Objective To compare the clinical and radiological features of vascular parkinsonism (VP) and Parkinson’s disease (PD).

Methods Cross-sectional study where 15 patients with VP (8 (53.3%) men; aged 75.7±10.4 years) and 30 patients with PD (17 (56.7%) men; aged 67.3±7.5 years) underwent motor and cognitive evaluation and brain MRI.

Results Patients with VP were, on average, 8.4 years older (p=0.004); all had arterial hypertension. They presented with a sudden onset of parkinsonism (80%) and a rapidly progressive clinical course (53.3%). Predominant lower body parkinsonism (p<0.001), postural instability (p=0.003) with freezing of gait (p<0.001) and falls (p<0.001), urinary incontinence (p<0.001) and pyramidal signs (p<0.001) were more common in patients with VP. Movement Disorders Society's Unified PD Rating Scale (MDS-UPDRS) scores were higher in patients with VP (p=0.005 in ‘OFF’ state and p<0.001 in ‘ON’ state). They had greater cognitive impairment and 12 (80%) fulfilled diagnostic criteria for probable vascular dementia. Most patients with VP had brain MRI changes: multiple lacunar infarcts (66.7%) or extensive white matter disease (26.7%).

Conclusions VP can be clinically distinguished from PD based on sudden onset of parkinsonism at an older age, characterised by lower body predominance, urinary incontinence, pyramidal signs, postural instability with freezing of gait and falls, and dementia.