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Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease

Malek, Naveed, Lawton, Michael A., Swallow, Diane M. A., Grosset, Katherine A., Marrinan, Sarah L., Bajaj, Nin, Barker, Roger A., Burn, David J., Hardy, John, Morris, Huw R., Williams, Nigel Melville, Wood, Nicholas, Ben-Shlomo, Yoav and Grosset, Donald G. 2016. Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease. Movement Disorders 31 (10) , pp. 1518-1526. 10.1002/mds.26698

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Abstract

ABSTRACT: Objective: 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). Methods: 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. Results: 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 5.075). 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 5 .002) and with cognitive impairment (ordinal odds ratio 2.24, 95% confidence interval 1.34, 3.74, p 5 .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 5 .006) and postural instability gait difficulty (p5.010). Conclusion: Vascular comorbidity is significantly associated with cognitive and gait impairment in patients with early PD, which may have prognostic and treatment implications.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Neuroscience and Mental Health Research Institute (NMHRI)
Subjects: R Medicine > R Medicine (General)
Publisher: John Wiley & Sons
ISSN: 0885-3185
Date of First Compliant Deposit: 10 November 2016
Date of Acceptance: 15 May 2016
Last Modified: 04 Jun 2017 09:30
URI: http://orca.cf.ac.uk/id/eprint/96020

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