title: The relationship between cerebral vascular disease and parkinsonism: The VADO study.
abstract: BACKGROUND
  The observation of gait abnormalities, parkinsonism and vascular lesions in elderly patients is often reported as vascular parkinsonism (VP). However the status of striatal dopamine transporter (DAT) and the effects of brain vascular lesions on motor features and levodopa responsiveness are poorly defined.
  
  
  METHODS
  We recorded clinical features, chronic response to levodopa and vascular risk factors in a cross-sectional cohort of consecutive elderly patients with possible Parkinson's disease (PD) or VP recruited in 20 centers in Italy.
  
  
  RESULTS
  We included a total of 158 patients. Onset of motor symptoms was asymmetric in 93 (59%) and symmetric in 65 patients (41%). Symmetric motor onset was associated with greater disease severity. Chronic levodopa response was positive in 75 (47.8%) and negative in 82 patients (52.2%). A negative response to levodopa was associated with greater frequency of symmetric onset of motor symptoms, worst disease severity, absence of dyskinesia and greater number of vascular risk factors. Frontal lobe showed largest vascular load. Striatal DAT was normal in 48 (30.4%) and abnormal in 110 (69.6%) patients. Patients with normal DAT binding showed higher vascular load at MRI. Significant predictive factors of worst disease severity and negative response to levodopa were hypertension, vascular lesions in basal ganglia/periventricular regions, and normal DAT uptake.
  
  
  CONCLUSIONS
  Multiple cerebral vascular lesions modify clinical presentation and severity in patients with parkinsonism and this is underlined by specific risk factors primarily hypertension. Striatal DAT assessment is helpful in identifying patients where therapy benefit is less likely.
authors.affiliation: Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Antonini
authors.forename: C
authors.initials: C
authors.lastname: Vitale
authors.forename: P
authors.initials: P
authors.lastname: Barone
authors.forename: R
authors.initials: R
authors.lastname: Cilia
authors.forename: A
authors.initials: A
authors.lastname: Righini
authors.forename: U
authors.initials: U
authors.lastname: Bonuccelli
authors.forename: G
authors.initials: G
authors.lastname: Abbruzzese
authors.forename: S
authors.initials: S
authors.lastname: Ramat
authors.forename: A
authors.initials: A
authors.lastname: Petrone
authors.forename: R
authors.initials: R
authors.lastname: Quatrale
authors.forename: R
authors.initials: R
authors.lastname: Marconi
authors.forename: R
authors.initials: R
authors.lastname: Ceravolo
authors.forename: A
authors.initials: A
authors.lastname: Stefani
authors.forename: L
authors.initials: L
authors.lastname: Lopiano
authors.forename: M
authors.initials: M
authors.lastname: Zappia
authors.forename: L
authors.initials: L
authors.lastname: Capus
authors.forename: L
authors.initials: L
authors.lastname: Morgante
authors.forename: F
authors.initials: F
authors.lastname: Tamma
authors.forename: M
authors.initials: M
authors.lastname: Tinazzi
authors.forename: C
authors.initials: C
authors.lastname: Colosimo
authors.forename: U P
authors.initials: UP
authors.lastname: Guerra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D015331:Cohort Studies; D003342:Corpus Striatum / Q000378:metabolism*; D003430:Cross-Sectional Studies; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology; D020734:Parkinsonian Disorders / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000978:Antiparkinson Agents; D050483:Dopamine Plasma Membrane Transport Proteins; D007980:Levodopa