Surprising Synergy Between Cerebrovascular and Lewy Body Disease in Parkinsonism

Abstract

Parkinsonism is a common and heterogeneous clinical syndrome with symptoms that include rigidity, bradykinesia, tremor, and autonomic dysfunction. The classic substrate of Parkinsonism is Lewy body pathology (LBP), identified by the presence of α-synuclein inclusion bodies. However, non-LBP pathologies may also be associated with Parkinsonism. In this issue of Neurology ® , Agrawal et al. 1 publish a study that confirms the association between Parkinsonism and LBP and also provide strong indication of the importance of cerebrovascular diseases (CVDs) as an underappreciated driver of Parkinsonism in older community-dwelling persons.This report is based on data from Rush University Medical Center (RUMC) community-based autopsy cohorts, a rich resource for dementia research. In these cohorts, community-dwelling research participants were followed longitudinally, most from a baseline of normal or unimpaired cognitive status. Thus, much of the relevant symptomatology described in the article represents incident rather than later-stage prevalent Parkinsonism. The evaluation of these participants included detailed neurobehavioral evaluation, combined with a high rate of detailed autopsy data among decedents. The community-based nature of this data set means that it is more generalizable (with less recruitment bias) in comparison with specialty movement or dementia clinic-based, referral-based, and/or hospital-based autopsy cohorts. Another major strength of the article is its outstanding team of contributing scientists, which includes neurologists, neuropathologists, and statisticians.