El índice de pulsatilidad intracraneal elevado apoya el diagnóstico de parkinsonismo vascular frente a enfermedad de Parkinson idiopática

Caba, L.M.; Ferrairó, José Ignacio Tembl; Torres, I.M.; Vázquez-Costa, Juan Francisco; Muñóz, Rodrigo; Martin, Aaron

doi:10.1016/j.nrl.2017.10.008

Cited by 3 publications

(1 citation statement)

References 18 publications

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“…e mechanisms proposed to lie behind this are endothelial changes and altered vascular reactivity, which ultimately lead to hypoperfusion and hypoxia [8]. In this context, some studies have used transcranial color-coded sonography (TCCS) to provide data on the brain hemodynamics of PD patients with associated CVD [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic Changes in Brain Hemodynamics in Patients with Parkinson’s Disease and Risk Factors for Cerebrovascular Disease: A Pilot Study

Brisson

Fernandes

Arruda

et al. 2021

Parkinson's Disease

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Recent epidemiological studies have revealed a correlation between atypical features and worse functional outcomes in Parkinson’s disease (PD) patients with cerebrovascular disease (CVD). We aimed to evaluate the brain hemodynamics of PD patients with risk factors for CVD using Doppler ultrasonography. In this prospective pilot study, we randomly included 27 outpatients diagnosed with PD. Transcranial color-coded sonography (TCCS) examinations were performed, obtaining measurements of middle cerebral artery mean flow velocities (Vm), the resistance index (RI), and the pulsatility index (PI). The breath-holding index (BHI) was used to assess cerebrovascular reactivity (cVR). Standardized functional scales (UPDRS III, Hoehn & Yahr scale, and MoCA) were administered. The patients were divided into two groups: those with two or more vascular risk factors (PDvasc) and those with fewer than two vascular risk factors (PDnvasc). Patients in the PDvasc group showed higher PI (1.00 vs. 0.85; p = 0.020 ), RI (0.59 vs. 0.5; p = 0.05 ), H&Y mean (2.4 vs. 1.4; p = 0.036 ), higher frequency of altered cVR (90.9% vs. 25.0%; p = 0.001 ), and lower BHI (0.46 vs. 1.01; p = 0.027 ). We also divided the patients in other two groups: one with patients with classical and another with akinetic-rigid PD clinical type. Patients with the akinetic-rigid type of PD had significantly higher RI (0.60 vs. 0.51; p = 0.03 ), PI (0.99 vs. 0.77; p = 0.03 ), higher frequency of altered cVR (80% vs. 35%; p = 0.02 ), and lower BHI (0.48 vs. 0.96; p = 0.05 ) than patients with classic-type PD. We concluded that TCCS displays impaired cerebrovascular reactivity and a more severe disease pattern in Parkinsonian patients with two or more risk factors for CVD and in the akinetic-rigid type. Doppler ultrasonography may be a useful tool in a clinical setting to investigate PD patients.

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Section: Introductionmentioning

confidence: 99%

Ultrasonographic Changes in Brain Hemodynamics in Patients with Parkinson’s Disease and Risk Factors for Cerebrovascular Disease: A Pilot Study

Brisson

Fernandes

Arruda

et al. 2021

Parkinson's Disease

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The clinical and neuroimaging differences between vascular parkinsonism and Parkinson’s disease: a case-control study

George,

Roushdy,

Fathy

et al. 2024

BMC Neurol

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Background Parkinson’s disease (PD) and vascular parkinsonism (VaP) have highly overlapping phenotypes, and different prognosis. This study comprehensively investigated the clinical, brain MRI and transcranial sonography differences between VaP and PD. Methods Forty-eight patients with PD, 27 patients with VaP, and 29 healthy controls were compared. All patients were assessed using the MDS-UPDRS, Berg Balance Scale (BBS), Ten-Meter Walking Test (10-MWT), Time Up and Go Test, and Non-Motor Symptoms Scale. Beck Depression Inventory, PD questionnaire- 39, international urine incontinence scale, cognitive assessment scales, MRI brain and transcranial colour-coded doppler. The study was registered on clinical-Trial.gov (NCT04308135) on 03/12/2020. Results VaP patients showed significantly older age of onset, shorter disease duration, lower drug doses and levodopa responsiveness, higher On and Off axial scores, On and Off BBS, higher On scores for PIGD, rigidity, bradykinesia and total motor MDS-UPDRS, lower On and Off tremor, lower-half predominance, lower asymmetrical presentation and symmetric index than PD patients. VaP patients had worse non-motor symptoms Scale (NMSS) than controls except for perceptual problems/hallucinations but better symptoms than PD patients except for urinary dysfunction. Quality of life (QoL) was impaired in VaP patients and was correlated with motor function and NMSs. The VaP group had significantly higher white matter lesions and brain atrophy, with lower hyperechogenicity of the substantia nigra and more impaired cerebral vascular resistance and vasoreactivity than the PD group. Conclusions VaP has a characteristic motor and non-motor profile, with impaired QoL, white matter, and transcranial sonography abnormalities that differentiate it from PD. Further studies are warranted to explore the role of vascular lesions in the pathogenesis of VaP. Trial registration The registered identifier NCT04308135 on clinical-Trial.gov. Registered on 03/12/2020.

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Characterizing Secondary and Atypical Parkinsonisms: Defining Features and Clinical Variability

Viveros-Martínez,

Zarate-Calderon,

Chi-Castañeda

et al. 2024

Neuroglia

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Parkinsonism is a clinical syndrome characterized by akinesia/bradykinesia, muscle rigidity, resting tremor, and postural instability. Within the group of parkinsonisms is Parkinson’s disease, also known as neurodegenerative parkinsonian syndrome. The group of atypical parkinsonisms was established due to the existence of sporadic parkinsonisms that do not share the exact etiology of Parkinson’s disease. Additionally, parkinsonisms that arise from causes other than neurodegeneration have been classified as secondary parkinsonisms. With this in mind, given the diversity of etiologies that can trigger parkinsonism, it is crucial to understand the symptomatology and its relationship with the basal ganglia (including damage to the nigrostriatal pathway, neuroinflammation, and neuronal damage). Only then will it be possible to propose appropriate treatments for each variant of parkinsonism.

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El índice de pulsatilidad intracraneal elevado apoya el diagnóstico de parkinsonismo vascular frente a enfermedad de Parkinson idiopática

Abstract: In our series, the PI was significantly higher in patients with VP than in those with IPD. We therefore support the use of transcranial Doppler ultrasonography for the initial assessment of elderly patients with akinetic-rigid syndrome.

Cited by 3 publications

References 18 publications

Ultrasonographic Changes in Brain Hemodynamics in Patients with Parkinson’s Disease and Risk Factors for Cerebrovascular Disease: A Pilot Study

Ultrasonographic Changes in Brain Hemodynamics in Patients with Parkinson’s Disease and Risk Factors for Cerebrovascular Disease: A Pilot Study

The clinical and neuroimaging differences between vascular parkinsonism and Parkinson’s disease: a case-control study

Characterizing Secondary and Atypical Parkinsonisms: Defining Features and Clinical Variability

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