Effect of Age and Arteriosclerosis on the Response of Parkinsonian Patients to Levodopa

Godwin-Austen, R B; Bergmann, S.; Frears, C. C.

doi:10.1136/bmj.4.5786.522

Cited by 12 publications

(8 citation statements)

References 15 publications

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“…Therefore, the effect of disease duration on the expression of residual motor symptoms might be related to age. Motor functions decline, however, also with normal ageing, and age-associated non-parkinsonian pathologies, such as vascular encephalopathy or senile dementia of the Alzheimer type may mimick levodopa-resistant parkinsonian motor symptoms (Godwin-Austen et al, 1971;Parkes et al, 1974;McGeer et al, 1977;Newman et al, 1985;Morris et al, 1989). The aim of the study was to analyse the effect of age and disease duration on parkinsonian residual motor scores in patients with a wide range of age (31-91 years) and to quantify the effect of normal age-related decline in motor functions on residual motor scores under optimum levodopa therapy.…”

Section: Introductionmentioning

confidence: 98%

Effect of age and disease duration on parkinsonian motor scores under levodopa therapy

Ransmayr

Künig

Neubauer

et al. 1995

J Neural Transm Gen Sect

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One hundred and fifty patients suffering from Parkinson's disease were analysed for the expression of the motor symptoms during optimum response to levodopa therapy (subscale III of the Unified-Parkinson's Disease Rating Scale). Patients were grouped according to age (< or = 64, 65-74, > or = 75 years). Disease duration and daily levodopa dosage were similar in the three groups. Pooled residual scores for posture and gait impairment (PGI), tremor (T), rigidity (R) and distal motor impairment (DMI; hand and foot movements) increased with age (Kruskal-Wallis ANOVA). The parkinsonian scores were significantly higher than the scores of 150 age-matched normal controls (Mann-Whitney U test). The differences between the patients' scores and the scores of the age-matched controls increased with age. In spite of a significant increase in the daily levodopa dosage with disease duration (linear regression), PGI aggravated age-dependently, and DMI age-independently with symptom duration (Spearman rank correlation). In contrast, T and R did not increase with disease duration.

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Section: Introductionmentioning

confidence: 98%

Effect of age and disease duration on parkinsonian motor scores under levodopa therapy

Ransmayr

Künig

Neubauer

et al. 1995

J Neural Transm Gen Sect

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“…L -Dopa-responsive cases with vascular lesions in the absence of pathological changes in the SNpc [15]and, conversely, L -dopa-unresponsive cases with pathological changes in the SNpc [44]have been reported. Third, IPD symptoms may possibly be modified by a few, small ischemic lesions [21, 45, 46]. A study reported that parkinsonian symptoms did not differ between patients with and without isolated lacunes in the basal ganglia on computed tomography scans except for less frequent tremor in the former [45].…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Characteristics of Parkinsonism and the Width of Substantia nigra pars compacta on MRI According to Ischemic Changes in the Putamen and Cerebral White Matter: Implications for the Diagnosis of Vascular Parkinsonism

Tohgi

Takahashi²,

Abe³

et al. 2001

Eur Neurol

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To investigate the significance of vascular lesions as a cause of secondary parkinsonism, we analyzed the symptomatic characteristics, the width of the substantia nigra pars compacta (SNpc) on MRI and the responsiveness to L-dopa in 227 parkinsonian cases, excluding those with drug-induced parkinsonism and neurodegenerative diseases other than idiopathic Parkinson’s disease (IPD). They were classified into those without a significant infarct in the basal ganglia (n = 144), those with status lacunaris in the putamen (SLP; n = 66) and those with confluent white matter hyperintensity signals (CWMH; n = 17). The 4- to 6-Hz tremor and cogwheel rigidity were significantly more frequent in cases without significant infarct (69%) than those with SLP (50%) and those with CWMH (12%; p < 0.05). Among cases with 4- to 6-Hz tremor and cogwheel rigidity, the frequency of patients with a reduced SNpc width and L-dopa responders did not significantly differ between those with SLP (73 and 83%, respectively) and those without significant infarct (83 and 86%, respectively), suggesting that the diagnosis for most of these cases would be probable IPD. In contrast, among cases without 4- to 6-Hz tremor and cogwheel rigidity, those with a reduced SNpc width or L-dopa responders were significantly less frequent among cases with SLP (25 and 38%, respectively) than among those without significant infarct (75 and 71%, respectively; p < 0.05). Patients with neither 4- to 6-Hz tremor and cogwheel rigidity nor reduction in the SNpc width, for whom the probable diagnosis was vascular parkinsonism (VP), were significantly more frequent in cases with SLP (26%) and with CWMH (40%) than those without significant infarct (8%), accounting for 10.6% of the total parkinsonian cases. These findings suggest that parkinsonian cases with SLP or CWMH consist of not only cases with vascular-lesion-related VP but also IPD in which vascular lesions are not directly related to parkinsonism. Absence of 4- to 6-Hz tremor, cogwheel rigidity and the reduction in the SNpc width could be indicators for differentiating VP from IPD.

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“…Two of the clinically based studies [2,1], two of the radiological studies [9,11] and one of the pathological studies [13] found a lower percentage response in VP patients. However, almost all studies find that some VP patients will respond to L-dopa [3-6, 9, 11, 14, 15].…”

Section: Clinical Features Defining Vpmentioning

confidence: 99%

“…Out of 580 patients with clinical parkinsonism, 2.5% were attributed to cerebrovascular disease [6] and among 100 patients diagnosed with idiopathic PD, again 3% were found to have VP at post mortem [41]. Garland, 1955 [26] 4 Neuroepidemiology 2002;21: [1][2][3][4][5][6][7] Foltynie/Barker/Brayne The frequency figures of both parkinsonism and VP from both population and hospital series are summarised in table 1.…”

Section: Hospital-/clinic-based Samplesmentioning

confidence: 99%

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Vascular Parkinsonism: A Review of the Precision and Frequency of the Diagnosis

Foltynie¹,

Barker²,

Brayne

2001

Neuroepidemiology

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Over the past century vascular parkinsonism (VP) has been established, dismissed and recently re-established as a possible clinical entity. We review the clinical features that have been proposed to suggest the diagnosis and explore how precisely VP has been defined on the basis of clinical, as well as radiological and pathological grounds. Estimates of the frequency of this condition have been based on population-based incidence and prevalence studies and also using case series of all types or parkinsonism. We performed a systematic search for all of these published studies and present their estimates of frequency. We conclude that the wide variations in these estimates may be largely explicable by variation in case definition. When studies are limited to those with either imaging or pathological support for the diagnosis, all but one estimate that 3–6% of all cases of parkinsonism have a vascular cause. In addition, features of parkinsonism have been seen in up to 38% of lacunar stroke patients at 1 year. On the basis of this appreciably high frequency, and with consideration of the implications for clinician and scientist, we suggest that VP needs to be recognised as an important clinical diagnosis, and includes a spectrum of distinct pathophysiological entities.

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Effect of Age and Arteriosclerosis on the Response of Parkinsonian Patients to Levodopa

Cited by 12 publications

References 15 publications

Effect of age and disease duration on parkinsonian motor scores under levodopa therapy

Effect of age and disease duration on parkinsonian motor scores under levodopa therapy

Symptomatic Characteristics of Parkinsonism and the Width of Substantia nigra pars compacta on MRI According to Ischemic Changes in the Putamen and Cerebral White Matter: Implications for the Diagnosis of Vascular Parkinsonism

Vascular Parkinsonism: A Review of the Precision and Frequency of the Diagnosis

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