Surprising Synergy between Cerebrovascular and Lewy Body Disease in Parkinsonism

Parkinsonism is a common and heterogeneous clinical syndrome with symptoms that include rigidity, bradykinesia, tremor, and autonomic dysfunction. The classic substrate of Parkinsonism is Lewy body pathology (LBP), identified by the presence of α-synuclein inclusion bodies. However, non-LBP pathologies may also be associated with Parkinsonism. In this issue of Neurology®, Agrawal et al.¹ publish a study that confirms the association between Parkinsonism and LBP and also provide strong indication of the importance of cerebrovascular diseases (CVDs) as an underappreciated driver of Parkinsonism in older community-dwelling persons.