pathologically confirmed vascular Parkinsonism
- Philip George Glass1,2,3,
- Andrew J Lees1,4,5,
- Aroldo Bacellar2,
- Jan Zijlmans6,
- Regina Katzenschlager7,
- Laura Silveira-Moriyama1,3,5
- 1Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, London, UK
- 2Department of Neurology, Hospital São Rafael, Salvador, Brazil
- 3Department of Neurology, University of Campinas, UNICAMP, Campinas, Brazil
- 4Sarah Koe PSP Research Centre, UCL Institute of Neurology, London, UK
- 5Queen Square Brain Bank, Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- 6Department of Neurology, Amphia Hospital, Breda, The Netherlands
- 7Department of Neurology, Karl Landstiner Institute for neuroimmunological and neurodegenerative disorders, Donauspital/Danube Hospital, Vienna, Austria
- Correspondence to Dr Laura Silveira-Moriyama, Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, 1 Wakefield St, London, WC1N 1PJ, UK;
Contributors Study design: AJL, LS-M. Data collection: PGG, LS-M. Data analysis: PGG, LS-M, AJL, AB, RK, JZ. Manuscript draft: PGG, LS-M. Manuscript review: AB, RK, JZ, AJL.
- Received 22 March 2012
- Revised 22 June 2012
- Accepted 25 July 2012
Objective To evaluate in detail the clinical features in a large series of pathologically confirmed cases of vascular Parkinsonism (VP).
Background In the absence of widely accepted diagnostic criteria for VP pathological confirmation of diagnosis is necessary to ensure diagnostic reliability, and has only been reported in a few small series.
Design/methods The archival records of the Queen Square Brain Bank (QSBB) have been used to identify cases of Parkinsonism where cerebrovascular disease was the only pathological finding. Clinical notes were scrutinised and milestones of disease progression were compared with other atypical Parkinsonian syndromes from previous QSBB studies.
Results Twenty-eight cases were included. Mean age of onset and disease duration were 70.6 (SD± 6.42) and 10.5 (SD± 66.1) years respectively. Bradykinesia was present in all cases, rigidity in 96%, falls in 76%, pyramidal signs in 54%, urinary incontinence in 50% and dementia in 39%.Visual hallucinations in 0%. Two-thirds had an insidious onset and a relentless rather than stepwise progression of disability. When compared with other Parkinsonian syndromes, VP had an older age of onset.
Conclusions In comparison with other Parkinsonian syndromes the patients were older and had an extremely low frequency of visual hallucinations compared with Parkinson's disease.
- Vascular Parkinsonism
- non-motor symptoms
- diagnosis and postmortem
- cerebrovascular disease
- movement disorders
- Parkinson's disease
Funding This work was supported by the Reta Lila Weston Trust for Medical Research.
Competing interests Dr Glass reports no disclosures. Professor Lees received honoraria for lecturing, advising or consultancies from Genus, Novartis, Teva, Meda, Boehringer Ingelheim, GSK, Ipsen, Lundbeck, Allergan, Orion, BIAL, Noscira and Roche; received grants from PSP Association, Weston Trust—The Reta Lila Howard Foundation. Dr Bacellar received honoraria for lecturing, advising or consultancies from Roche, Merk Serono, Novartis and Lundbeck. Dr Zijlmans has received honoraria for lecturing or advising from GSK and Novartis. Dr Katzenschlager has received honoraria for lecturing or advising from GSK, Boehringer, UCB, Cephalon, Abbott, Novartis and Lundbeck. Dr Silveira-Moriyama works for the Reta Lila Weston Trust for Medical Research, UCL; received honoraria from Teva Lundbeck and grants from Parkinson's UK, UCB, Genus and Abbott.
Patient consent Obtained.
Ethics approval The London Multi-Centre Research Ethics Committee had approved procedures for the donation of brains to the Queen Square Brain Bank for Neurological Disorders as well as retention of and access to clinical records. Tissue is stored at the QSBB under a full license from the UK Human Tissue Authority.
Provenance and peer review Not commissioned; externally peer reviewed.