Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease

Malek, N. et al. (2016) Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease. Movement Disorders, 31(10), pp. 1518-1526. (doi: 10.1002/mds.26698) (PMID:27324570) (PMCID:PMC5082556)

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Abstract

Objective The purpose of this study was to examine the relationship between vascular disease (and vascular risk factors), cognition and motor phenotype in Parkinson's disease (PD). Methods Recently diagnosed PD cases were enrolled in a multicenter prospective observational longitudinal cohort study. Montreal cognitive assessment (normal >23, mild cognitive impairment 22 to 23 or lower but without functional impairment, and dementia 21 or less with functional impairment) and Movement Disorder Society Unified PD Rating Scale part 3 (UPDRS 3) scores were analyzed in relation to a history of vascular events and risk factors. Results In 1759 PD cases, mean age 67.5 (standard deviation 9.3) years, mean disease duration 1.3 (standard deviation 0.9) years, 65.2% were men, 4.7% had a history of prior stroke or transient ischemic attack, and 12.5% had cardiac disease (angina, myocardial infarction, heart failure). In cases without a history of vascular disease, hypertension was recorded in 30.4%, high cholesterol 27.3%, obesity 20.7%, diabetes 7.2%, and cigarette smoking in 4.6%. Patients with prior stroke or transient ischemic attack were more likely to have cognitive impairment (42% vs 25%) and postural instability gait difficulty (53.5% vs 39.5%), but these findings were not significant after adjustment for age, sex, and disease duration (P = .075). The presence of more than 2 vascular risks was associated with worse UPDRS 3 motor scores (beta coefficient 4.05, 95% confidence interval 1.48, 6.61, p = .002) and with cognitive impairment (ordinal odds ratio 2.24, 95% confidence interval 1.34, 3.74, p = .002). In 842 patients (47.8%) with structural brain imaging, white matter leukoaraiosis, but not lacunar or territorial infarction, was associated with impaired cognition (p = .006) and postural instability gait difficulty (p = .010). Conclusion Vascular comorbidity is significantly associated with cognitive and gait impairment in patients with early PD, which may have prognostic and treatment implications.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Swallow, Dr Diane and Grosset, Dr Donald and Grosset, Dr Katherine
Authors: Malek, N., Lawton, M. A., Swallow, D. M.A., Grosset, K., Marrinan, S. L., Bajaj, N., Barker, R. A., Burn, D. J., Hardy, J., Morris, H. R., Williams, N. M., Wood, N., Ben-Shlomo, Y., and Grosset, D.
College/School:College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Movement Disorders
Publisher:Wiley-Blackwell
ISSN:0885-3185
ISSN (Online):1531-8257
Published Online:21 June 2016
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in Movement Disorders 31(10):1518-1526
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
525044PROBAND: Parkinson's repository of biosamples and networked datasetsDonald GrossetParkinson's Disease Society (PARKINSONS)J-1101RI NEUROSCIENCE & PSYCHOLOGY