Parkinson's disease, stroke, and related epidemiology

Abstract

We investigated the prevalence of cerebrovascular disease and other comorbidities in Parkinson's disease (PD) patients compared to the general population. Five hundred PD patients were chosen randomly from one author's (A.H.R.) database. Age- and sex-matched controls were derived from 270 patients with essential tremor from the same database and from 490 patients in a general practitioner's database. Age, hypertensive status, smoking status, coronary artery disease, orthostatic hypotension, diabetes mellitus, and symptomatic cerebrovascular disease (stroke or transient ischemic attack) were assessed. Statistical analysis was performed using Pearson chi(2) testing and binary logistic regression analysis. The prevalence of coronary artery disease, hypertension, diabetes mellitus, and orthostatic hypotension was similar among groups. The PD group had more patients who never smoked and less current smokers than the other groups. While there were similar frequencies of symptomatic cerebrovascular disease among groups, the prevalence of stroke was lower in PD patients. This difference disappeared upon stratification into groups based on smoking status and in the addition of smoking as a covariate in the multivariate analysis. Diminished smoking in PD patients likely plays a role in our finding of decreased stroke in patients with PD. Increased access to appropriate neurological care and subsequent prevention of stroke after a warning transient ischemic attack may also play a role, as may diminished levels of excitotoxic neurotransmitters in PD patients.

Parkinson's Disease in the Very Old - Clinicopathological Observations

“…However no such association could be established in PDO cases. One epidemiological study which included general population, ET and PD cases, found that the incidence of stroke was similar in the three groups [39]. One autopsy study reported 13% vascular disease in all forms of PS [32].…”

The Impact of MRI White Matter Hyperintensities on Dementia in Parkinson's Disease in Relation to the Homocysteine Level and Other Vascular Risk Factors

“…However, studies devoted to an exploration of stroke prevalence in PD patients showed inconsistent results [58,59,60] that would require confirmation in the future. The lack of evidence that cerebrovascular disorders contribute to motor and cognitive decline in PD patients may be explained by recent data on levodopa-induced sympathetic modulation, which reduced the burden of vascular risk factors.…”

Parkinson's disease – pathology, aetiology and diagnosis

“…Atypical parkinsonian syndromes should be considered in the differential diagnosis of such cases, 122 as should overlap with other common disorders of ageing such as Alzheimer's and cerebrovascular disease. 123 Older patients may have less motor fluctuation and dyskinesia despite more rapid progression. 124 In contrast, the sub-type of tremor dominant PD is generally associated with a younger age at onset, 125 a more benign clinical course and preserved mental status.…”

“…124 In contrast, the sub-type of tremor dominant PD is generally associated with a younger age at onset, 125 a more benign clinical course and preserved mental status. 119,[120][121][122][123][124][125][126] Conflicting studies report that prominent tremor is associated with older age, 127 dementia 128 and to a lesser extent rapid disease progression. 128 Other data suggest few clinical differences between youngand old-onset PD, 129 although muscular stiffness and sensory symptoms may be a more common presentation in younger patients.…”