Different clinical and evolutional patterns in late idiopathic and vascular parkinsonism

The aim of this study was to examine the clinicalpicture of Parkinson’s disease(PD) and vascular parkinsonism(VP) in the elderly, in an attempt todifferentiate the clinical history,symptoms, signs and response totherapy.Material and methodsThirty-two elderly patients withlate onset PD and 45 with VP wereenrolled and the clinical features oftwo groups were compared.All patientsunderwent brain MRI andwere scored using the UnifiedParkinson’s Disease Rating Scales(UPDRS) -II, -III. Results Patientswith PD had a younger age at onsetand a longer duration of the diseaseas compared to patients withVP.Nearly all PD patients showed agood response to levodopa therapy,while only 29% of patients with VPwere responsive to levodopa treatment.Vascular risk factors as wellas postural tremor, gait disordersand pyramidal signs with lowerbody predominance,were morefrequent in patients with VP.Ninety-three % of PD patients hadnormal MRI,whereas all patientswith VP had cerebral vascular lesions.UPDRS-II, -III scores atbaseline were higher in VP than inPD patients and their increasesthroughout the follow-up periodwere more marked in VP than inPD patients. Conclusions Clinicalhistory, symptoms, signs, responseto therapy, and brain imaging helpto differentiate PD and VP as twoclinical entities with different clinical,prognostic and therapeutic implications,even if the coexistenceof PD and a cerebral vascular diseasein elderly patients is not infrequentand can make the diagnosisdifficult.