What to know about Former President George H.W. Bush's Vascular Parkinsonism

George H.W. Bush, who served as the 43^rd president of the United States, notably revealed that he has Vascular Parkinsonism in an interview by Parade Magazine. The severity of his condition wasn't as recognized until Super Bowl 51, when he went onto the field in a wheelchair. But, George H.W. Bush has been using a wheelchair and motorized scooters since 2012. 

While Vascular Parkinsonism mimics Parkinson’s disease, the two are not actually the same. The former is actually a syndrome while the latter is just as its name says— a disease. The two can’t be used interchangeably since they are different cases.

The difference between Vascular Parkinsonism and Parkinson’s disease

As Vascular Parkinsonism imitates a lot of characteristics of Parkinson’s disease, it still doesn't meet the same criteria. Since it is a syndrome, it only exhibits a number of symptoms that distinguish a specific condition. Vascular Parkinsonism occurs because of the problems in the region of the brain that manages the body's movement. These problems are often caused by small strokes. However, despite the fact that small strokes will increasingly intensify the symptoms of Vascular Parkinsonism, it is still not viewed as a developing neurodegenerative disease like Parkinson's disease.

The term ‘Parkinsonism’ covers a wide range of concepts, which involve many conditions that share similar symptoms as the Parkinson's disease. Actually, there are different types of Parkinsonism such as:

• Progressive Supranuclear Palsy (PSP)
• Multiple System Atrophy (MSA)
• Vascular Parkinsonism
• Dementia with Lewy Bodies
• Juvenile Parkinson’s disease
• Idiopathic Parkinson’s disease
• Corticobasal Degeneration (CBD)
• Essential tremor
• Drug-induced Parkinsonism
• Inherited Parkinson’s disease

From the list, Idiopathic Parkinson’s disease is the most common type of Parkinsonism. All of the conditions are considered to fall under ‘Parkinsonism’, but they are actually not the same and exhibit different symptoms apart from each other.

Then, what is Vascular Parkinsonism?

In 1929, Dr Macdonald Critchley from King’s College Hospital in London described Vascular Parkinsonism. Approximately 3 to 6% of the existing cases of Parkinsonism are estimated to have a vascular cause. Vascular Parkinsonism, otherwise called "multi-infarct", is a type of “atypical parkinsonism” where typical parkinsonian symptoms like tremor, stiffness, slow movements, rigidity and difficulty with walking and balance are caused by one or maybe more small strokes.

Patients that are diagnosed with Vascular Parkinsonism often experience a “lower body parkinsonism”. Due to that fact, they seemingly have troubles in walking and maintaining balance, which are also similar to patients with the classic Parkinson’s disease.

Former President George H.W. Bush also experiences these symptoms and currently uses a wheelchair. In an interview conducted by Parade Magazine in the year 2012, President Bush said, “It just affects the legs. It’s not painful. You tell your legs to move, and they don’t move. It’s strange, but if you have to have some bad-sounding disease, this is a good one to get.”

However, in general, people with Vascular Parkinsonism have a lesser chance to accumulate the tremor, which is experienced by patients with Parkinson’s disease.

In a study performed by Thiago Cardoso Vale, et. al., it was found out that approximately 15.1% of all the cases of Parkinsonism in a Brazilian Community were categorized as Vascular Parkinsonism. It had a prevalence rate of 1.1% in the elderly group. Another Brazilian-based study on Parkinsonism found out that a prevalence of approximately 2.3% of Vascular Parkinsonism in the same group.

Another study on Vascular Parkinsonism which was conducted by Joaquin A. Vizcarra, et. al., states that in diagnosing Vascular Parkinsonism, both the progressive ambulatory impairment and an abnormal white matter signal on neuroimaging appear together. However, upon assessing the syndrome, it was found out that there is no abnormal structural imaging pattern that shows Vascular Parkinsonism particularly. Also, a poor correlation exists between the Parkinsonism, the brain magnetic resonance imaging hyperintensities, and the microangiopathic brain disease from the existing accessible clinicopathologic data.

From the recent findings conducted by Sibon et. al., approximately 3 to 5% of all the existing cases of Parkinsonism was represented by Vascular Parkinsonism. Specific clinical features stated were lower body Parkinsonism, poor levodopa response, and a history of stroke.

There is still no scientific explanation as of today about the reason why some of the patients have Vascular Parkinsonism while other patients do not, even though they have the same visible vascular lesion load. There is still a need for further study and research to fully understand the syndrome and to create a criterion to increase the accuracy of diagnosing Vascular Parkinsonism.

What can cause the strokes which are associated with Vascular Parkinsonism?

Unlike the symptoms of Parkinson's disease, the symptoms of Vascular Parkinsonism have the tendency to appear all of a sudden, but they normally do not progress. As of now, there is no existing study about the causes of mini-strokes, which are linked to Vascular Parkinsonism. These mini strokes may also differ from one person to another. Although, generally, most doctors suppose that diabetes and high blood pressure are the most probable causal factors. A heart disease can also play a role.

Dr Tanya Simuni, a doctor in Chicago, Illinois, said that people who are 70 and above are the most probable persons to be diagnosed with Vascular Parkinsonism. She also manages a lot of research about Parkinson’s and other movement disorders in Chicago. Dr Simuni considered Vascular Parkinsonism as a hard diagnosis since there is not enough diagnostic tests of this syndrome.

While the elderly cohort is the most likely to be diagnosed with Vascular Parkinsonism, the risk factors are similar to a stroke and heart disease—lack of exercise, poor diet, and a history of smoking. Vascular Parkinsonism is actually rarer than Parkinson’s disease wherein approximately 20,000 people in the United States have Vascular Parkinsonism as compared to 1 million Americans who are affected by Parkinson’s disease.

How is Vascular Parkinsonism treated?

Since Vascular Parkinsonism is different from Parkinson's disease, medications for Parkinson's do not always respond well with patients with Vascular Parkinsonism. Treatment would only rely on the prevention of accumulating the condition, like decreasing the chance of stroke. In short, it is recommended to exercise daily, eat a healthy diet, and quit smoking.

Dr Corneliu Luca, an Associate Professor of Neurology at the University of Miami, said that physical therapy can help the patients who have trouble with balance and walking, but the damage caused by Vascular Parkinsonism cannot be reversed. She also said that if the risk factors for stroke are not controlled, the patients can be diagnosed with another stroke and troubles associated with walking and balancing, which can get even worse.

Photo source: George H W Bush by DV V