"Parkinson's Disease via Blood Vessels: Recognizing Symptoms, Discovering Causes, and Exploring Treatment Options"
Distinguishing Vascular Parkinsonism from Parkinson's Disease
Vascular Parkinsonism (VP) and Parkinson's Disease (PD) share some similarities, but their underlying causes, symptoms, and treatment responses differ significantly. This differentiation is crucial for accurate diagnosis, prognosis, and therapeutic strategies.
Causes
VP is primarily caused by vascular issues in the brain, often due to small strokes or infarcts affecting blood flow to key motor areas, such as the basal ganglia and deep brain structures. Risk factors for VP include prior strokes, hypertension, diabetes, and smoking. On the other hand, PD is a neurodegenerative disorder caused by the loss of dopamine-producing neurons in the substantia nigra of the midbrain, with Lewy body formation implicated. The cause of PD is mostly idiopathic but may involve genetic and environmental factors.
Symptoms
VP symptoms include parkinsonism features such as bradykinesia and rigidity, but resting tremors are less common or absent. Gait disturbances and lower body predominance are typical. VP often presents with a less pronounced tremor and may show more symmetrical motor signs. PD is characterised by the classic triad: resting tremor, bradykinesia, and rigidity, often starting asymmetrically, plus postural instability. Non-motor symptoms such as sleep disturbances, mood changes, and cognitive decline also develop as the disease progresses.
Treatment
VP typically responds poorly to levodopa, the primary medication for PD. Management focuses on controlling vascular risk factors (e.g., hypertension, diabetes) and stroke prevention. PD usually shows a robust initial response to levodopa and dopamine agonists, improving motor symptoms significantly. Advanced PD may require additional treatments such as deep brain stimulation (DBS) for refractory motor symptoms.
Differentiating VP
Brain imaging can help differentiate VP from other forms of parkinsonism, such as PD. VP develops when strokes affect a specific area of the brainstem called the basal ganglia. There is no specific diagnostic test for VP. A medical professional will review a person's medical history, ask about symptoms, and perform a physical examination to diagnose VP.
Living with VP
VP is a chronic condition and can reduce a person's life expectancy, especially if the diagnosis occurs before a person reaches 70 years old, often due to other cardiovascular issues such as heart disease. A physiotherapist may provide exercises that a person can do at home to maintain muscle tone and reduce the risk of falls. The symptoms of VP may come on suddenly or gradually, and they typically affect the lower body, causing wide-based walking, a shuffling or freezing gait, falls, resting tremors, stiffness, sleep problems, and depression.
Preventing VP
Risk factors for VP include smoking, diabetes mellitus, high blood pressure, various types of heart disease, a family history of stroke, sleep apnea, a personal history of stroke, high BMI, and high cholesterol. Managing conditions such as high blood pressure and diabetes, taking part in physical exercise, stopping smoking, reducing alcohol intake, and eating a healthy diet can help prevent another stroke in VP patients.
Seeking Medical Advice
Any person experiencing symptoms of parkinsonism should arrange an appointment to speak with a primary care doctor. A person should seek emergency medical attention for any symptoms of stroke. If a person is experiencing tremors, issues with controlling their movement, trouble walking, or stiffness, they should seek advice from a healthcare professional.
Table: Comparing VP and PD
| Feature | Vascular Parkinsonism (VP) | Parkinson's Disease (PD) | |-------------------|-----------------------------------------------------|------------------------------------------------| | Cause | Cerebrovascular disease (strokes, infarcts) | Neurodegeneration of substantia nigra (dopamine loss) | | Primary Symptoms | Bradykinesia, rigidity, gait disturbance; resting tremor uncommon | Resting tremor, bradykinesia, rigidity, postural instability | | Symptom Onset | Often sudden/stepwise related to strokes | Gradual onset, usually asymmetric | | Response to Levodopa | Poor response | Generally good initial response | | Treatment Focus | Vascular risk management, stroke prevention | Dopaminergic medication, DBS in advanced cases |
The article discusses three subsets of VP: acute or delayed progressive onset form, vascular parkinsonism of insidious onset, and mixed neurodegenerative parkinsonism and cerebrovascular disease. VP is vascular in origin and causes sudden damage to the same area of the brain that PD affects. VP usually affects one side of the body, unlike PD which usually affects both sides of the body. Treatment for VP involves easing symptoms and reducing the risk factors of stroke.
Sources: [1] Johnston, I., & Lang, A. E. (2018). Vascular parkinsonism: clinical features, pathophysiology, and diagnosis. Journal of Neurology, Neurosurgery, and Psychiatry, 89(6), 568-575. [2] Jankovic, J., & Tolosa, E. (2010). Movement disorders: clinical diagnosis and management (vol. 3). Elsevier Health Sciences. [3] Lees, A. J., Pillon, B., & Obeso, J. (2009). Parkinson's disease: pathophysiology, clinical features, and diagnosis. The Lancet Neurology, 8(1), 3-13. [4] O'Sullivan, B., & Goetz, C. G. (2016). Deep brain stimulation for Parkinson's disease. The Lancet Neurology, 15(1), 7-16. [5] Quinn, N. P., & Lang, A. E. (2014). Parkinson's disease. The Lancet, 383(9928), 1513-1523.
- Vascular Parkinsonism (VP) and Parkinson's Disease (PD) can lead to chronic diseases related to cardiovascular health and neurological disorders.
- In the workplace, focusing on workplace-wellness, mental-health, nutrition, and fitness-and-exercise can help manage the symptoms and prevent the onset of these conditions.
- Both VP and PD share some symptoms, such as bradykinesia and rigidity, but resting tremors are less common or absent in VP, and PD usually starts asymmetrically with a resting tremor.
- Sports, such as football, can be beneficial for maintaining cardiovascular health and may help delay the onset of certain medical conditions in individuals with a history of stroke or hypertension.
- For those diagnosed with VP, skin-care is also an important aspect of health and wellness, as the condition may increase the risk of falls and associated injuries.
- Cancer, particularly with cardiovascular and neurological complications, may present with symptoms similar to VP, making it essential for diagnosis to be prompt and accurate.
- The European leagues, including football leagues, have invested in sports-betting, raising concerns about gambling-related mental-health issues and the potential impact on health-and-wellness.
- To avoid the risk of another stroke, VP patients should maintain good nutrition, engage in regular physical exercise, manage conditions such as diabetes and high blood pressure, and avoid smoking.
- If experiencing symptoms such as tremors, issues with controlling movement, trouble walking, or stiffness, seeking professional advice from a healthcare professional is crucial for early diagnosis and effective treatment.
