Objective: To establish a clinical scoring system to differentiate between vascualar from degenerative parkinsonism.

Background: Vascular parkinsonism (VP) constitutes (5-8) % of all parkinsonian disorders. Despite several existing diagnostic criteria for VP, there is no standard clinical grading scale for VP analogous to those for vascular dementia, like Hachinski score.

Method: Records of all patients with parkinsonism presenting to tertiary neurology referral hospital were reviewed. Independent predictors of VP were identified by logistic regression. A stratification scale (VP Score) was developed with the weighting of independent predictors based on the strength of association.

Results: Factors independently associated with VP were h/o stroke(P<0.001), strict unilateral involvement (P=0.001), pyramidal sign (P=0.03), bulbar dysfunction (P=0.047), and presence of vascular risk factors (P=0.021). Factors independently associated with degenerative parkinsonism were RBD (P<0.001), orthostatic hypotension (P=0.001), rest tremor (P=0.03), hallucination (P=0.047), and levodopa-induced dyskinesia (P=0.052). The VP Score was the sum of individual points assigned as follows: h/o stroke (+1), presence of vascular risk factors (+1), strict unilateral involvement (+1), pyramidal sign (+1), bulbar dysfunction (+1), RBD (-1), orthostatic hypotension (-1), rest tremor (-1), hallucination (-1), levodopa-induced dyskinesia (-1). All 11patients with a VP Score of 3 had a diagnosis of VP, and all 86patients with a VP Score of (-3) had a diagnosis of degenerative parkinsonism. The chance of diagnosing vascular parkinsonism increased steadily with VP Score (P<0.005).

Conclusion: The proposed VP Score is a simple clinical scoring system that allows stratification of parkinsonism based on clinical presentation into vascular or degenerative. The use of such a scoring system could improve standardization of clinical treatment protocols and clinical research studies in the field of parkinsonism.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/vascular-parkinsonism-vp-score-a-clinical-scoring-system-to-differentiate-between-vascular-from-degenerative-parkinsonism/