Vascular Parkinsonism?

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Former President George H. W. Bush passed away on November 30, 2018.  He was the 41st President of the United States (POTUS).  He was only the second president to see a child hold the position of POTUS. At the age of 94, he was the oldest living president.  While an official cause of death has not been released, it is known that Bush suffered from vascular parkinsonism, diagnosed in 2012.  This condition significantly contributed to his rapid decline in health over the recent years.

Vascular parkinsonism is much less common than Parkinson disease, but many of the clinical features mimic classic Parkinson disease.  Vascular parkinsonism is caused by many, small subcortical white matter infarcts secondary to atherosclerosis sand microvascular disease.  This etiology is in contrast to that of Parkinson disease, which is caused by degeneration of the dopaminergic neurons in the brain.

The infarcts associated with vascular parkinsonism lead to many of the clinical findings of classic parkinsonism, but the tendon reflexes are brisk and patients exhibit extensor plantar responses. Patients typically present with gait disturbances, including frequent falls. MRI may assist in diagnosis, revealing the numerous small infarcts. 

Because the etiology of vascular parkinsonism is different than that of Parkinson disease, the response to antiparkinsonian medication is low-to-moderate, as most act to increase the amount of dopamine at the dopamine receptors.  The mainstay of treatment is symptom management, physical therapy, and prevention of further ischemic events.  Improvement of modifiable risk factors such as diabetes, hypertension, and hypercholesterolemia may help to reduce the incidence of further ischemic events.  Some patients may benefit from antiplatelet medications to reduce the risk of stroke.  All patients should be encouraged to stop smoking, as this increases their risk for ischemic events.

Read more about vascular parkinsonism below:

Clinical Neurology: 10e: Chapter 11: Movement Disorders

Harrison's Principles of Internal Medicine, 20e: Chapter 427: Parkinson’s Disease

Principles and Practice of Hospital Medicine, 2e: Chapter 210: Parkinson’s Disease and Related Disorder

Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education