Comparative Study Of Clinical Features,imaging Characteristics And Olfactory Function Between Vascular Parkinsonism And Parkinson's Disease

ObjectiveTo study and compare the clinical expressions,imaging features and olfactory function in of vascular parkinsonism(VP) and Parkinson disease (PD),in order to define the clinical ,imaging and olfactory characteristics and estimate the value of these parameters in differential diagnosis of VP and PD.MethodsThirty seven patients with vascular parkinsonism(n=37), forty patients with PD(n=40) and forty nomal controls matched for age and sex were selected as objects of study. Demographic materials and history were collected, the clinical feature were collected and analyzed using Unified Parkinson's Disease Rating Scale (UPDRS-I,II,III) score,Hoehn-Yahr scale, Hamilton Depression Scale(HAMD),National Institutes of Health Stroke Scale(NIHSS) score, and Mini-mental state examination(MMSE).The cranial MRI were performed and the imaging features were analyzed.Olfactory functions were examined using test method designed by Connecticut Chemosensory Clinical Research Center(CCCRC) in 31 patients with VP, 40 patients with PD, and 40 normal controls.Results1. While the general UPDRS scores were not significantly different for VP group and PD group,the history,average onset age and clinical features had some distint expressions for the two groups . Specifically ,patients with VP ,with an older average onset age ,had a significantly higher frequencies of risk factors for stroke such as hypertension ,atherosclerosis , diabetes mellitus and tansitent ischemic attack,than PD group. Most of the VP patients had a history of stroke while patients with PD seldom had. Pakinsonism symtoms in VP patients were untypical and had following characteristics:Symptom distribution in VP was mostly symetrical,the arms were more severely affected than legs. Tremor was mostly postural and kinetic,while rest tremor was uncommon and milder even if presented,no patient showed typical pill-rolling tremor.Increased muscle tone was mostly lead-pipe like rigidity or a combination of spasticity and rigidity,cogwheel like rigidity was uncommon. Bradykinesia of varying degree was often seen,but usually less apparent than PD.Gait disturbance ,mainly presented as wide-base short-stepped gait ,was common and obvious,the posture was mostly upright or slightly stooped, the characteristic stooped posture commonly seen in idiopathic PD was not observed.Non movement symptoms such as"oily face"and constipation were less common in VP,while the cognitive impairment, pyramidal tracts sign, pseudobulbar palsy and incontinence were often presented. The NIHSS score was significantly higher in patients with VP.2.MRI in VP mainly displayed multiple lacunar infarcts in basal ganglia and periventricular cerebral white matter ,frequently accompanied with cerebral atrophy or leukoaraiosis,only individual patient showed single infarcts in basal ganglia. MRI in PD generally showed mild cerebral atropy and slight hyperintense signal in periventricular areas commonly seen in nomal aging stages, a small group PD patients had a few lacunar infarcts in basal ganglia or cerebral white matter.3.CCCRC scores in VP (56.97±12.86) were significantly higer than in PD (36.43±23.04)(P<0.001), and did not differ from the healthy controls. There was no association observed between the olfactory function and the age, duration of disease, UPDRS score and H-Y leve1. ConclusionsVP is mainly expressed as atypical parkinsonism involving both of pyramidal and extrapyramidal system ,the clinical features of VP have some characteristics different from idiopathic PD. Patients with VP have prominant ischemic imaging feature and normal olfactory funcions ,in contrast to imaging of normal aging or mild lucular infarcts and impaired olfactory function for PD patients,as displayed by cerebral MRI study and olfactory function test,suggesting that cerebral imaging and olfactory function test are helpful in the differential diagnosis of VP and PD.