Diagnosis of vascular parkinsonism: A new tool for gait hypokinesia occurring in older persons

• Published in: Parkinsonism & related disorders Vol. 109; p. 105360
• Main Authors: Kiesmann, Michèle, Martin, Raphaël Ewald, Sauleau, Erik, Bulubas, Irina, Fleury, Marie Céline, Perisse, Jérémie, Kaltenbach, Georges, Schmitt, Elise
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2023
• Subjects: Aged; Aged, 80 and over; Female; Gait; Humans; Hypokinesia - diagnosis; Hypokinesia - etiology; Male; Movement Disorders; Older persons; Parkinson Disease, Secondary - diagnosis; Parkinson Disease, Secondary - etiology; Parkinson's disease; Parkinsonian Disorders - complications; Parkinsonian Disorders - diagnosis; Tremor - epidemiology; Vascular Diseases; Vascular parkinsonism; Parkinson's disease; Gait; Vascular parkinsonism; Older persons
• ISSN: 1353-8020; 1873-5126
• DOI: 10.1016/j.parkreldis.2023.105360

Reliable diagnosis of vascular parkinsonism (VaP) in the presence of a gait hypokinesia is an issue that is encountered in geriatrics. The EVAMAR-AGEX study was focusing on the phenomenon of recurrent falls in older persons (OP) with this parkinsonian gait. The present study is focusing on the diagnosis of VaP-related parkinsonian gait by developing a diagnostic guidance model adapted to OP.
Data from baseline and the 2-year follow-up visit were used to carry out univariate analysis and calculation of odds ratios, allowing to identify relevant variables to include in the diagnostic guidance model. To evaluate the model, confusion matrices were created, evaluating true positive, false negative, false positive and true negative incidences, sensitivity and specificity, and negative and positive predictive values.
79 patients included 58% male; average age 81.24 years. VaP diagnosis according to Zijlmans criteria occurred in 28%; neurodegenerative parkinsonian syndromes in 72%. A 4-criteria model was established to facilitate diagnostic: lack of prior hallucinations, lack of movement disorders tremor excluded, no cognitive fluctuations, and ≥75 years of age at diagnosis. In combination of 4/4 criteria, all of them were required to disclose a specificity of 91% in the diagnosis of VaP. In combination of 3/4, in case of negative test, a negative predictive value for VaP diagnosis of 0.97 was obtained.
The challenge of our tool is both to be able to rule out what is probably not a VaP and to argue what makes a VaP diagnosis probable in OP.
•The most relevant slow gait of neurological origin is the parkinsonian gait.•The two main etiologies are vascular (VaP) and neurodegenerative parkinsonism.•Distinguishing the etiology of gait hypokinesia is clinically relevant.•We have developed a new tool of four items as diagnostic guidance.•It is able to rule out what is probably not a VaP and what makes a VaP probable.