Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease.
The purpose of this study was to examine the relationship between vascular disease (and vascular risk factors), cognition and motor phenotype in Parkinson's disease (PD).



Recently diagnosed PD cases were enrolled in a multicenter prospective observational longitudinal cohort study. Montreal cognitive assessment (normal >23, mild cognitive impairment 22 to 23 or lower but without functional impairment, and dementia 21 or less with functional impairment) and Movement Disorder Society Unified PD Rating Scale part 3 (UPDRS 3) scores were analyzed in relation to a history of vascular events and risk factors.



In 1759 PD cases, mean age 67.5 (standard deviation 9.3) years, mean disease duration 1.3 (standard deviation 0.9) years, 65.2% were men, 4.7% had a history of prior stroke or transient ischemic attack, and 12.5% had cardiac disease (angina, myocardial infarction, heart failure). In cases without a history of vascular disease, hypertension was recorded in 30.4%, high cholesterol 27.3%, obesity 20.7%, diabetes 7.2%, and cigarette smoking in 4.6%. Patients with prior stroke or transient ischemic attack were more likely to have cognitive impairment (42% vs 25%) and postural instability gait difficulty (53.5% vs 39.5%), but these findings were not significant after adjustment for age, sex, and disease duration (P = .075). The presence of more than 2 vascular risks was associated with worse UPDRS 3 motor scores (beta coefficient 4.05, 95% confidence interval 1.48, 6.61, p = .002) and with cognitive impairment (ordinal odds ratio 2.24, 95% confidence interval 1.34, 3.74, p = .002). In 842 patients (47.8%) with structural brain imaging, white matter leukoaraiosis, but not lacunar or territorial infarction, was associated with impaired cognition (p = .006) and postural instability gait difficulty (p = .010).



Vascular comorbidity is significantly associated with cognitive and gait impairment in patients with early PD, which may have prognostic and treatment implications. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom. nmalek@nhs.net.
Naveed
N
Malek
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Michael A
MA
Lawton
Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
Diane M A
DM
Swallow
Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
Katherine A
KA
Grosset
Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, United Kingdom.
Sarah L
SL
Marrinan
Department of Neurology, Queen's Medical Centre, Nottingham, United Kingdom.
Nin
N
Bajaj
Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, Cambridge, United Kingdom.
Roger A
RA
Barker
Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, United Kingdom.
David J
DJ
Burn
Reta Lila Weston Laboratories, Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom.
John
J
Hardy
Department of Clinical Neuroscience, UCL Institute of Neurology, London, United Kingdom.
Huw R
HR
Morris
Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom.
Nigel M
NM
Williams
Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom.
Nicholas
N
Wood
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Yoav
Y
Ben-Shlomo
Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
Donald G
DG
Grosset
D000368:Aged; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000503:physiopathology*; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014652:Vascular Diseases / Q000453:epidemiology / Q000503:physiopathology*
Parkinson's disease; cerebrovascular; diabetes; gender; phenotype