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

Abstract

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.

Altered Cerebral Vasoreactivity on Transcranial Color-Coded Sonography Related to Akinetic-Rigid Phenotype of Parkinson’s Disease: Interim Analysis of a Cross-Sectional Study

“…Other published papers found that patients with vascular risk factors are also more prone to rapid deterioration and increased mortality [9,10,18]. In accordance with a previous study, the presence of two or more vascular risk factors is associated with worse motor impairment, as well as cognitive decline [5,18].…”

“…PD patients may be classified into three different clinical phenotypes: one in which tremor is the predominant manifestation (Tremor-dominant type), another in which the dominant symptom is rigidity (Akinetic-rigid type) and a third phenotype with no predominant motor manifestation (Mixed type) [24]. A previous small study of our research group evidenced an association between these clinical phenotypes of PD and the presence of risk factors for CVD associated with altered cVR found in transcranial Doppler [5]. However, despite this evidence, none of the previous studies correlated MRI findings, cVR sonographic data, PD motor phenotype, or presence of risk factors for CVD in PD patients together.…”

“…However, vascular lesions are common incidental findings in pathologically confirmed PD [3,4]. Furthermore, it remains unknown, or the evidence is scarce, whether is there an additive effect between the neurodegenerative loss of neurons and the burden of small vessel disease (SVD) in idiopathic PD [5][6][7][8]. Some papers have indeed found worse outcomes in PD individuals with risk factors for cerebrovascular disease (CVD), as evidenced by a higher degree of disability and premature death [9][10][11][12].…”

Factors affecting transtemporal window quality in transcranial sonography

“…Apart from bidimensional mode ultrasound, transcranial colorcoded sonography has already been reported in patients with PD. The F I G U R E 2 Correlation between age and temporal bone thickness in females and males changes on cerebral hemodynamics may determine the severity and clinical outcomes of PD (Brisson, de Cássia Leite Fernandes, et al, 2021). Standardized axial imaging of the butterfly-shaped midbrain is performed with the transducer placed at the preauricular site and the patient in a supine position.…”

Comparison between a handheld ultrasound device and a traditional ultrasound for performing transcranial sonography in patients with Parkinson's disease

“…Transcranial sonography (TCS) is a neuroimaging technique used to obtain and evaluate images of the cerebral parenchyma in movement disorders through B‐mode and assess the blood flow velocities of the intracranial vessels through Doppler mode (Brisson et al., 2021 ; Monaco et al., 2018 ). This is an ultrasonographic technique used to detect abnormalities in the echogenicity of substantia nigra (SN), thalamus, lenticular nuclei, red nuclei, the continuation of the median raphe nucleus, and ventricular diameters and assesses vascular reactivity (Brisson et al., 2021 ; Monaco et al., 2018 ; Walter et al., 2008 ). The main limitation of TCS is the lack of bone window, which could vary between 5% and 44% of the population, according to Brisson, Santos et al ( 2021 ), depending on various factors, including, sex, age, and ethnicity.…”