Movement symptoms caused by vascular damage
Vascular parkinsonism is a condition that causes Parkinson’s-like symptoms, which develop due to tiny strokes or chronic changes to small blood vessels, damaging areas in the brain that affect movement-control pathways.
Certain groups of people are more commonly affected by this vascular parkinsonism, including those with:
- a history of stroke – including small, sometimes unnoticed (‘silent’) strokes, which can accumulate and affect movement control
- diabetes or high cholesterol – both of which increase the risk of small strokes and vascular changes in the brain
- high blood pressure – particularly when longstanding or poorly controlled, as this contributes to small vessel damage over time.
Over time, vascular parkinsonism typically affects:
- walking and balance
- movement speed and stiffness, particularly in the legs
- tremor, which is usually mild, different in pattern or absent compared with typical Parkinson’s disease
- bladder control, in some cases
- thinking and memory, particularly if small vessel damage is widespread.
What happens in the brain?
Vascular parkinsonism develops when small strokes or chronic small vessel disease damage parts of the brain and pathways that control movement.
What increases the risk of vascular parkinsonism?
This condition is driven by vascular damage rather than a distinct neurodegenerative process, so its risk factors closely mirror those for stroke and other vascular disease.
Factors that can’t be changed include:
- age – risk increases as people get older, particularly from the mid-60s onward
- family history – having a close relative with stroke or vascular disease may slightly increase risk
- prior stroke – having had one or more strokes, including small ‘silent’ strokes, increases the likelihood of developing vascular parkinsonism.
Factors that may be modifiable, meaning they can potentially be reduced through lifestyle changes or medical care, include:
- being overweight or physically inactive – both linked to a higher risk of vascular disease generally
- diabetes – poorly controlled blood sugar can damage blood vessels over time, including those supplying the brain
- heart conditions – irregular heart rhythms and other heart disease can increase the risk of blood clots reaching the brain
- high blood pressure – well-managed blood pressure helps protect the brain’s small blood vessels
- high cholesterol – contributes to narrowing and hardening of blood vessels, reducing blood flow
- smoking – damages blood vessels throughout the body and brain, which increases stroke risk.
Common patient questions
No, vascular parkinsonism is not the same as Parkinson’s disease. They can look alike because both can cause slowness and stiffness, but the causes are different:
- Parkinson’s disease is usually due to a gradual loss of brain cells that make dopamine (a chemical that helps control movement)
- vascular parkinsonism is usually due to poor blood flow in the brain, often from small strokes or long-term damage to small blood vessels.
Vascular parkinsonism often:
- affects the legs and walking more than the arms
- has little or no tremor
- does not improve much with levodopa (a common Parkinson’s medicine), because dopamine loss is not the main problem.
While the vascular damage causing this condition typically doesn’t reverse, managing underlying risk factors can help prevent further damage and slow progression.
No. It is related to vascular risk factors and blood vessel health rather than inherited or genetic causes. However, some vascular risk factors, such as high blood pressure or diabetes, can run in families.
The main treatment focuses on controlling vascular risk factors, such as blood pressure, cholesterol and diabetes, to reduce further damage. This should be done in consultation with your GP or specialist as part of an ongoing care plan.
Physiotherapy for walking and balance, occupational therapy for daily living support and a trial of Parkinson’s medication may also be considered in some cases. However, the response to medication is often limited.