Clinical Differences between Vascular Parkinsonism and Parkinson’s Disease- a Study in a Tertiary Hospital

Résumé

Objective: Parkinson's disease is a neurodegenerative disorder while vascular Parkinsonism (VP) is a form of secondary Parkinsonism resulting from ischaemic cerebrovascular disease. For treatment purpose, risk stratification and prognosis, these two conditions must be differentiated clinically. This study was done to clinically differentiateParkinson's disease (PD) and vascular Parkinsonism. Materials and Methods: This observational study was done in the neurology department of Dhaka Medical College and Hospital from January 2014 to December 2015. Fifty patients with Parkinson’s disease and 30 patients with vascular Parkinsonism were included in the study. Results: Patients with vascular Parkinsonism were on an average of 8 years older than patients with Parkinson’s disease. Male patients were more common than females in both groups. Risk factors like hypertension, stroke and dyslipidaemia (90%, 86.7% and 63.3% respectively) were found in higher proportion in VP group than in PD group (52.0%, 8.0% and 10.0% respectively). Onset of vascular Parkinsonism was sudden combined with a rapidly progressive clinical course, in contrast to a gradual onset and a slowly progressive course in Parkinson’s disease. Abnormal postural instability (86.7%), gait abnormality (90.0%), lower body predominant findings (63.3%), urinary incontinence (76.7%), corticospinal findings (76.7%), pseudobulbar palsy (78.0%) and dementia (53.3%) were more common in vascular Parkinsonism than in PD group (16.0%, 62%, 8.0%.12.0%, 8.0%, 2.0% and 14.0% respectively). Both patient groups presented with asymmetric involvement but marked asymmetric involvement was
present in the PD group. Presentation with resting tremor was the main feature of patients with Parkinson’s disease. No significant difference was seen in rigidity, orthostatic hypotension and psychiatric symptoms. Conclusions: Parkinson's disease and vascular Parkinsonism can be differentiated by clinical features.