An updated diagnostic approach to subtype definition of vascular parkinsonism - Recommendations from an expert working group

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Authors	REKTOR Ivan BOHNEN N.I. KORCZYN A.D. GRYB V. KUMAR H. KRAMBERGER M.G. DE LEEUW F.E. PIRTOSEK Z. REKTOROVÁ Irena SCHLESINGER I. SLAWEK J. VALKOVIC P. VESELÝ Branislav
Year of publication	2018
Type	Article in Periodical
Magazine / Source	PARKINSONISM & RELATED DISORDERS
MU Faculty or unit	Central European Institute of Technology
Citation
Web	https://www.sciencedirect.com/science/article/pii/S1353802017308696?via%3Dihub
Doi	http://dx.doi.org/10.1016/j.parkreldis.2017.12.030
Keywords	Binswanger's disease; Cerebrovascular disease; Gait; Vascular parkinsonism; Imaging
Description	This expert working group report proposes an, updated approach to subtype definition of vascular parkinsonism (VaP) based on a review of the existing literature. The persistent lack of consensus on clear terminology and inconsistent conceptual definition of VaP formed the impetus for the current expert recommendation report. The updated diagnostic approach intends to provide a comprehensive tool for clinical practice. The preamble for this initiative is that VaP can be diagnosed in individual patients with possible prognostic and therapeutic consequences and therefore should be recognized as a clinical entity. The diagnosis of VaP is based on the presence of clinical parkinsonism, with variable motor and non motor signs that are corroborated by clinical, anatomic or imaging findings of cerebrovascular disease. Three VaP subtypes are presented: (1) The acute or subacute post-stroke VaP subtype presents with acute or subacute onset of parkinsonism, which is typically asymmetric and responds to dopaminergic drugs; (2) The more frequent insidious onset VaP subtype presents with progressive parkinsonism with prominent postural instability, gait impairment, corticospinal, cerebellar, pseudobulbar, cognitive and urinary symptoms and poor responsiveness to dopaminergic drugs. A higher-level gait disorder occurs frequently as a dominant manifestation in the clinical spectrum of insidious onset VaP, and (3) With the emergence of molecular imaging biomarkers in clinical practice, our diagnostic approach also allows the recognition of mixed or overlapping syndromes of VaP with Parkinson's disease or other neurodegenfor erative parkinsonisms. Directions for future research are also discussed. (C) 2018 Elsevier Ltd. All rights reserved.