Vascular Parkinsonism and cognitive impairment: literature review, Brazilian studies and case vignettes

Views & Reviews Vascular Parkinsonism and cognitive impairment: literature review, Brazilian studies and case vignettes PARKINSONISMO VASCULAR E DISFUNÇÃO COGNITIVA: REVISÃO DA LITERATURA E ESTUDO DE CASOS BRASILEIROS Thiago Cardoso Vale1  Maira Tonidandel Barbosa2  Paulo Caramelli1  Francisco Cardoso1  1Neurology Division, University Hospital, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte MG, Brazil 2Internal and Geriatric Medicine, Internal Medicine Department, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte MG, Brazil ABSTRACT Vascular Parkinsonism (VP) is a form of secondary Parkinsonism resulting from cerebrovascular disease. Estimates of the frequency of VP vary greatly worldwide; 3% to 6% of all cases of Parkinsonism are found to have a vascular etiology. In a Brazilian community-based study on Parkinsonism, 15.1% of all cases were classified as VP, the third most common form, with a prevalence of 1.1% in an elderly cohort. Another Brazilian survey found a prevalence of 2.3% of VP in the elderly. VP is usually the result of conventional vascular risk factors, particularly hypertension, leading to strategic infarcts of subcortical gray matter nuclei, diffuse white matter ischaemic lesions and less commonly, large vessel infarcts. Patients with VP tend to be older and present with gait difficulties, symmetrical predominant lower-body involvement, poor levodopa responsiveness, postural instability, falls, cognitive impairment and dementia, corticospinal findings, urinary incontinence and pseudobulbar palsy. This article intends to provide physicians with an insight on the practical issues of VP, a disease potentially confounded with vascular dementia, idiopathic Parkinson's disease, dementia with Lewy bodies and other secondary causes of Parkinsonism. Key words: vascular parkinsonism; vascular cognitive impairment; vascular dementia; Parkinson's disease; diffuse white-matter lesions RESUMO Parkinsonismo vascular (VP) é a forma secundária da síndrome parkinsoniana resultante de doença cerebrovascular. Há grande variação das estimativas de frequência em estudos mundiais, sendo que em média 3% a 6% de todos os casos de parkinsonismo têm a etiologia vascular. Em um estudo brasileiro de base comunitária sobre parkinsonismo, 15,1% de todos os casos foram classificados como VP, que foi a terceira causa mais comum, com uma prevalência de 1,1% em uma coorte de idosos. Outro estudo brasileiro encontrou uma prevalência de 2,3% de VP também em idosos. VP usualmente resulta de fatores de risco vasculares como a hipertensão, levando a infartos estratégicos nos núcleos da base, lesões isquêmicas difusas da substância branca subcortical e menos comumente, infartos de grandes vasos. Os pacientes com VP geralmente são mais idosos e apresentam dificuldades para a marcha, envolvimento simétrico predominante em membros inferiores, resposta pobre à terapêutica com levodopa, instabilidade postural e quedas, comprometimento cognitivo e demência, sinais de acometimento corticoespinhal, incontinência urinária e paralisia pseudobulbar. Este artigo apresenta algumas informações práticas sobre o VP, uma condição neurológica potencialmente confundida com demência vascular, doença de Parkinson idiopática, demência com corpos de Lewy e com outras causas de parkinsonismo. Palavras-chave: parkinsonismo vascular; comprometimento cognitivo vascular; demência vascular; doença de Parkinson; lesões difusas de substância branca Texto completo disponível apenas em PDF. Full text available only in PDF format. REFERENCES Gupta D, Kuruvilla A. Vascular parkinsonism: what makes it different? Postgrad Med J 2011;87:829-836. [ Links ] Critchley M. Arteriosclerotic parkinsonism. Brain 1929;52:23-83. [ Links ] Fisher CM. Lacunes: Small, Deep Cerebral Infarcts. Neurology 1965; 15:774-784. [ Links ] Critchley M. Arteriosclerotic pseudo-parkinsonism. London: Pitman Books Ltd; 1981. [ Links ] Eadie MJ, Sutherland JM. Arteriosclerosis in Parkinsonism. J Neurol Neurosurg Psychiatry 1964;27:237-240. [ Links ] Marttila RJ, Rinne UK. Arteriosclerosis, heredity, and some previous infections in the etiology of Parkinson's disease. A case-control study. Clin Neurol Neurosurg 1976;79:46-56. [ Links ] Parkes JD, Marsden CD, Rees JE, et al. Parkinson's disease, cerebral arteriosclerosis, and senile dementia. Clinical features and response to levodopa. Q J Med 1974;43:49-61. [ Links ] Thompson PD, Marsden CD. Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger's disease. Mov Disord 1987;2:1-8. [ Links ] Hachinski VC, Potter P, Merskey H. Leuko-araiosis. Arch Neurol1987;44:21-23. [ Links ] O'Sullivan M. Leukoaraiosis. Pract Neurol 2008;8:26-38. [ Links ] FitzGerald PM, Jankovic J. Lower body parkinsonism: evidence for vascular etiology. Mov Disord 1989;4:249-260. [ Links ] Winikates J, Jankovic J. Clinical correlates of vascular parkinsonism. Arch Neurol 1999;56: 98-102. [ Links ] Zijlmans JC, Daniel SE, Hughes AJ, Revesz T, Lees AJ. Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord 2004;19:630-640. [ Links ] de Lau LM, Giesbergen PC, de Rijk MC, Hofman A, Koudstaal PJ, Breteler MM. Incidence of parkinsonism and Parkinson disease in a general population: the Rotterdam Study. Neurology 2004;63:1240-1244. [ Links ] Benito-Leon J, Bermejo-Pareja F, Rodriguez J, Molina JA, Gabriel R, Morales JM. Prevalence of PD and other types of parkinsonism in three elderly populations of central Spain. Mov Disord 2003;18:267-274. [ Links ] de Rijk MC, Tzourio C, Breteler MM, et al. Prevalence of parkinsonism and Parkinson's disease in Europe: the EUROPARKINSON Collaborative Study. European Community Concerted Action on the Epidemiology of Parkinson's disease. J Neurol Neurosurg Psychiatry 1997;62:10-15. [ Links ] Cardoso F, Camargos ST, Silva Junior GA. Etiology of parkinsonism in a Brazilian movement disorders clinic. Arq Neuropsiquiatr 1998;56:171-175. [ Links ] Munhoz RP, Werneck LC, Teive HA. The differential diagnoses of parkinsonism: findings from a cohort of 1528 patients and a 10 years comparison in tertiary movement disorders clinics. Clin Neurol Neurosurg 2010;112:431-435. [ Links ] Barbosa MT, Caramelli P, Maia DP, et al. Parkinsonism and Parkinson's disease in the elderly: a community-based survey in Brazil (the Bambui study). Mov Disord 2006;21:800-808. [ Links ] Roriz-Cruz M R-CI, Prado RCP, Schuh AS, Bianchin MM, Chaves ML, Rieder CRM. Parkinsonian syndromes among the community-dwelling elderly: High prevalence of vascular parkinsonism in southern Brazil. Mov Disord 2010;25:S262-263. [ Links ] van Zagten M, Lodder J, Kessels F. Gait disorder and parkinsonian signs in patients with stroke related to small deep infarcts and white matter lesions. M (...truncated)