Earlier onset of motor complications in Parkinson's patients with comorbid diabetes mellitus

Ibrahim, Norlinah Mohamed; Ramli, R.; Kutty, Shahedah Koya; Shah, Shamsul Azhar

doi:10.1002/mds.27526

Cited by 18 publications

(11 citation statements)

References 3 publications

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“…Furthermore, DM in PD patients is associated with more severe motor disability, less response to dopaminergic drugs, 1,4 more severe axial motor symptoms, 5 and cognitive impairment 6,7 . A case‐control study 8 also observed that patients with comorbid DM developed motor complications on average 12 months earlier in PD, independent of medications or other disease‐related factors.…”

Section: Introductionmentioning

confidence: 99%

Effect of diabetes control status on the progression of Parkinson’s disease: A prospective study

Wei

Hou

et al. 2021

Ann Clin Transl Neurol

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Objective To evaluate whether the control status of type 2 diabetes mellitus (DM) influences the progression of Parkinson’s disease (PD). Methods We conducted a prospective cohort study from March 2009 to August 2020. Patients at baseline were categorized into DM and non‐DM groups, and those with DM were further classified into the well and poorly controlled DM groups based on the 7.0% of glycated hemoglobin (HbA1C) levels. Multivariate Cox proportional hazards regression models were used to explore the predictors for PD‐related outcomes by hazard ratios (HRs) and 95% confidence intervals (CIs). Results Of the 379 patients enrolled, 49 (12.9%) had DM, and 22 of DM (44.9%) were poorly controlled. The adjusted HRs were 2.060 (95% CI 1.165‐3.641) for United Rating Scale (UPDRS) III score increased ≥14 in the poorly controlled‐DM group, and 1.066 (95% CI 0.572‐1.986) in the well‐controlled DM group, relative to the non‐DM group (p trend = 0.025), after adjusting for sex, age, age of onset, body mass index, and UPDRS III and Montreal Cognitive Assessment (MoCA) scores at baseline. The adjusted HRs were 2.079 (95% CI 1.212‐3.566) for reaching Hoehn & Yahr stage ≥3 in the poorly controlled DM group, and 0.879 (95% CI 0.413‐1.871) in the well‐controlled DM group, compared with the non‐DM group (p trend = 0.021). Time to death or time to MoCA 3‐point decrease were not significantly different among the three groups. Interpretation Poorly controlled DM is an independent risk factor contributing to motor progression in PD. Our study highlights the importance of adequate control of diabetes in PD.

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Section: Introductionmentioning

confidence: 99%

Effect of diabetes control status on the progression of Parkinson’s disease: A prospective study

Wei

Hou

et al. 2021

Ann Clin Transl Neurol

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“…One case-control research indicated that PD patients with T2DM scored higher on the severity scale including the H-Y stage than those with PD ( Cereda et al, 2012 ). A retrospective study with 72 patients with PD indicated that patients accompanied with T2DM developed motor complications 12 months in advance ( Mohamed Ibrahim et al, 2018 ). The above views were consistent with our results.…”

Section: Discussionmentioning

confidence: 99%

Iron deposition heterogeneity in extrapyramidal system assessed by quantitative susceptibility mapping in Parkinson’s disease patients with type 2 diabetes mellitus

Gao²,

Du³

et al. 2022

Front. Aging Neurosci.

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PurposeExcessive brain iron depositions were found in both patients with Parkinson’s disease (PD) and those with type 2 diabetes mellitus (T2DM). The present study aimed to explore iron deposition and heterogeneity in the extrapyramidal system in PD patients with T2DM using quantitative susceptibility mapping (QSM) and further to reveal the effect of T2DM on the changes in brain iron in patients with PD.Materials and methodsA total of 38 PD patients with T2DM (PDDM), 30 PD patients without T2DM (PDND), and 20 asymptomatic control subjects (CSs) were recruited for this study. All subjects underwent multiple MRI sequences involving enhanced gradient echo T2 star weighted angiography (ESWAN). The magnetic sensitivity values (MSV) and volume of the whole nuclei (MSVW, VW) and high iron region (MSVRII, VRII) were measured on the bilateral caudate nucleus (CN), the putamen (PUT), the globus pallidus (GP), the substantia nigra (SN), the red nucleus (RN) and the dentate nucleus (DN). Clinical and laboratory data were recorded, especially for the Hoehn and Yahr (H-Y) stage, the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), the Hamilton Depression Rating Scale (HAMD), and the Hamilton Anxiety Rating Scale (HAMA). All QSM data were compared between PDDM and PDND groups and correlated with clinical and laboratory data.ResultsCompared to the PDND group, the VRII/VW of the left CN was significantly increased in the PDDM group. Significantly higher MSVW and MSVRII were also found in the PDDM group, including bilateral SN of MSVW, right PUT, and bilateral CN, GP, and SN of MSVRII. The H-Y stage of the PDDM group was significantly higher than that of the PDND group. The MSVRII of bilateral RN of the PDDM group was positively correlated with the HAMA scores. HDL, DBP, and SBP levels were associated with MSVRII of right CN in the PDDM group.ConclusionT2DM could aggravate the disease severity and anxiety in patients with PD. The iron distribution of deep gray matter nuclei in PD patients with T2DM was significantly heterogeneous, which was related to blood pressure and blood lipids.

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“…Such damages may be associated with dopamine regulation deficiency and neuroinflammation [31–34], confirmed by image tests that showed white matter injuries, lacunar infarctions and cortical atrophy in T2DM patients [137, 138]. Moreover, motor complications (motor fluctuations and dyskinesia) happened one year earlier compared with subjects with only PD [68]. Therefore, longer periods of hospitalization, as well as daily care, are typically required for these patients [72].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Relationship between Type II Diabetes Mellitus and Parkinson’s Disease: A Systematic Review

Maluf

Feder

Carvalho

2019

Parkinson's Disease

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In the early sixties, a discussion started regarding the association between Parkinson's disease (PD) and type II diabetes mellitus (T2DM). Today, this potential relationship is still a matter of debate. This review aims to analyze both diseases concerning causal relationships and treatments. A total of 104 articles were found, and studies on animal and “in vitro” models showed that T2DM causes neurological alterations that may be associated with PD, such as deregulation of the dopaminergic system, a decrease in the expression of peroxisome proliferator-activated receptor-gamma coactivator-1α (PGC-1α), an increase in the expression of phosphoprotein enriched in diabetes/phosphoprotein enriched in astrocytes 15 (PED/PEA-15), and neuroinflammation, as well as acceleration of the formation of alpha-synuclein amyloid fibrils. In addition, clinical studies described that Parkinson's symptoms were notably worse after the onset of T2DM, and seven deregulated genes were identified in the DNA of T2DM and PD patients. Regarding treatment, the action of antidiabetic drugs, especially incretin mimetic agents, seems to confer certain degree of neuroprotection to PD patients. In conclusion, the available evidence on the interaction between T2DM and PD justifies more robust clinical trials exploring this interaction especially the clinical management of patients with both conditions.

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Earlier onset of motor complications in Parkinson's patients with comorbid diabetes mellitus

Cited by 18 publications

References 3 publications

Effect of diabetes control status on the progression of Parkinson’s disease: A prospective study

Effect of diabetes control status on the progression of Parkinson’s disease: A prospective study

Iron deposition heterogeneity in extrapyramidal system assessed by quantitative susceptibility mapping in Parkinson’s disease patients with type 2 diabetes mellitus

Analysis of the Relationship between Type II Diabetes Mellitus and Parkinson’s Disease: A Systematic Review

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