Abstract: OBJECTIVE To investigate the effect of pramipexole on non-motor symptoms and oxidative stress in elderly patients with vascular parkinsonism (VP). METHODS A total number of 96 elderly patients with VP who were treated in Fenghua People's Hospital of Ningbo from January 2015 to June 2016 were randomly divided into 2 groups, each of 48 cases. Two groups were treated with anticoagulation, circulation improvement and nerve nutrition therapy, and on this basis, the observation group was treated with pramipexole, while the control group was treated with madopar. Before treatment and at 12 months after treatment, the changes of unified Parkinson's disease rating scale (UPDRS), Hamilton depression scale (HAMD), functional activities questionnaire (FAQ) and pittsburgh sleep quality index (PSQI) were tested and evaluated; the conditions of abnormal body feeling and autonomic nerve symptoms were counted, at the same time, fasting blood in patients were collected to detect the changes of serum malondialdehyde (MDA), homocysteine (Hcy), serum calcium and paraoxonase-1 (PON-1) in 2 groups. RESULTS Before treatment, the scores of UPDRS, HAMD, FAQ and PSQI, and the expression of MDA, Hcy, calcium and PON-1 in serum of 2 groups showed no significant differences. After treatment, the above indexes were significantly better than those before treatment in two groups, and the scores of UPDRS, HAMD, FAQ, PSQI in the observation group were significantly lower than those in the control group (P<0.05), the levels of MDA and Hcy were significantly lower than those in the control group (P<0.05), PON-1 was significantly higher than that in the control group (P<0.05). The incidences of abnormal body feeling and autonomic nerve symptoms in the observation group were significantly lower than those in the control group (P<0.05). CONCLUSION Pramipexole can effectively improve non-motor symptoms and inhibit oxidative stress injury in elderly patients with VP, which may contribute to the better clinical outcomes.