Monday, March 4, 2024

Vascular Parkinson’s Disease Treatment

How Does Vp Subjects Response Rate To Levodopa Therapy Differ From Parkinsons Disease Subjects

1.12. Vascular Parkinsonism – Parkinsonism and Related [Spring Video Atlas]

To answer this question, we performed a third meta-analysis where we pooled the OR of the probability VP subjects have of responding to levodopa compared with the probability of PD subjects . The response of a total of 340 VP subjects and 734 PD subjects distributed in nine studies were included in this analysis. An overall OR of 0.018 was found. A high heterogeneity measure was found . The subgroup analysis by VP diagnosis criteria also evidenced different ORs and 95% CI, although the CIs overlapped . This same subgroup analysis by VP diagnosis criteria exhibited no heterogeneity in the Other subgroup , while great heterogeneity in the Zijlmans and Winikates subgroup was found . Surprisingly, subgroup analysis for quality showed null heterogeneity in the low-quality group whereas high heterogeneity was found in the high-quality group . Sensitivity analysis pointed out ORs ranging from 0.011 to 0.024 Supplementary Material . Funnel plot showed asymmetry, especially in the upper part of the graph and statistical analysis for publication bias showed evidence of this bias however, results remain solid due to a classic fail-safe N: the calculated number of studies missing needed to bring the p-value greater than 0.05 would be 315 . Information of sensitivity and group subanalysis data are depicted on Tables S9S14 in Supplementary Material.

Who Does It Affect

Parkinsonism overall is usually an age-related disease. Its slightly more common in people assigned male at birth than in those assigned female at birth. The most common forms of parkinsonism are more likely to happen after age 60.

But some forms can happen at a much earlier age. The average age when juvenile parkinsonism starts is 17. That form of parkinsonism is also four times more common in assigned males than assigned females.

What Tests Will Be Done To Diagnose This Condition

When healthcare providers suspect a condition that falls under parkinsonism, various imaging and diagnostic tests are possible. These include:

New lab tests forthcoming

There are also new lab tests that, while still experimental or waiting for approval, might be able to help with diagnosing Parkinson’s disease or other conditions like it. These tests look for misfolded or malfunctioning alpha-synuclein proteins in your cerebrospinal fluid or nerves. But more research and testing are necessary before these tests are widely available.

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Are There Caveats Of Diagnosing Vascular Parkinsonism

The diagnostic criteria for VP as suggested by Zijlmans et al., which is widely used, were based on a study that compared the brains of 17 patients with suspected VP to those of 10 age-matched controls who had hypertension and other vascular risk factors in life, but no evidence of parkinsonism. The study observed macroscopically visible lacunar infarcts or lacunae caused by enlarged perivascular spaces which were seen in the caudate, putamen, globus pallidus, and thalamus in 11 of the parkinsonian brains, compared to only one control brain. It was also noted that the severity of microscopic small-vessel disease pathology was substantially greater in the VP cohort compared to controls.

However, there are several commonitions, worth highlighting about these observations which include the following: severity of microscopic small-vessel disease did not differ between frontal, temporal, parietal, occipital, and striatal regions and suggest lack of regional specificity 12/17 patients had nigral cell loss suggestive of underlying neurodegenerative parkinsonism and proposed VP criteria could be acute, delayed, or insidious in onset, with unilateral or bilateral parkinsonism, with or without gait impairment, and with focal or diffuse lesions, located anywhere in the parenchyma. Such imprecise clinical and neuroimaging criteria have contributed to less defined diagnostic boundaries, resulting in misrepresentation of other entities as VP.

What Is Parkinsonism Characterized By

Parkinsonism causes, symptoms, diagnosis, treatment &  life expectancy

Parkinsonism is characterized by the loss of dopamine, a neurotransmitter that helps regulate movement.

Without dopamine, a person will experience the symptoms of bradykinesia, rigidity, and tremors that are characteristic of Parkinsonism.

The exact cause of the damage to dopamine-producing cells is unknown and likely differs from person to person.

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Therapeutic Interventions For Vascular Parkinsonism: A Systematic Review And Meta

  • 1Unidad de Trastornos del Movimiento y Sueño , Hospital General Dr. Manuel Gea González, México City, México
  • 2Plan de Estudios Combinados en Medicina , Facultad de Medicina, Universidad Nacional Autónoma de México, México City, México
  • 3Instituto de Investigación Científica, Universidad Juárez del Estado de Durango, Durango, México
  • 4Centro de Innovación Médica Aplicada , Hospital General Dr. Manuel Gea González, México City, México

Background: Vascular parkinsonism is defined as the presence of parkinsonian syndrome, evidence of cerebrovascular disease, and an established relationship between the two disorders. However, the diagnosis of VP is problematic, particularly for the clinician confronted with moving from diagnosis to treatment. Given the different criteria used in the diagnosis of VP, the effectiveness of available therapeutic interventions for this disease are currently unknown.

Results: 436 non-duplicate citations were identified for screening, 107 articles were assessed for eligibility, and only 23 observational studies were included in this review. No randomized clinical trials were found. Four different therapies were found in the literature among them, levodopa was the only one repetitively reported. The calculated event rate of levodopa response in VP subjects was of 0.304 . The overall odds ratio for good response to levodopa in VP with lesion in the nigrostriatal pathway vs. no lesion in the nigrostriatal pathway was 15.15 .

Whats The Difference Between Drug

Parkinsons is a progressive disorder, which will become worse over time, while DIP does not. In DIP, Parkinson-like symptoms can begin within four days to one month of starting the medication. However, all the symptoms could completely subside once the effecting medication is stopped, though it may take up to 18 months for all the symptoms to subside.

For more information on drug-induced parkinsonism, read this journal article and/or information sheet.

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How Can I Prevent This Condition Or Reduce My Risk Of Developing It

Parkinsonism happens unpredictably in most cases, so it’s usually impossible to prevent it or reduce your risk of developing it. However, there are specific types of secondary parkinsonism that you can reduce the risk of developing. These are:

  • Toxin-induced parkinsonism. Its possible to reduce your risk of developing this type of parkinsonism by avoiding toxins or substances that can cause it or by using safety equipment to reduce your exposure to these substances when you cant avoid them.
  • Post-traumatic parkinsonism. You can reduce your risk of developing this by using safety equipment to protect yourself from head injuries.
  • Vascular parkinsonism. Reducing your risk of developing this involves taking care of your circulatory health, especially the circulation in your brain. Managing this involves maintaining a weight that’s healthy for you, eating a balanced diet and staying physically active.

How Do I Take Care Of Myself

Vascular Parkinsonism

If you have parkinsonism, it’s important to follow your healthcare provider’s guidance on caring for yourself and managing this condition. They are the best source of information about how your specific condition will affect you and what you can do to help yourself.

In general, you should do the following:

  • Take your medication as prescribed. Taking your medications if your provider prescribes any can make a huge difference in the symptoms of parkinsonism. You should also talk to your provider if you notice side effects or start to feel like your medications aren’t as effective.
  • See your provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help manage your conditions, find the right medications and dosages, and minimize any side effects.
  • Dont ignore or avoid symptoms. Parkinsonism can cause a wide range of symptoms, many of which are treatable by treating the condition or the symptoms themselves. It’s also important to tell your provider about symptoms, even minor ones. Many parkinsonism conditions are easily mistaken for others, so telling your provider about all your symptoms can sometimes help avoid an incorrect diagnosis.

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What Are The Different Forms Of Parkinsonism

There are three main forms of parkinsonism, as well as other related conditions.

Most people with parkinsonism have idiopathic Parkinsons disease, also known as Parkinsons. Idiopathic means the cause is unknown.

The most common symptoms of idiopathic Parkinsons are tremor, rigidity and slowness of movement.

Vascular parkinsonism affects people with restricted blood supply to the brain. Sometimes people who have had a mild stroke may develop this form of parkinsonism.

Common symptoms include problems with memory, sleep, mood and movement.

Some drugs can cause parkinsonism.

Neuroleptic drugs , which block the action of the chemical dopamine in the brain, are thought to be the biggest cause of drug-induced parkinsonism.

The symptoms of drug-induced parkinsonism tend to stay the same only in rare cases do they progress in the way that Parkinsons symptoms do.

Drug-induced parkinsonism only affects a small number of people, and most will recover within months and often within days or weeks of stopping the drug thats causing it.

Vascular Parkinsonism In The News

George H.W. Bush, the 41st President of the United States died on November 30, 2018, at the age of 94. He was diagnosed with vascular parkinsonism in 2012 which affected his walking and caused him to require a wheelchair for his mobility over the past few years. His passing puts a spotlight on this disease, which can be confused with Parkinsons disease .

Vascular parkinsonism is a brain disorder that mimics some of the features of PD, particularly the characteristic gait and balance symptoms. Vascular parkinsonism is thought to be due to an accumulation of small strokes in the parts of the brain that control movement. Lewy bodies, the key pathological hallmark of PD, are not present in vascular parkinsonism. People with vascular parkinsonism are less likely to be responsive to Levodopa and other PD meds than people with typical PD, but some are responsive, so it is common practice to try PD meds even if vascular parkinsonism is suspected. Treatment also focuses on preventing any further strokes with management of high blood pressure, high cholesterol, and diabetes and maximizing mobility with physical therapy.

A neurologist or movement disorder specialist can identify the distinctions between these diseases in order to make the proper Parkinsons diagnosis.

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What Can I Expect If I Have This Condition

All cases of parkinsonism regardless of the specific condition involved slowed movements plus other related symptoms. What you can expect depends on the specific condition you have and what treatments if any that you receive. Your healthcare provider is the best person to tell you more about what you can expect if you have parkinsonism.

How long does parkinsonism last?

How long parkinsonism lasts depends on the specific condition. Nearly all conditions that fall under parkinsonism are life-long conditions. One condition that isn’t always a life-long problem is drug-induced parkinsonism.

Because parkinsonism includes so many different conditions, it’s best to talk to your healthcare provider about how long your condition will last. They can best explain what you can expect, including the likely timeline for how this condition will affect you.

Whats the outlook for this condition?

The outlook for parkinsonism depends on your condition, how severe it is, and whether or not it’s treatable. Many forms of parkinsonism aren’t deadly on their own but can contribute to deadly complications. An example of this is trouble swallowing, a common symptom of Parkinsons disease and other forms of parkinsonism, and how this increases your risk of developing pneumonia.

Imaging Of Striatal Dopamine Transporters In Vp

mini stroke  The Science of Parkinson

Several studies looked at dopamine transporters in VP using -CIT single-photon emission computed tomography and FP-CIT SPECT. Gerschlager et al. reported preserved or mild reduction in the striatal -CIT and putamen/caudate ratio in 13 patients with VP when compared to 20 PD cases. On the other hand, Zijlmans et al. found that the mean striatal FP-CIT uptake was significantly lower in 13 VP patients than in healthy controls. When compared with the PD group, only the mean asymmetry index was significantly lower in VP patients. They suggested that in the majority of VP patients, the pre-synaptic dopaminergic function is reduced and they proposed using the asymmetry index as a criterion for the clinical diagnosis of VP.

Lorberboym et al. studied 20 patients who developed VP in the course of cerebrovascular disease with FP-CIT SPECT and 20 healthy controls. Nine patients had normal striatal FP-CIT binding similar to that of controls. In contrast, 11 patients had significantly diminished striatal binding when compared with controls.

It is therefore difficult to reach any firm conclusion from available studies about the role of dopamine transporter imaging in VP. The lack of uniform clinical diagnostic criteria clearly contributes to difficulties of interpretation of the results, some of which are conflicting. Further research is needed.

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What Are The Clinical Effects Of The Current Pharmacological And Non

A total of 23 studies were included and analyzed in a qualitative revision. Figure 1 summarizes the study identification and selection process. Four different therapies were identified: 1 study investigated vitamin D therapy , 1 study assessed repetitive transcranial magnetic stimulation therapy , 1 study was focused on lumbar puncture as therapy and 20 studies reported levodopa therapy . Clinical trials were not found for any therapeutic. Pilot studies were retrieved for rTMS and lumbar puncture therapy . A casecontrol study was found in the vitamin D study . For levodopa, we obtained 14 cross-sectional studies , 2 casecontrol studies , 2 cohort studies , and 2 clinicopathological studies . All studies are summarized in Table 4. Specific characteristics of every study are depicted on Tables S1S3 in Supplementary Material.

Table 4. Summary of included studies.

The study on vitamin D therapy was a casecontrol study that was carried out on a Japanese population. It included a total of 178 subjects, 90 of them with a VP diagnosis according to Zijlmans criteria . The study evaluated the effectiveness of vitamin D therapy for prevention of falls and hip fractures. After 2 years of treatment with 1,200 UI/day of ergocalciferol, it was reported that VP subjects had 18% fewer falls compared with PD subjects , no change in parkinsonian symptoms were observed .

What Are The Complications Of Parkinson Disease

Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.

Parkinson disease dementia can cause problems with:

  • Speaking and communicating with others
  • Problem solving
  • Forgetfulness
  • Paying attention

If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.

Experts don’t understand how or why dementia often occurs with Parkinson disease. Its clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimer’s disease, another type of dementia.

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Diffuse Lewy Body Disease

Diffuse Lewy body disease is a spectrum of diseases involving dementia and motor symptoms, and the second most common cause of dementia. Because the dementia is similar to that of Alzheimers, and other symptoms imitate Parkinsons disease, the disease can be difficult to diagnose. However, patients with DLBD have hallucinations and are very sensitive to antipsychotic medications. DLBD is more common in men than women.

How Is Parkinson Disease Diagnosed

Researchers look to cycling as possible treatment option for Parkinson’s disease

Parkinson disease can be hard to diagnose. No single test can identify it. Parkinson can be easily mistaken for another health condition. A healthcare provider will usually take a medical history, including a family history to find out if anyone else in your family has Parkinson’s disease. He or she will also do a neurological exam. Sometimes, an MRI or CT scan, or some other imaging scan of the brain can identify other problems or rule out other diseases.

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Treatments Other Than Medication Or Surgery

Staying active and pursuing therapy can help you adjust your lifestyle with Parkinson’s disease. We offer a full range of therapy and other services to help you, including:

  • Exercise, physical, occupational and recreational therapy to keep you mobile, living your life and doing things your enjoy
  • Nutrition and speech therapy to help with throat and swallowing issues.
  • Mental health support and social services to treat depression and anxiety stemming from disease-related challenges, such as lifestyle changes.

Learn more about the nonsurgical- and nonmedication-based Parkinson’s disease programs we offer. Talk to your care team about these and additional options.

We will also provide you with resources to manage your Parkinson’s Disease including new patient orientation, classes, support groups and links to national associations.

How Parkinsonism Differs From Parkinsons Disease

Parkinsons disease is one of many types of parkinsonism. Its caused by a loss of cells in the part of your brain that produces the neurotransmitter dopamine.

Parkinsons disease and the different types of parkinsonism progress in different ways. Some may progress more rapidly than Parkinsons disease. Others, like secondary parkinsonism, may be reversible.

The conditions also respond differently to treatments. For instance, someone who has a type of parkinsonism may not respond to the drug levodopa, which is commonly used for Parkinsons disease.

It can be hard to tell the difference between types of parkinsonism. Heres a look at some of the identified categories of parkinsonism with their typical symptoms and treatments.

  • involuntary muscle contractions


No treatment has been found to slow the progression of corticobasal syndrome. Parkinsons drugs are generally ineffective but may help manage stiffness in some people.

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