Department of Neurology Service and Internal Medicine, Faculty of Medicine, University Hospital, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil.
Cognitive and Behavioral Neurology Unit, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
J Neurol Neurosurg Psychiatry. 2015 May;86(5):547-53. doi: 10.1136/jnnp-2014-307867. Epub 2014 Jul 8.
To compare the clinical and radiological features of vascular parkinsonism (VP) and Parkinson's disease (PD).
Cross-sectional study where 15 patients with VP (8 (53.3%) men; aged 75.7 ± 10.4 years) and 30 patients with PD (17 (56.7%) men; aged 67.3 ± 7.5 years) underwent motor and cognitive evaluation and brain MRI.
Patients with VP were, on average, 8.4 years older (p = 0.004); all had arterial hypertension. They presented with a sudden onset of parkinsonism (80%) and a rapidly progressive clinical course (53.3%). Predominant lower body parkinsonism (p<0.001), postural instability (p=0.003) with freezing of gait (p<0.001) and falls (p<0.001), urinary incontinence (p < 0.001) and pyramidal signs (p<0.001) were more common in patients with VP. Movement Disorders Society's Unified PD Rating Scale (MDS-UPDRS) scores were higher in patients with VP (p=0.005 in 'OFF' state and p<0.001 in 'ON' state). They had greater cognitive impairment and 12 (80%) fulfilled diagnostic criteria for probable vascular dementia. Most patients with VP had brain MRI changes: multiple lacunar infarcts (66.7%) or extensive white matter disease (26.7%).
VP can be clinically distinguished from PD based on sudden onset of parkinsonism at an older age, characterised by lower body predominance, urinary incontinence, pyramidal signs, postural instability with freezing of gait and falls, and dementia.
比较血管性帕金森病（VP）和帕金森病（PD）的临床和影像学特征。
这是一项横断面研究，纳入了 15 例 VP 患者（8 例男性，53.3%；年龄 75.7±10.4 岁）和 30 例 PD 患者（17 例男性，56.7%；年龄 67.3±7.5 岁），对他们进行了运动和认知评估以及脑部 MRI 检查。
VP 患者的平均年龄大 8.4 岁（p=0.004）；所有患者均有动脉高血压。他们表现为帕金森病的突然发作（80%）和快速进展的临床病程（53.3%）。下半身帕金森病更为常见（p<0.001）、姿势不稳（p=0.003）伴步态冻结（p<0.001）和跌倒（p<0.001）、尿失禁（p < 0.001）和锥体束征（p<0.001）。VP 患者的运动障碍协会统一帕金森病评定量表（MDS-UPDRS）评分更高（“OFF”状态下 p=0.005，“ON”状态下 p<0.001）。他们的认知障碍更严重，12 例（80%）符合血管性痴呆的诊断标准。大多数 VP 患者的脑部 MRI 有变化：多发性腔隙性梗死（66.7%）或广泛的白质疾病（26.7%）。
根据帕金森病的突然发作、以身体下部为主、尿失禁、锥体束征、姿势不稳伴步态冻结和跌倒以及痴呆等特点，VP 可与 PD 进行临床鉴别。
