Vascular parkinsonism

From James Beck, Ph.D., Director of Research Programs

Recently, former President George H.W. Bush revealed in an interview with PARADE Magazine that he has vascular parkinsonism.

While not meeting the criteria for true Parkinson’s disease (PD), vascular parkinsonism mimics many features of PD.  As its name implies, vascular parkinsonism is often due to problems with the vessels in the brain regions that control movement and small strokes are the primary cause.  Although small strokes will cumulatively worsen the symptoms of vascular parkinsonism, it is otherwise not considered a progressive neurodegenerative disease like PD.

People with vascular parkinsonism often experience a “lower body parkinsonism” and have trouble with walking and maintaining balance – much like people with classic Parkinson's.  President Bush reports that he experiences such symptoms.  Generally, people with vascular PD are less likely to have the tremor of Parkinson’s disease.

Because the cause of vascular parkinsonism is fundamentally different from true PD, people do not always respond well to the current Parkinson’s disease medications.

Like all people who struggle with a neurological disease, President Bush has many obstacles to overcome.  Because his disease can mimic true PD, his story emphasizes the importance of getting an accurate diagnosis from a movement disorders specialist in order to best manage one’s disease.  PDF maintains a nationwide list of movement disorder specialists and encourages you to call (800) 457-6676 or email us at info@pdf.org to find one in your area.

Notes from AAN 2011, Part II: Which Doctors Treat Parkinson's?

From James Beck, Ph.D., Director of Research Programs

As mentioned last week, this year the American Academy of Neurology held its annual convention in Honolulu, Hawaii, attracting nearly 7,000 neurologists and neuroscientists.

I wanted to provide you with an update of interesting and new developments that were presented at the meeting last week, in particular, three studies which discussed whom people with living with Parkinson's disease see for their care.

#1-The first was a health economics presented by Marcy Tarrants, Ph.D., of Teva Neuroscience and her colleagues (presentation P01.087).

This group examined the records of newly-filled prescriptions for people diagnosed with Parkinson's and found that, overall:

• the prescribing doctor was a neurologist (both general and movement disorder specialists) in 46 percent of the cases;
• while the prescribing doctor was an internist or primary care physician in another 41 percent of cases.
  

However, when one examines whether those prescriptions are for new treatments (think newly diagnosed or just starting a medication) or for existing treatments (those who have been living with the disease), the numbers shifted:

• only 40 percent of the new treatment prescriptions were from neurologists;
• versus 59 percent of existing treatment prescriptions being made by neurologists.
  

#2- A similar study by Benjamin George, a medical student at the University of Rochester, and his colleagues who worked under the mentorship of Ray Dorsey, M.D., M.BA., now at Johns Hopkins University (presentation P01.088) found in a small study that:

• only 30 percent of those individuals with Parkinson's living in nursing homes see a neurologist;

• the rest see primary care physician or internist 50 percent of the time;

• and 20 percent see no physician at all.

#3-The results of the first two studies tie into the outcomes reported from a related report by Karen Zheng and colleagues working under the mentorship of Melissa Nirenberg, M.D., Ph.D., from the PDF Research Center at Weill Cornell Medical Center. (see photo; presentation P01.081). In a chart review of 120 people with Parkinson's, this group examined the underlying cause of those 25 percent who experienced acute worsening of their Parkinson's motor symptoms, or exacerbations. They found two main causes of exacerbations: infections and medication problems: about 25 percent suffered an infection, often a urinary tract infection, and 35 percent had problems with pharmacy errors or taking their medications on time (evenly split). While many of the exacerbations were reversible, about a third had recurrent problems and about a fifth never improved.



The lesson here is that prompt medical attention by someone trained to recognize the complications of Parkinson's by, you guessed it, a movement disorder specialist is important to achieving the best outcomes to these exacerbations.

Conclusions
These numbers in the first two studies, and the conclusions of the third, reiterate a concern that PDF has for PD community: not enough people are seeing the medical specialists who can best treat their disease.

PDF recommends everyone with PD see a movement disorder specialist or, if one is not in your area, a neurologist who can perhaps work with a specialist that you travel to see once or twice a year.

Do you need a recommendation? Call PDF to find the specialist nearest to you.

Please share your thoughts on these studies and check for further reports!