Co-occurrence of Binswanger dementia with vascular Parkinsonism – A case report

Vascular dementia (VaD) is the second most common form of dementia, after Alzheimer’s dementia. Binswanger’s disease is a slowly progressive, non-hereditary form of VaD. Herein, we describe the rare co-occurrence of Binswanger’s disease with vascular Parkinsonism (VP). This is a case of an elderly gentleman with a background of cerebrovascular disease that presented with mild cognitive and severe executive dysfunction alongside early gait and urinary disturbances. Neuroimaging with magnetic resonance imaging demonstrated characteristic white matter hyperintensities with vascular involvement. With this clinical– radiological profile, a diagnosis of Binswanger dementia was established according to the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences (NINDS-AIREN) diagnostic criteria. These criteria classify VaD into probable, possible and definite VaD based on the presence of clinical signs of dementia, clinical and radiological evidence of cerebrovascular disease, and a clear temporal relationship between the onset of dementia and cerebrovascular events. However, the incidence of bradykinesia and lower limb–predominant rigidity raised the possibility of a coexisting VP. The co-occurrence of the two established an academic interest. Furthermore, the patient showed unsatisfactory response to Levodopa-Carbidopa and was treated with cholinesterase inhibitor; rivastigmine; and neuroprotective piracetam. A stringent control of risk factors is imperative in preventing another vascular event. However, the prognosis of Binswanger dementia is poor as there are no means to deter the progression of the disease.