Vascular Parkinsonism

Vascular Parkinsonism is a Parkinson-like syndrome caused by small vessel disease or multiple tiny strokes affecting the brain regions that control movement. People often develop slowness, gait disturbance, and balance problems, typically with symptoms that affect the legs more than the arms.

At The Royal Buckinghamshire Hospital, we support adults living with vascular parkinsonism through consultant-led inpatient neurorehabilitation. Our goal is to improve walking, stability, confidence, and independence.

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What Causes Vascular Parkinsonism?

Vascular parkinsonism results from reduced blood flow or small infarcts in movement pathways (often the basal ganglia and frontal-subcortical circuits). Common contributors include:

• Long-standing high blood pressure
• Diabetes and high cholesterol
• Small vessel disease (chronic changes on brain imaging)
• Previous ischaemic strokes or silent infarcts
• Smoking and cardiovascular risk factors

Unlike idiopathic Parkinson’s disease, symptoms are driven by vascular damage, not loss of dopamine-producing cells alone.

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Symptoms

Symptoms tend to develop gradually and may include:

• Gait disturbance: shuffling steps, difficulty initiating walking, “lower-body parkinsonism”
• Postural instability and frequent falls
• Slowness of movement (bradykinesia)
• Rigidity (often milder than in Parkinson’s disease)
• Reduced stride length and difficulty turning
• Cognitive slowing, reduced attention, or apathy (in some patients)
• Urinary urgency and vascular risk factors in the history

Tremor is less prominent than in idiopathic Parkinson’s disease.

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How Is It Diagnosed?

Diagnosis is clinical, supported by history and examination. A neurologist may arrange:

• MRI brain to look for small vessel disease or lacunar infarcts
• CT brain if MRI is unsuitable
• Vascular risk assessment (blood pressure, lipids, diabetes screening)
• Trial of dopaminergic medication (response is often limited)

If you require imaging or specialist review, your GP/consultant can arrange referral pathways.

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Treatment And Management

There is no single curative treatment. Management focuses on:

• Optimising vascular risk factors: blood pressure, diabetes, lipids, smoking cessation, weight and activity
• Medication: some benefit from levodopa or other symptomatic therapies, though response varies
• Physiotherapy-led gait retraining and balance work
• Occupational therapy for home safety, fatigue, and daily tasks
• Falls prevention strategies and walking aids (correctly prescribed and trained)
• Cognitive support where attention or planning is affected

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Rehabilitation At The Royal Buckinghamshire Hospital

Our inpatient neurorehabilitation programmes support adults with mobility, balance, and confidence problems due to vascular parkinsonism or small vessel disease.

Your programme may include:

• Neurophysiotherapy: gait initiation, cueing strategies, step length, dual-task training, strength and endurance
• Occupational therapy: energy conservation, safe transfers, home/environment adaptations, goal-based re-engagement in daily life
• Falls prevention: postural stability, turning practice, assistive device optimisation
• Neuropsychology: attention and executive strategies, mood support, adjustment to long-term condition
• Education: self-management, risk-factor modification, relapse and fall-prevention plans
• Discharge planning: structured home exercise, community follow-up recommendations

Explore Our Rehabilitation Centre
Learn About Parkinson’s Rehabilitation

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When To Consider Inpatient Rehab

• Walking has become unsafe or you’re experiencing recurrent falls
• Marked slowness, freezing, or difficulty turning
• Fatigue, reduced confidence, or fear of falling limits activity
• You need co-ordinated input from physiotherapy, occupational therapy, and psychology
• Outpatient therapy has not delivered sufficient progress

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Living Well With Vascular Parkinsonism

• Keep blood pressure and diabetes well-controlled
• Follow a supervised activity plan to maintain strength and balance
• Use external cues (metronome beats, counting, floor markers) to assist gait initiation and step length
• Review footwear and home hazards to reduce falls
• Address sleep, mood, and cognition, which can affect mobility