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 for the recognition of mixed or overlapping syndromes of VaP with Parkinson's disease or other neurodegenerative parkinsonisms. Directions for future research are also discussed.

2nd Department of Neurology Faculty of Medicine Comenius University Bratislava Slovak Republic

Department of Neurology Hospital Nitra Slovak Republic

Department of Neurology Institute of Neurosciences Kolkata India

Department of Neurology Rambam Health Care Campus Technion Faculty of Medicine Haifa Israel

Department of Neurology Sackler Faculty of Medicine Tel Aviv University Ramat Aviv 69978 Israel

Department of Neurology University Medical Centre Ljubljana Slovenia

Departments of Radiology and Neurology University of Michigan and Ann Arbor VA Medical Center Ann Arbor MI USA

Ivano Frankivsk Medical University Department of Neurology and Neurosurgery Ivano Frankivsk Regional Hospital Vascular Neurology Department Ivano Frankivsk Ukraine

Masaryk University Central European Institute of Technology CEITEC Neuroscience Centre and Movement Disorders Centre Brno Czech Republic

Neurology Department St Adalbert Hospital Department of Neurological Psychiatric Nursing Medical University of Gdansk Gdansk Poland

Radboud University Nijmegen Medical Center Donders Institute Brain Cognition and Behaviour Center for Neuroscience Department of Neurology Nijmegen The Netherlands

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Parkinsonism Relat Disord. 2018 Jul;52:107-108. doi: 10.1016/j.parkreldis.2018.03.005. PubMed

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Parkinsonism Relat Disord. 2018 Jul;52:109-110. doi: 10.1016/j.parkreldis.2018.03.004. PubMed

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Zijlmans JC, Daniel SE, Hughes AJ, Revesz T, Lees AJ. Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis. Mov Disord. 2004;19:630–40. PubMed

Vizcarra JA, Lang AE, Sethi KD, Espay AJ. Vascular Parkinsonism: deconstructing a syndrome. Mov Disord. 2015;30:886–94. PubMed PMC

Korczyn AD. Vascular parkinsonism--characteristics, pathogenesis and treatment. Nat Rev Neurol. 2015;11:319–26. PubMed

Antonini A, Vitale C, Barone P, Cilia R, Righini A, Bonuccelli U, Abbruzzese G, Ramat S, Petrone A, Quatrale R, Marconi R, Ceravolo R, Stefani A, Lopiano L, Zappia M, Capus L, Morgante L, Tamma F, Tinazzi M, Colosimo C, Guerra UP. The relationship between cerebral vascular disease and parkinsonism: The VADO study. Parkinsonism Relat Disord. 2012;18:775–80. PubMed

Rektor I, Rektorova I, Kubova D. Vascular parkinsonism--an update. J Neurol Sci. 2006;248:185–91. PubMed

Nutt JG, Marsden CD, Thompson PD. Human walking and higher-level gait disorders, particularly in the elderly. Neurology. 1993;43:268–79. PubMed

Critchley M. Arteriosclerotic parkinsonism. Brain. 1929;52:23–83.

Fenelon G, Houeto JL. Vascular Parkinson syndromes: a controversial concept. Rev Neurol (Paris) 1998;154:291–302. PubMed

Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55:181–4. PubMed PMC

Winikates J, Jankovic J. Clinical correlates of vascular parkinsonism. Arch Neurol. 1999;56:98–102. PubMed

Jellinger KA. Prevalence of cerebrovascular lesions in Parkinson’s disease. A postmortem study. Acta Neuropathol. 2003;105:415–9. PubMed

de Reuck J, Sieben G, de Coster W, vander Ecken H. Parkinsonism in patients with cerebral infarcts. Clin Neurol Neurosurg. 1980;82:177–85. PubMed

van der Holst HM, van Uden IW, Tuladhar AM, de Laat KF, van Norden AG, Norris DG, van Dijk EJ, Esselink RA, Platel B, de Leeuw FE. Cerebral small vessel disease and incident parkinsonism: The RUN DMC study. Neurology. 2015;85:1569–77. PubMed PMC

Glass PG, Lees AJ, Bacellar A, Zijlmans J, Katzenschlager R, Silveira-Moriyama L. The clinical features of pathologically confirmed vascular parkinsonism. J Neurol Neurosurg Psychiatry. 2012;83:1027–9. PubMed

Thompson PD, Marsden CD. Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger’s disease. Mov Disord. 1987;2:1–8. PubMed

Bohnen NI, Muller ML, Zarzhevsky N, Koeppe RA, Bogan CW, Kilbourn MR, Frey KA, Albin RL. Leucoaraiosis, nigrostriatal denervation and motor symptoms in Parkinson’s disease. Brain. 2011;134:2358–65. PubMed PMC

Fenelon G, Houeto JL. Unilateral parkinsonism following a large infarct in the territory of the lenticulostriate arteries. Mov Disord. 1997;12:1086–90. PubMed

Murrow RW, Schweiger GD, Kepes JJ, Koller WC. Parkinsonism due to a basal ganglia lacunar state: clinicopathologic correlation. Neurology. 1990;40:897–900. PubMed

Kim JS. Involuntary movements after anterior cerebral artery territory infarction. Stroke. 2001;32:258–61. PubMed

Sibon I, Fenelon G, Quinn NP, Tison F. Vascular parkinsonism. J Neurol. 2004;251:513–24. PubMed

Rosso AL, Bohnen NI, Launer LJ, Aizenstein HJ, Yaffe K, Rosano C. Vascular and dopaminergic contributions to mild parkinsonians signs in older adults. Neurology. 2018 in press. PubMed PMC

FitzGerald PM, Jankovic J. Lower body parkinsonism: evidence for vascular etiology. Mov Disord. 1989;4:249–60. PubMed

Gupta D, Kuruvilla A. Vascular parkinsonism: what makes it different? Postgrad Med J. 2011;87:829–36. PubMed

Thompson PD, Nutt JG. Gait Disorders. In: Robert B, Gerald M, Joseph J, John C, editors. Bradley’s neurology in clinical practice. 6. Vol. 2012. Philadelphia, PA: Elsevier/Saunders; c2012. pp. 260–72.

Nutt JG. Classification of Gait and Balance Disorders. In: Ružika E, Hallett M, Jankovic J, editors. Advances in Neurology. Philadelphia, PA: Lippincott Williams and Wilkins; 2001. pp. 135–41. PubMed

Nutt JG. Higher-level gait disorders: an open frontier. Mov Disord. 2013;28:1560–5. PubMed

Ebersbach G, Sojer M, Valldeoriola F, Wissel J, Muller J, Tolosa E, Poewe W. Comparative analysis of gait in Parkinson’s disease, cerebellar ataxia and subcortical arteriosclerotic encephalopathy. Brain. 1999;122( Pt 7):1349–55. PubMed

Zijlmans JC, Poels PJ, Duysens J, van der Straaten J, Thien T, van’t Hof MA, Thijssen HO, Horstink MW. Quantitative gait analysis in patients with vascular parkinsonism. Mov Disord. 1996;11:501–8. PubMed

Factor SA. The clinical spectrum of freezing of gait in atypical parkinsonism. Mov Disord. 2008;23(Suppl 2):S431–8. PubMed

Bazner H, Oster M, Daffertshofer M, Hennerici M. Assessment of gait in subcortical vascular encephalopathy by computerized analysis: a cross-sectional and longitudinal study. J Neurol. 2000;247:841–9. PubMed

Sakakibara R, Panicker J, Fowler CJ, Tateno F, Kishi M, Tsuyuzaki Y, Ogawa E, Uchiyama T, Yamamoto T. Vascular incontinence: incontinence in the elderly due to ischemic white matter changes. Neurol Int. 2012;4:e13. PubMed PMC

Zijlmans JC. The role of imaging in the diagnosis of vascular parkinsonism. Neuroimaging Clin N Am. 2010;20:69–76. PubMed

Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, Lindley RI, O’Brien JT, Barkhof F, Benavente OR, Black SE, Brayne C, Breteler M, Chabriat H, Decarli C, de Leeuw FE, Doubal F, Duering M, Fox NC, Greenberg S, Hachinski V, Kilimann I, Mok V, Oostenbrugge R, Pantoni L, Speck O, Stephan BC, Teipel S, Viswanathan A, Werring D, Chen C, Smith C, van Buchem M, Norrving B, Gorelick PB, Dichgans M nEuroimaging STfRVco. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12:822–38. PubMed PMC

Yamanouchi H, Nagura H. Neurological signs and frontal white matter lesions in vascular parkinsonism. A clinicopathologic study. Stroke. 1997;28:965–9. PubMed

van Veluw SJ, Zwanenburg JJ, Rozemuller AJ, Luijten PR, Spliet WG, Biessels GJ. The spectrum of MR detectable cortical microinfarcts: a classification study with 7-tesla postmortem MRI and histopathology. J Cereb Blood Flow Metab. 2015;35:676–83. PubMed PMC

Zijlmans J, Evans A, Fontes F, Katzenschlager R, Gacinovic S, Lees AJ, Costa D. [123I] FP-CIT spect study in vascular parkinsonism and Parkinson’s disease. Mov Disord. 2007;22:1278–85. PubMed

Espay AJ, Narayan RK, Duker AP, Barrett ET, Jr, de Courten-Myers G. Lower-body parkinsonism: reconsidering the threshold for external lumbar drainage. Nat Clin Pract Neurol. 2008;4:50–5. PubMed

Rektor I, Goldemund D, Sheardova K, Rektorova I, Michalkova Z, Dufek M. Vascular pathology in patients with idiopathic Parkinson’s disease. Parkinsonism Relat Disord. 2009;15:24–9. PubMed

Rektor I, Goldemund D, Bednarik P, Sheardova K, Michalkova Z, Telecka S, Dufek M, Rektorova I. Impairment of brain vessels may contribute to mortality in patients with Parkinson’s disease. Mov Disord. 2012;27:1169–72. PubMed

McKeith IG, Dickson DW, Lowe J, Emre M, O’Brien JT, Feldman H, Cummings J, Duda JE, Lippa C, Perry EK, Aarsland D, Arai H, Ballard CG, Boeve B, Burn DJ, Costa D, Del Ser T, Dubois B, Galasko D, Gauthier S, Goetz CG, Gomez-Tortosa E, Halliday G, Hansen LA, Hardy J, Iwatsubo T, Kalaria RN, Kaufer D, Kenny RA, Korczyn A, Kosaka K, Lee VM, Lees A, Litvan I, Londos E, Lopez OL, Minoshima S, Mizuno Y, Molina JA, Mukaetova-Ladinska EB, Pasquier F, Perry RH, Schulz JB, Trojanowski JQ, Yamada M Consortium on DLB. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology. 2005;65:1863–72. PubMed

Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, Wood NW, Colosimo C, Durr A, Fowler CJ, Kaufmann H, Klockgether T, Lees A, Poewe W, Quinn N, Revesz T, Robertson D, Sandroni P, Seppi K, Vidailhet M. Second consensus statement on the diagnosis of multiple system atrophy. Neurology. 2008;71:670–6. PubMed PMC

Litvan I, Agid Y, Jankovic J, Goetz C, Brandel JP, Lai EC, Wenning G, D’Olhaberriague L, Verny M, Chaudhuri KR, McKee A, Jellinger K, Bartko JJ, Mangone CA, Pearce RK. Accuracy of clinical criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome) Neurology. 1996;46:922–30. PubMed

Armstrong MJ, Litvan I, Lang AE, Bak TH, Bhatia KP, Borroni B, Boxer AL, Dickson DW, Grossman M, Hallett M, Josephs KA, Kertesz A, Lee SE, Miller BL, Reich SG, Riley DE, Tolosa E, Troster AI, Vidailhet M, Weiner WJ. Criteria for the diagnosis of corticobasal degeneration. Neurology. 2013;80:496–503. PubMed PMC

Leverenz JB, Yu CE, Montine TJ, Steinbart E, Bekris LM, Zabetian C, Kwong LK, Lee VM, Schellenberg GD, Bird TD. A novel progranulin mutation associated with variable clinical presentation and tau, TDP43 and alpha-synuclein pathology. Brain. 2007;130:1360–74. PubMed

Mosca L, Lunetta C, Tarlarini C, Avemaria F, Maestri E, Melazzini M, Corbo M, Penco S. Wide phenotypic spectrum of the TARDBP gene: homozygosity of A382T mutation in a patient presenting with amyotrophic lateral sclerosis, Parkinson’s disease, and frontotemporal lobar degeneration, and in neurologically healthy subject. Neurobiol Aging. 2012;33:1846, e1–4. PubMed

Navarro-Otano J, Gaig C, Muxi A, Lomena F, Compta Y, Buongiorno MT, Marti MJ, Tolosa E, Valldeoriola F. 123I-MIBG cardiac uptake, smell identification and 123I-FP-CIT SPECT in the differential diagnosis between vascular parkinsonism and Parkinson’s disease. Parkinsonism Relat Disord. 2014;20:192–7. PubMed

Brigo F, Matinella A, Erro R, Tinazzi M. [(1)(2)(3)I]FP-CIT SPECT (DaTSCAN) may be a useful tool to differentiate between Parkinson’s disease and vascular or drug-induced parkinsonisms: a meta-analysis. Eur J Neurol. 2014;21:1369–e90. PubMed

Mochel F, Schiffmann R, Steenweg ME, Akman HO, Wallace M, Sedel F, Laforet P, Levy R, Powers JM, Demeret S, Maisonobe T, Froissart R, Da Nobrega BB, Fogel BL, Natowicz MR, Lubetzki C, Durr A, Brice A, Rosenmann H, Barash V, Kakhlon O, Gomori JM, van der Knaap MS, Lossos A. Adult polyglucosan body disease: Natural History and Key Magnetic Resonance Imaging Findings. Ann Neurol. 2012;72:433–41. PubMed PMC

Jellinger KA. The pathology of Parkinson’s disease. Adv Neurol. 2001;86:55–72. PubMed

Choi SA, Evidente VG, Caviness JN, Shill HA, Sabbagh MN, Connor DJ, Hentz JG, Adler CH, Beach TG. Are there differences in cerebral white matter lesion burdens between Parkinson’s disease patients with or without dementia? Acta Neuropathol. 2010;119:147–9. PubMed PMC

Jansen WJ, Ossenkoppele R, Knol DL, Tijms BM, Scheltens P, Verhey FR, Visser PJ, Aalten P, Aarsland D, Alcolea D, Alexander M, Almdahl IS, Arnold SE, Baldeiras I, Barthel H, van Berckel BN, Bibeau K, Blennow K, Brooks DJ, van Buchem MA, Camus V, Cavedo E, Chen K, Chetelat G, Cohen AD, Drzezga A, Engelborghs S, Fagan AM, Fladby T, Fleisher AS, van der Flier WM, Ford L, Forster S, Fortea J, Foskett N, Frederiksen KS, Freund-Levi Y, Frisoni GB, Froelich L, Gabryelewicz T, Gill KD, Gkatzima O, Gomez-Tortosa E, Gordon MF, Grimmer T, Hampel H, Hausner L, Hellwig S, Herukka SK, Hildebrandt H, Ishihara L, Ivanoiu A, Jagust WJ, Johannsen P, Kandimalla R, Kapaki E, Klimkowicz-Mrowiec A, Klunk WE, Kohler S, Koglin N, Kornhuber J, Kramberger MG, Van Laere K, Landau SM, Lee DY, de Leon M, Lisetti V, Lleo A, Madsen K, Maier W, Marcusson J, Mattsson N, de Mendonca A, Meulenbroek O, Meyer PT, Mintun MA, Mok V, Molinuevo JL, Mollergard HM, Morris JC, Mroczko B, Van der Mussele S, Na DL, Newberg A, Nordberg A, Nordlund A, Novak GP, Paraskevas GP, Parnetti L, Perera G, Peters O, Popp J, Prabhakar S, Rabinovici GD, Ramakers IH, Rami L, Resende de Oliveira C, Rinne JO, Rodrigue KM, Rodriguez-Rodriguez E, Roe CM, Rot U, Rowe CC, Ruther E, Sabri O, Sanchez-Juan P, Santana I, Sarazin M, Schroder J, Schutte C, Seo SW, Soetewey F, Soininen H, Spiru L, Struyfs H, Teunissen CE, Tsolaki M, Vandenberghe R, Verbeek MM, Villemagne VL, Vos SJ, van Waalwijk van Doorn LJ, Waldemar G, Wallin A, Wallin AK, Wiltfang J, Wolk DA, Zboch M, Zetterberg H Amyloid Biomarker Study G. Prevalence of cerebral amyloid pathology in persons without dementia: a meta-analysis. JAMA. 2015;313:1924–38. PubMed PMC

Bennett DA, Schneider JA, Arvanitakis Z, Kelly JF, Aggarwal NT, Shah RC, Wilson RS. Neuropathology of older persons without cognitive impairment from two community-based studies. Neurology. 2006;66:1837–44. PubMed

Ghebremedhin E, Rosenberger A, Rub U, Vuksic M, Berhe T, Bickeboller H, de Vos RA, Thal DR, Deller T. Inverse relationship between cerebrovascular lesions and severity of lewy body pathology in patients with lewy body diseases. J Neuropathol Exp Neurol. 2010;69:442–8. PubMed

Frey KA, Koeppe RA, Kilbourn MR, Vander Borght TM, Albin RL, Gilman S, Kuhl DE. Presynaptic monoaminergic vesicles in Parkinson’s disease and normal aging. Ann Neurol. 1996;40:873–84. PubMed

Bohnen NI, Muller ML, Kuwabara H, Cham R, Constantine GM, Studenski SA. Age-associated striatal dopaminergic denervation and falls in community-dwelling subjects. J Rehabil Res Dev. 2009;46:1045–52. PubMed PMC

Muller ML, Frey KA, Petrou M, Kotagal V, Koeppe RA, Albin RL, Bohnen NI. beta-Amyloid and postural instability and gait difficulty in Parkinson’s disease at risk for dementia. Mov Disord. 2013;28:296–301. PubMed PMC