Diagnosis Of Vascular Parkinsonism Research Articles

Diagnosis of vascular parkinsonism: A new tool for gait hypokinesia occurring in older persons

IntroductionReliable diagnosis of vascular parkinsonism (VaP) in the presence of a gait hypokinesia is an issue that is encountered in geriatrics. The EVAMAR-AGEX study was focusing on the phenomenon of recurrent falls in older persons (OP) with this parkinsonian gait. The present study is focusing on the diagnosis of VaP-related parkinsonian gait by developing a diagnostic guidance model adapted to OP. MethodsData from baseline and the 2-year follow-up visit were used to carry out univariate analysis and calculation of odds ratios, allowing to identify relevant variables to include in the diagnostic guidance model. To evaluate the model, confusion matrices were created, evaluating true positive, false negative, false positive and true negative incidences, sensitivity and specificity, and negative and positive predictive values. Results79 patients included 58% male; average age 81.24 years. VaP diagnosis according to Zijlmans criteria occurred in 28%; neurodegenerative parkinsonian syndromes in 72%. A 4-criteria model was established to facilitate diagnostic: lack of prior hallucinations, lack of movement disorders tremor excluded, no cognitive fluctuations, and ≥75 years of age at diagnosis. In combination of 4/4 criteria, all of them were required to disclose a specificity of 91% in the diagnosis of VaP. In combination of 3/4, in case of negative test, a negative predictive value for VaP diagnosis of 0.97 was obtained. ConclusionThe challenge of our tool is both to be able to rule out what is probably not a VaP and to argue what makes a VaP diagnosis probable in OP.

Magnetic resonance morphometry of the brain in the advanced stages of Parkinson's disease and vascular parkinsonism

Introduction. MR-morphometry is a method of image processing independent of the researcher, which allows you to get the results of measuring the volume of the brain structures and the thickness of various areas of the cortex and helps in the differential diagnosis in assessing the results of MRI. Our study used MR-morphometry to identify structural markers in the differential diagnosis of vascular parkinsonism in the examination of patients with Parkinson's symptoms. Purpose of research. Visualization of the distribution of atrophic changes in brain structures in vascular parkinsonism and in the advanced stages of Parkinson's disease, as well as the identification of characteristic parts of the brain that undergo a pathological process to increase the accuracy of differential diagnosis. Materials and methods. The results of magnetic resonance morphometry of patients using the postprocessing of native MR images using Freesurfer software are analyzed. We examined 29 patients with vascular parkinsonism and 19 patients with Parknison disease, at stage 4 according to Hyun and Yar. Summary. The application of the method of postprocessing data processing of MR-morphometry allows instrumental confirmation of the clinical diagnosis, as well as to clarify the pathogenesis of neurological syndromes observed in progressive supranuclear paralysis.

Clinical features of vascular parkinsonism: a modern view on the problem (literature review and own observations)

The aim of our research was to study modern ideas about the clinical course, diagnosis and differential diagnosis of vascular, post-stroke parkinsonism among the patients who suffered from the cerebral stroke during 10 years of the observation in Brovary. The resources PubMed (1990-2018) and UpToDate (2016) were used to write the review article. The vascular parkinsonism is a variant of secondary parkinsonism, caused by the ischemic or hemorrhagic lesions of the basal ganglia, the middle brain and/or their connections with the frontal lobes. The part of patients with the vascular parkinsonism (VP) makes up only 1.0-3.2% in the structure of all patients with parkinsonism [22, 37]. The vascular parkinsonism differs from Parkinson’s disease with more rapid disease progression and unfavorable course [3, 6, 9, 16, 22, 27, 37]. Taking into consideration the wide range of clinical manifestations, not clear criteria, the diagnosis of vascular parkinsonism is ambiguous, which makes relevant the problem of studying this pathology and modern concepts of diagnosis and therapy. Dopaminergic drugs are ineffective in most patients with vascular parkinsonism [26, 27, 28]. This article shows the analysis of the epidemiological parameters of cerebral strokes in Brovary, Kiev region. The total number of patients was 5818 (mean age 73.5 ± 10.2). Signs of vascular parkinsonism were detected in 73 patients (1.25%), including 44 (60%) women and 29 (39%) men. The lesions of subcortical structures were verified on CT and МRI. The dispensary group consisted of 312 patients with parkinsonism in 2016. The proportion of vascular parkinsonism was 23.3% of all patients with parkinsonism. Taking into consideration the progressive increase in stroke risk factors, the increase in stroke incidence among the population in Brovary (Kyiv region, Ukraine) has increased more than 4 times since 1991 (from 186 to 752 patients). The actual problem of the current time are cerebrovascular disease, strokes and their complications, which placed a heavy burden on the country’s society. Based on the aforementioned, further research would be required in this area, as well as the development of a new scientific concept regarding the prevention, early diagnosis and treatment of cerebral stroke, thus reducing disability and mortality, improving the quality of life of patients and their relatives. Keywords: vascular parkinsonism, clinical features, disease course, diagnostic criteria, differential diagnosis, risk factors.

Therapeutic Interventions for Vascular Parkinsonism: A Systematic Review and Meta-analysis.

Vascular parkinsonism (VP) is defined as the presence of parkinsonian syndrome, evidence of cerebrovascular disease, and an established relationship between the two disorders. However, the diagnosis of VP is problematic, particularly for the clinician confronted with moving from diagnosis to treatment. Given the different criteria used in the diagnosis of VP, the effectiveness of available therapeutic interventions for this disease are currently unknown. To assess the clinical response of all published therapeutic interventions for VP that have been reported in the literature, we conducted a systematic review looking for VP subjects treated with any therapeutic intervention. To clarify the prevalence of responsiveness to levodopa among VP subjects, we conducted a meta-analysis of 17 observational studies retrieved with the search criteria of our review. Also, four studies were included in a second analysis to explore if nigrostriatal lesion affected the prevalence of levodopa response in VP subjects. Relevant articles were identified from MEDLINE, Scopus, and Web of Science published until June 2017. 436 non-duplicate citations were identified for screening, 107 articles were assessed for eligibility, and only 23 observational studies were included in this review. No randomized clinical trials were found. Four different therapies were found in the literature; among them, levodopa was the only one repetitively reported. The calculated event rate of levodopa response in VP subjects was of 0.304 [95% confidence interval (CI) of 0.230-0.388]. The overall odds ratio for good response to levodopa in VP with lesion in the nigrostriatal pathway vs. no lesion in the nigrostriatal pathway was 15.15 (95% CI: 5.2-44.17). Despite the lack of randomized controlled trials, results of this systematic review and meta-analysis show that VP subjects, as operationally defined here, have a low response rate to levodopa; nigrostriatal lesion could be used as a proxy predictor of levodopa response in VP subjects. Other therapies seem to be co-adjuvant. Randomized controlled trials with a clear definition of VP are necessary to be able to assign positive or negative predictive values to available treatments and to recommend any of the therapeutic interventions for these subjects.

Impact of subcortical white matter lesions on dopamine transporter SPECT

Subcortical arteriosclerotic encephalopathy (SAE) can affect the nigrostriatal system and presumably cause vascular parkinsonism (VP). However, in patients with SAE, the differentiation of VP from idiopathic Parkinson's disease (IPS) is challenging. The aim of the present study was to examine the striatal dopamine transporter (DAT) density in patients with parkinsonism and SAE. Fifteen consecutive patients with parkinsonian symptoms displayed SAE, as detected by magnetic resonance imaging (MRI). Fifteen retrospectively chosen, matched patients with diagnosis of IPS without any abnormalities in MRI served as a reference group. DAT SPECT was performed using the tracer ¹²³I-FP-CIT. Scans were acquired on a triple-head SPECT system (Multispect 3, Siemens) and analysed using the investigator-independent BRASS™ software (HERMES). In the SAE group, a DAT deficit was observed in 9/15 patients. In contrast, all patients from the IPS group showed a reduced DAT binding (p = 0.008). The specific binding ratios (BR) of putamen contralateral to the side of the more affected limb versus occipital lobe were in trend higher in patients with SAE versus patients in the IPS-group (p = 0.053). Indices for putaminal asymmetry (p = 0.036) and asymmetry caudate-to-putamen (p = 0.026) as well as the ratio caudate-to-putamen (p = 0.048) were significantly higher in IPS patients having no SAE. DAT deficit was less pronounced in patients with SAE and parkinsonism than in patients with IPS without any abnormalities in the MRI. A potential role of DAT SPECT in the differential diagnosis of VP and IPS requires more assessments within prospective studies.

Specificity and sensitivity of transcranial sonography of the substantia nigra in the diagnosis of Parkinson's disease: prospective cohort study in 196 patients

ObjectiveNumerous ultrasound studies have suggested that a typical enlarged area of echogenicity in the substantia nigra (SN+) can help diagnose idiopathic Parkinson's disease (IPD). Almost all these studies were retrospective...

Vascular parkinsonism — an update

Vascular parkinsonism (VP) is a heterogeneous clinical entity. The idea of a relationship between cerebral vascular disease and parkinsonism may be traced back to the 1920s, when the diagnostic unit called “arteriosclerotic parkinsonism”, a predecessor of VP, was established. This review is concerned with historical and contemporary views regarding the possible vascular genesis of parkinsonism. Confusion persists as a result of vaguely defined diagnostic criteria. The following types of simultaneous occurrence of parkinsonism and cerebral vascular disease (CVD) may be recognised: 1. gait disorders of the lower body parkinsonism type are caused mostly by white matter lesions in the frontal lobes; such disorders may require a diagnosis of vascular origin. We suggest replacing the term “lower body parkinsonism” with a more appropriate term not including the word “parkinsonism”: an alternative term could be “cerebrovascular gait disorder”; 2. if the signs and symptoms are typical for idiopathic Parkinson's disease (IPD), the coincidence of IPD and CVD should be considered; 3. if the symptoms of parkinsonism are neither typical for IPD nor for VP, and there are clinical or MR signs of CVD, VP should be regarded as possible when alternative causes are excluded; 4. if the symptoms of parkinsonism and clinical and MR signs are typical for VP, VP should be regarded as probable; 5. if a stroke affecting the contralateral basal ganglia is followed by the occurrence of hemiparkinsonism, the diagnosis of VP is unambiguous. Vascular parkinsonism (VP) is probably one of the most frequently erroneous neurological diagnoses. The reason for this misdiagnosis is that both cerebral vascular disease (CVD) and parkinsonism usually occur at the same age. Due to the high incidence of CVD, it is possible for CVD and idiopathic Parkinson's disease (IPD) to coincide in some cases. Another reason for the misdiagnosis is that the concept of VP lacks clarity. This review aims to contribute to an improved understanding of VP in clinical practice. In this context, the term “CVD” is understood in the broad sense of a brain impairment caused by cerebral vessel pathology. It covers various concepts, as some authors use the term CVD to mean a manifestation of vascular lesions in pathologico-anatomical material or in the imaging techniques; others mean the history and clinical manifestation of cerebral ischaemia, or, more rarely, haemorrhage. The term CVD may cover large vessel disease as well as small vessel disease. This means that territorial and lacunar infarcts and white matter lesions (WML) are all considered as CVD.

Imaging of dopamine transporters and D2 receptors in vascular parkinsonism: a report of four cases

The role of nuclear medicine imaging in the diagnosis of vascular parkinsonism (VP) has been addressed by only few studies up to now. Most previous reports suggest no or only mild impairment of DAT and D2 receptors in VP. In contrast, in four patients with VP, reported here, the combined DAT and D2 receptor SPECT showed highly unusual changes in the pre- and/or postsynaptic dopaminergic system. The possible value of combined DAT/D2 receptor SPECT imaging should be investigated by future prospective studies.

Anticardiolipin antibody in vascular parkinsonism.

Vascular parkinsonism (VP) is characterized by predominantly lower body involvement with gait impairment and postural instability, often without tremor, and by relative levodopa unresponsiveness. Neuroimaging studies demonstrate multiple infarcts or ischemic changes in periventricular white matter. Anticardiolipin antibodies (ACLA) are associated with hypercoagulable states and increased stroke risk. Review of our Movement Disorders Clinic records identified 44 individuals with a diagnosis of VP. ACLA have been obtained in 22 of these patients (mean age, 78.3 years; mean Mini-Mental Status Exam score, 25.8). Gait disturbance was the initial clinical feature in 82% of the patients, and levodopa responsiveness was present in 18% of those treated. In 9 of the 22 (40.9%), ACLA immunoglobulin G was positive. No significant differences in clinical features or risk factors (hypertension, diabetes, coronary artery disease, and clinical stroke) were evident between ACLA+ and ACLA- groups. Since the presence of ACLA in individuals with stroke is usually treated by full-scale anticoagulation with warfarin, our findings raise the question whether such treatment should also be used in persons with VP who are ACLA positive.

Plasma von Willebrand factor activities in vascular Parkinsonism: Comparison with Parkinson's disease

We measured the level of plasma von Willebrand factor (vWF), a marker of vascular endothelial damage, in patients with vascular parkinsonism (VP) to clarify whether the level of plasma vWF is useful in the diagnosis of VP. We examined 26 patients with VP, 26 with Parkinson's disease (PD), 26 with cerebral infarct (CI), and 26 age-matched normal controls (NC). The vWF was measured by the ristocetin cofactor assay. The level of plasma vWF in the VP group was significantly higher than that in the PD or in the NC groups (P <.01). However, there was no difference between the VP group and the CI group. These findings suggest marked endothelial cell damage in patients suffering from VP and CI. Thus, the level of plasma vWF may be useful in diagnosing VP. Copyright © 2001 by National Stroke Association