Table 3.

Updated diagnostic approach VaPark subtypes

	Acute/subacute Post-stroke VaPark	Insidious VaPark	Mixed neurodegenerative parkinsonism and CVD (mixed PD/CVD)
Obligatory	Acute/subacute onset of parkinsonism (typically) asymmetric Imaging evidence of stroke in the nigrostriatal pathway	Progressive disease (insidious or stepwise) Mixed shuffling/ataxic gait Postural instability Imaging evidence of cerebrovascular small vessel disease beyond the nigrostriatal pathway	Patients meeting clinical diagnostic criteria for probable neurodegenerative parkinsonism (PD, DLB, PSP, MSA, CBS, non-tau FTD parkinsonism) and Imaging evidence of cerebrovascular disease in location(s) that is/are spatially congruent with presenting parkinsonism, in particular postural instability and gait difficulties, upper motor neuron signs or incontinence.
Supportive	Presynaptic striatal dopamine transporter deficiency congruent with the stroke Preserved levodopa responsiveness	Freezing of gait Pyramidal signs Cognitive decline Urinary urgency/incontinence Pseudobulbar symptoms Absence of significant levodopa responsiveness	Abnormal striatal dopamine transporter imaging findings not explained by vascular lesions Abnormal cardiac sympathetic nerve terminal imaging findings
Non-supportive	Abnormal striatal dopamine transporter imaging findings not explained by nigrostriatal pathway vascular lesions Abnormal cardiac sympathetic nerve terminal imaging	Abnormal striatal dopamine transporter imaging findings not explained by striatal vascular lesions Abnormal cardiac sympathetic nerve terminal imaging findings	Normal striatal dopamine transporter imaging

Legend: CBS, corticobasal syndrome; CVD, cerebrovascular disease; DLB, dementia with Lewy bodies; FTD, frontotemporal dementia; MSA, multiple system atrophy; PD, Parkinson disease; PSP, progressive supranuclear palsy.