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Lookup NU author(s): Dr Sarah Marrinan, Professor David BurnORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
ObjectiveThe 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).MethodsRecently 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.ResultsIn 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).ConclusionVascular comorbidity is significantly associated with cognitive and gait impairment in patients with early PD, which may have prognostic and treatment implications. (c) 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
Author(s): Malek N, Lawton MA, Swallow DMA, Grosset KA, Marrinan SL, Bajaj N, Barker RA, Burn DJ, Hardy J, Morris HR, Williams NM, Wood N, Ben-Shlomo Y, Grosset DG, PRoBaND Clinical Consortium
Publication type: Article
Publication status: Published
Journal: Movement Disorders
Year: 2016
Volume: 31
Issue: 10
Pages: 1518-1526
Print publication date: 01/10/2016
Online publication date: 21/06/2016
Acceptance date: 15/05/2016
Date deposited: 16/12/2016
ISSN (print): 0885-3185
ISSN (electronic): 1531-8257
Publisher: John Wiley & Sons, Inc.
URL: http://dx.doi.org/10.1002/mds.26698
DOI: 10.1002/mds.26698
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