The effect of vascular disease on late onset Parkinson's disease

Abstract

The clinical severity of late onset Parkinson's disease (PD) varies from patient to patient and it is further complicated by the increasing prevalence of accompanying disorders in the elderly. We set out to study the impact of ischemic heart disease, minor stroke, hypertension and diabetes mellitus in a group of late onset PD patients (age >or=70 years). Consecutive late onset PD patients seen in the Department of Neurology, Medical School of Patras, Greece were included in this study. We used very strict criteria to eliminate the possibility of including patients with vascular parkinsonism. Comparisons were made between groups of patients suffering with idiopathic Parkinson's disease (IPD) and the above-mentioned diseases. One hundred and sixty-seven consecutive late onset PD patients were included in this study. The most common accompanying disorders in our group were hypertension in 31 (18%) of the patients and minor stroke in 20 (12%). The Hoen and Yahr score in late onset IPD patients who suffered from minor stroke, ischemic heart disease or diabetes mellitus was significantly higher when compared with patients without the above disorders. The results clearly suggest that the presence of vascular disease on an IPD patient may aggravate PD severity. In clinical grounds, these findings can be proved significant since early and aggressive prevention of vascular disease and treatment of vascular risk may contribute in controlling symptom severity in PD.

The Cardiovascular and Cerebrovascular Effects on Cognition in Persons with Parkinson’s Disease: A Systematic Review of the Literature

“…Although similar post-mortem findings have been reported in age-matched controls, it is suspected that these vascular changes may have a significant impact on the presentation of nonmotor symptoms, such as CI, in persons with PD [10] [11]. In late onset PD, clinically symptomatic vascular pathology in the form of minor stroke (in addition to diabetes and ischemic heart disease) resulted in higher Hoehn & Yahr scores, suggesting that cerebrovascular changes had an effect on PD progression [13]. Finally, several studies have shown that cerebrovascular dysfunction presents in the form of widespread cerebral hypoperfusion in persons with PD [14]- [16].…”

Association of Blood Pressure and Hypertension With the Risk of Parkinson Disease

“…Clinicopathological studies suggest that cerebral microvascular diseases (eg, white-matter lesions and cerebral amyloid angiopathy) are likely to contribute to the clinical expression and deterioration of idiopathic PD symptomatology. 23,24 Therefore, hypertension and elevated BP can be linked to PD by affecting the nondopaminergic subcortical structures. Second, chronic high BP causes hypertensive vasculopathy in the basal ganglia, thalamus, and brain stem, 25 which may affect dopaminergic cells in the pars compacta and break the connections between neurons in the substantia nigra and the putamen portion of the striatum.…”

123-I ioflupane (Datscan®) presynaptic nigrostriatal imaging in patients with movement disorders

“…Prevalence of vascular encephalopathy in PD patients ranges from 6% to 44% according to different series (Chang et al, 1992;Piccini et al, 1995;Jellinger et al, 2003), and similar prevalence rates have been found in other forms of parkinsonism, such as progressive supranuclear palsy (35%) (Dubinsky et al, 1987). In addition, the presence of vascular encephalopathy, or even the existence of vascular risk factors, may aggravate the symptomatic picture in a patient with known PD (Papapetropoulos et al, 2004). The most relevant clinical characteristics of VP include: gait disorder, predominance in lower half of the body, postural instability, stiffness, pyramidal signs, and poor or no response to Ldopa (Tolosa et al, 1984;Trenkwalder et al, 1995), all of them occurring in a patient with evidence of cerebrovascular damage with no signs of other degenerative diseases, intake of antidopaminergic drugs, or hydrocephalus that could induce parkinsonism.…”