THUR 116 Vascular prevention in patients with parkinson’s disease

BackgroundVascular prevention is appropriate for patients with a vascular history (secondary prevention) and increased risk (primary prevention). Cerebrovascular disease adds to gait and cognitive problems in patients with Parkinson’s disease (PD).MethodsA convenience cross-sectional sample of consecutive PD patients attending the Neurology Movement Disorder clinic was assessed, and QRISK3 scored when appropriate (cases without vascular events, age <85 years).ResultsOf 100 cases, mean age 66.5 (SD 9.0) years, 52.0% male, with PD duration 8.3 (SD 5.5) years, 15 had a vascular history meriting statin therapy, of whom 12 (80.0%) were prescribed statins. 22 had a high vascular risk (QRISK3 >20%), mean QRISK3 28.6 (SD 7.7) of whom 2 (9.1%) were prescribed statins. We are now actively assessing QRISK3 and recommending statin therapy where appropriate.ConclusionsSecondary vascular prevention with statins is more commonly implemented than primary prevention, in patients with PD. In patients without a vascular diagnosis, vascular risk should be assessed and statin therapy offered where appropriate, noting that around one-fifth of patients have a high vascular risk and are not on statin treatment.

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Aspirin use for primary prevention in elderly patients

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2015.728 ◽

2016 ◽

Vol 84 (1-2) ◽

Author(s):

Pierfranco Terrosu

Keyword(s):

Primary Prevention ◽

Older People ◽

Meta Analysis ◽

Vascular Risk ◽

Vascular Events ◽

Rischio Cardiovascolare ◽

Increased Risk ◽

Coronary Events ◽

Cardio Vascular ◽

Net Clinical Benefit

The net clinical benefit of aspirin in primary prevention is uncertain as the reduction in occlusive events needs to be balanced against the increase in gastro-intestinal and cerebral bleedings. The meta-analysis of ATT (Anti Thrombotic Trialists) Collaboration in 2009 showed that aspirin therapy in primary prevention was associated with 12% reduction in cardio-vascular events, due mainly to a reduction in non-fatal myocardial infarction (0.18% vs 0.23% per year, p<0.0001). However, the benefit in term of coronary events was almost balanced by the increase in major bleedings. The balance between potential benefit and harm of aspirin differs in each person and appears to be favorable in subjects at higher cardio-vascular risk. Older people have increased risk of hemorrhage as well as increased risk of heart attack and stroke. As a consequence, it is important consider both likelihoods of benefits as well as harm within the lifespan and functioning of the person. The older people who most likely benefit from aspirin in primary prevention are those at higher cardio-vascular risk, with preserved functional abilities, low comorbidity, low risk of bleeding and a prolonged life expectancy. RiassuntoIl beneficio clinico netto dell’aspirina in prevenzione primaria è poco chiaro, a causa del bilancio critico tra riduzione delle occlusioni vascolari e aumento dei sanguinamenti gastro-intestinali e cerebrali. La metanalisi del 2009 del ATT (Anti Thrombotic Trialists) Collaboration mostra che l’aspirina in prevenzione primaria determina una riduzione del 12% degli eventi cardiovascolari, principalmente dovuta ad una riduzione dell’infarto miocardico non-fatale (0.18% vs 0.23% per anno, p<0.0001). Tuttavia il beneficio in termini di eventi coronarici è controbilanciato dall’incremento dei sanguinamenti maggiori. Ne deriva che il bilancio tra vantaggi ed effetti avversi differisce nel singolo soggetto ed appare potenzialmente favorevole nei casi a più elevato rischio cardiovascolare. Nella popolazione anziana è aumentato sia il rischio trombotico che quello emorragico. Di conseguenza, è importante considerare il rapporto rischio/beneficio in relazione alla aspettativa di vita e alla capacità funzionale. In sostanza gli anziani che possono trarre vantaggio dall’aspirina in prevenzione primaria sono quelli a più alto rischio cardiovascolare, con mobilità conservata, scarsa comorbidità, basso rischio emorragico e lunga aspettativa di vita.

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The “Gender Factor” in Wearing-Off among Patients with Parkinson’s Disease: A Post Hoc Analysis of DEEP Study

The Scientific World JOURNAL ◽

10.1155/2015/787451 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 20

Author(s):

Delia Colombo ◽

Giovanni Abbruzzese ◽

Angelo Antonini ◽

Paolo Barone ◽

Gilberto Bellia ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cross Sectional Study ◽

Motor Symptom ◽

Cross Sectional ◽

Post Hoc Analysis ◽

Increased Risk ◽

Wearing Off ◽

Gender Factor ◽

Post Hoc

Background. The early detection of wearing-off in Parkinson disease (DEEP) observational study demonstrated that women with Parkinson’s disease (PD) carry an increased risk (80.1%) for wearing-off (WO). This post hoc analysis of DEEP study evaluates gender differences on WO and associated phenomena.Methods. Patients on dopaminergic treatment for ≥1 year were included in this multicenter observational cross-sectional study. In a single visit, WO was diagnosed based on neurologist assessment as well as the use of the 19-item wearing-off questionnaire (WOQ-19); WO was defined for scores ≥2. Post hoc analyses were conducted to investigate gender difference for demographic and clinical features with respect to WO.Results. Of 617 patients enrolled, 236 were women and 381 were men. Prevalence of WO was higher among women, according to both neurologists’ judgment (61.9% versus 53.8%,P=0.045) and the WOQ-19 analysis (72.5% versus 64.0%,P=0.034). In patients with WO (WOQ-19), women experienced ≥1 motor symptom in 72.5% versus 64.0% in men and ≥1 nonmotor symptom in 44.5% versus 36.7%, in men.Conclusions. Our results suggest WO as more common among women, for both motor and nonmotor symptoms. Prospective studies are warranted to investigate this potential gender-effect.

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Late onset depression: dopaminergic deficit and clinical features of prodromal Parkinson’s disease: a cross-sectional study

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-324266 ◽

2020 ◽

pp. jnnp-2020-324266

Author(s):

Hiba Kazmi ◽

Zuzana Walker ◽

Jan Booij ◽

Faraan Khan ◽

Sachit Shah ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Late Onset ◽

Emission Computed Tomography ◽

Imaging Features ◽

Cross Sectional ◽

Screening Questionnaire ◽

Imaging Results ◽

Increased Risk

BackgroundLate onset depression (LOD) may precede the diagnosis of Parkinson’s disease (PD) or dementia with Lewy bodies (DLB). We aimed to determine the rate of clinical and imaging features associated with prodromal PD/DLB in patients with LOD.MethodsIn a cross-sectional design, 36 patients with first onset of a depressive disorder (Diagnostic and Statistical Manual of Mental Disorders IV criteria) diagnosed after the age of 55 (LOD group) and 30 healthy controls (HC) underwent a detailed clinical assessment. In addition, 28/36 patients with LOD and 20/30 HC underwent a head MRI and 29/36 and 25/30, respectively, had dopamine transporter imaging by 123I-ioflupane single-photon emission computed tomography (SPECT) imaging. Image analysis of both scans was performed by a rater blind to the participant group. Results of clinical assessments and imaging results were compared between the two groups.ResultsPatients with LOD (n=36) had significantly worse scores than HC (n=30) on the PD screening questionnaire (mean (SD) 1.8 (1.9) vs 0.8 (1.2); p=0.01), Movement Disorder Society Unified Parkinson’s Disease Rating Scale total (mean (SD) 19.2 (12.7) vs 6.1 (5.7); p<0.001), REM-sleep behaviour disorder screening questionnaire (mean (SD) 4.3 (3.2) vs 2.1 (2.1); p=0.001), Lille Apathy Rating Scale (mean (SD) −23.3 (9.6) vs −27.0 (4.7); p=0.04) and the Scales for Outcomes in PD-Autonomic (mean (SD) 14.9 (8.7) vs 7.7 (4.9); p<0.001). Twenty-four per cent of patients with LOD versus 4% HC had an abnormal 123I-ioflupane SPECT scan (p=0.04).ConclusionsLOD is associated with increased rates of motor and non-motor features of PD/DLB and of abnormal 123I-ioflupane SPECTs. These results suggest that patients with LOD should be considered at increased risk of PD/DLB.

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A Cross-Sectional Study of Set Shifting Impairments and Falling in Individuals with and without Parkinson’s Disease

10.1101/146332 ◽

2017 ◽

Author(s):

J. Lucas McKay ◽

Kimberly C. Lang ◽

Lena H. Ting ◽

Madeleine E. Hackney

Keyword(s):

Older Adults ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Function ◽

Freezing Of Gait ◽

Cross Sectional Study ◽

Set Shifting ◽

Sectional Study ◽

Cross Sectional ◽

Increased Risk

AbstractINTRODUCTION. Individuals with Parkinson’s disease (PD) are at increased risk for falls, and exhibit deficits in executive function, including Set Shifting, which can be measured as the difference between parts B and A of the Trailmaking Test. METHODS. We conducted a cross-sectional study using baseline data of PD patients with and without freezing of gait (FOG) (n=69) and community-dwelling neurologically-normal older adults (NON-PD) (n=84) who had volunteered to participate in clinical rehabilitation research. Multivariate logistic regression analyses were performed to determine associations between Set Shifting, PD, and faller status, as determined by ≥1 self-reported falls in the previous 6 months, after adjusting for demographic and cognitive factors and clinical disease characteristics. RESULTS. Impaired Set Shifting was associated with previous falls after controlling for age, sex, overall cognitive function, PD, FOG, and PD disease duration (OR=1.29 [1.03-1.60]; P=0.02). In models controlling for age, sex, and overall cognitive function, PD was associated with increased fall prevalence among the study sample (OR=4.15 [95% CI 1.65-10.44], P<0.01) and FOG was associated with increased fall prevalence among the PD sample (OR=3.63 [1.22-10.80], P=0.02). Although the strongest associations between Set Shifting and falling were observed among PD without FOG (OR=2.11) compared to HOA (OR=1.14) and PD with FOG (OR=1.46) in a multivariate model that allowed for interaction between set shifting and PD status, there was insufficient evidence to reject the null hypothesis of no interaction. CONCLUSIONS. Set Shifting is associated with previous falls in non-demented older adults with and without PD.HighlightsIndividuals with PD are at increased risk for falls, although causes are unclear.Impaired Set Shifting was associated with falls in older adults with and without PD.Associations were strongest among those with PD but without freezing of gait.

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Statin usage, vascular diagnosis and vascular risk factors in Parkinson’s disease

Scottish Medical Journal ◽

10.1177/0036933017727432 ◽

2017 ◽

Vol 62 (3) ◽

pp. 104-109 ◽

Cited By ~ 5

Author(s):

Kelvin KW Cheng ◽

Diane MA Swallow ◽

Katherine A Grosset ◽

Donald G Grosset

Keyword(s):

Risk Factors ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cardiovascular Risk ◽

Statin Therapy ◽

Cardiac Risk ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Neuroprotective Effects ◽

Statin Use

Background and aims Vascular disease is a common comorbidity in Parkinson’s disease patients. Statins are potentially neuroprotective for Parkinson’s disease through non-vascular mechanisms. We investigated prevailing statin use in a Parkinson’s disease cohort. Methods and results Data on diagnostic indication for statins, anti-Parkinson therapy, vascular risk factors, and statin prescription, were obtained from electronic medical record review for consecutive Parkinson’s disease patients. The ASsessing cardiac risk using Scottish Intercollegiate Guidelines Network system was used to calculate future cardiovascular risk and identify those warranting statin use. Of 441 patients included, 59.9% were male, with a mean age of 68.9 years (standard deviation 10.3). One hundred and seventy-four (39.5%) patients had at least one diagnostic indication for statin use, of whom 136 (78.2%) were prescribed a statin. In the 267 (60.5%) cases without a diagnostic indication, 54 (20.2%) were excluded owing to age limitations defined in ASsessing cardiac risk using Scottish Intercollegiate Guidelines Network. Of the remaining 213, 62 (29.1%) had an ASsessing cardiac risk using Scottish Intercollegiate Guidelines Network score in the recommended range for statin therapy, of whom 15 (24.1%) were prescribed statins. Conclusion There is suboptimal implementation of statin therapy in Parkinson’s disease patients. Given the possible neuroprotective effects of statins in Parkinson’s disease in addition to reducing cardiovascular risk, reasons for suboptimal implementation warrant further investigation.

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Abnormal Echogenicity of the Substantia Nigra, Raphe Nuclei, and Third-Ventricle Width as Markers of Cognitive Impairment in Parkinsonian Disorders: A Cross-Sectional Study

Parkinson s Disease ◽

10.1155/2016/4058580 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Angela E. P. Bouwmans ◽

Albert F. G. Leentjens ◽

Werner H. Mess ◽

Wim E. J. Weber

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Substantia Nigra ◽

Third Ventricle ◽

Raphe Nuclei ◽

Cross Sectional ◽

The Third ◽

Raphé Nuclei ◽

Cognitive Problems

Background. Patients with Parkinson’s disease (PD) have a high risk of cognitive problems.Objective. This study assesses whether abnormal echogenicity of the substantia nigra (SN) and raphe nuclei (RN) and the diameter of third ventricle are markers of cognitive impairment in patients with PD and other forms of parkinsonism.Methods. 126 outpatients with early signs of parkinsonism underwent transcranial sonography (TCS). The scales for the outcome of Parkinson’s disease cognition (SCOPA-COG) were used as cognitive measure. Definite neurological diagnosis was established after two-year follow-up.Results. One-third of the patients with PD and half of those with APS had signs of cognitive impairment. The echogenicity of the SN was not related to cognitive impairment. The diameter of the third ventricle was significantly larger in PD patients with cognitive impairment compared to those without. In patients with APS we found a significantly higher frequency of hypoechogenic RN in patients with cognitive problems.Conclusions. Cognitive impairment is already present in a substantial proportion of patients with PD and APS at first referral. In patients with APS the frequency of hypoechogenic RN points to the direction of other pathophysiology with more emphasis on deficits in the serotonergic neurotransmitter system. The larger diameter of the third ventricle in PD patients with cognitive impairment may reflect Alzheimer like brain atrophy, as has been reported in earlier studies.

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Assessment of Parkinson’s Disease symptoms and toxin exposures in firefighters: a cross-sectional survey

10.21203/rs.3.rs-223780/v1 ◽

2021 ◽

Author(s):

Roshni Kotwani ◽

Andrea N. Clapp ◽

Haley E. Huggins ◽

Oceanis Vaou ◽

Anna DePold Hohler

Keyword(s):

Risk Factors ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Behavior Disorder ◽

Muscle Stiffness ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Disease Symptoms ◽

Increased Risk ◽

Toxin Exposure

Abstract BACKGROUND: Parkinson’s disease (PD) has been correlated with several environmental and toxic exposures. The frequency of PD in firefighters is higher than the general population, which may be due to the high amounts of toxin exposures firefighters experience on the job. There is a need to further address the high rates of PD among this subgroup. The purpose of this study is to improve our understanding of the relationship between toxin exposure in firefighters and Parkinson’s Disease symptoms. METHODS: An anonymous survey distributed to Massachusetts firefighters assessed risk factors for toxin exposure and presence of PD symptoms. Risk factors included frequency and duration of time spent firefighting, number of fires worked, and history of toxin exposure (i.e., pesticides). We collected the frequency of PD symptoms including tremors, muscle stiffness, REM behavior disorder, hyposmia, micrographia, and decreased walking pace. Analyses comparing toxin exposure and presence of PD symptoms were performed using Chi-square testing, p < 0.05 was considered significant.RESULTS: Two hundred participants were included in the study. The number of years as a firefighter, the number of days per week working, and the number of fires worked correlated with higher reports of hyposmia, micrographia, and decreased walking pace.CONCLUSION: Firefighters have an increased risk for PD symptoms as a result of the toxin exposures that are frequently present in fires.

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Interaction Between Genetic Variants and Serum Levels of Organochlorine Pesticides Contributes to Parkinson’s Disease

10.21203/rs.3.rs-64368/v1 ◽

2020 ◽

Author(s):

Shaoqing Xu ◽

Xiaodong Yang ◽

Yiwei Qian ◽

Dayong Wan ◽

Fenghua Sun ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Organochlorine Pesticides ◽

Genetic Variants ◽

Elevated Serum ◽

Depression Scale ◽

Serum Levels ◽

Hamilton Depression Scale ◽

Cross Sectional ◽

Increased Risk

Abstract Background: There is evidence that genetic and environmental factors contribute to the onset and progression of Parkinson’s disease (PD). Pesticides are a class of environmental toxins that are linked to increased risk of PD. However, few studies have investigated the interaction between specific pesticides and genetic variants related to PD in the Chinese population.Methods: In this cross-sectional study, 19 serum levels of pesticides were measured. In addition, we also analyzed the interaction between specific pesticides and candidate genetic variants for PD. Finally, we investigated the mechanistic basis for the association between pesticides and increased risk of PD.Results: Serum levels of organochlorine pesticides including α-hexachlorocyclohexane (α-HCH), β-HCH, γ-HCH, δ-HCH, propanil, heptachlor, dieldrin, hexachlorobenzene, p,p’-dichlorodiphenyltrichloroethane (p,p’-DDE) and o,p’-dichloro-diphenyl-trichloroethane (o,p’-DDT) were higher in PD patients than in controls. α-HCH and propanil levels were associated with increased PD risk. Serum levels of dieldrin were associated with Hamilton Depression Scale and Montreal Cognitive Assessment scores in PD patients. The interaction between rs11931074 in α-synuclein (SNCA) and α-HCH or β-HCH, respectively, as well as rs16940758 in the microtubule-associated protein tau (MAPT) gene and δ-HCH were related to increased risk of PD. In addition, α-HCH and propanil enhanced the production of reactive oxygen species and decreased of mitochondrial membrane potential. Propanil but not α-HCH induced the aggregation of α-synuclein.Conclusions: Elevated serum levels of α-HCH and propanil are associated with increased risk of PD. Serum levels of dieldrin were associated with depression and cognitive function in PD patients. The interaction between genetic variants and pesticides also increased the risk of PD. Effects of genetic variants and pesticides on the risk of PD should be studied in more detail with a larger sample size to further understand the mechanisms involved.

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Premature cognitive decline in specific domains found in young veterans with mTBI coincide with elder normative scores and advanced-age subjects with early-stage Parkinson’s disease

PLoS ONE ◽

10.1371/journal.pone.0258851 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0258851

Author(s):

Vicki A. Nejtek ◽

Rachael N. James ◽

Michael F. Salvatore ◽

Helene M. Alphonso ◽

Gary W. Boehm

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Decline ◽

Military Service ◽

Early Stage ◽

Cognitive Tests ◽

Post Injury ◽

Cross Sectional ◽

Cognitive Domains ◽

Increased Risk

Importance Epidemiologists report a 56% increased risk of veterans with (+) mild traumatic brain injury (mTBI) developing Parkinson’s disease (PD) within 12-years post-injury. The most relevant contributors to this high risk of PD in veterans (+) mTBI is unknown. As cognitive problems often precede PD diagnosis, identifying specific domains most involved with mTBI-related PD onset is critical. Objectives To discern which cognitive domains underlie the mTBI-PD risk relationship proposed in epidemiology studies. Design and setting This exploratory match-controlled, cross-sectional study was conducted in a medical school laboratory from 2017–2020. Participants Age- and IQ-matched veterans with (+) and without mTBI, non-veteran healthy controls, and IQ-matched non-demented early-stage PD were compared. Chronic neurological, unremitted/debilitating diseases, disorders, dementia, and substance use among others were excluded. Exposure Veterans were or were not exposed to non-penetrating combat-related mTBI occurring within the past 7-years. No other groups had recent military service or mTBI. Main outcomes / measures Cognitive flexibility, attention, memory, visuospatial ability, and verbal fluency were examined with well-known standardized neuropsychological assessments. Results Out of 200 volunteers, 114 provided evaluable data. Groups significantly differed on cognitive tests [F (21,299) = 3.09, p<0.0001]. Post hoc tests showed veterans (+) mTBI performed significantly worse than matched-control groups on four out of eight cognitive tests (range: p = .009 to .049), and more often than not performed comparably to early-stage PD (range: p = .749 to .140). Conclusions and relevance We found subtle, premature cognitive decline occurring in very specific cognitive domains in veterans (+) mTBI that would typically be overlooked in a clinic setting, This result potentially puts them at-risk for continual cognitive decline that may portend to the eventual onset of PD or some other neurodegenerative disease.

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Neuroimaging cerebrovascular biomarkers in Parkinson’s disease

The Neuroradiology Journal ◽

10.1177/19714009211059118 ◽

2021 ◽

pp. 197140092110591

Author(s):

Mariana Alves ◽

Patrícia Pita Lobo ◽

Linda Azevedo Kauppila ◽

Leonor Rebordão ◽

M Manuela Cruz ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Mr Imaging ◽

Community Based ◽

Imaging Evaluation ◽

Cross Sectional ◽

Imaging Sequence ◽

Increased Risk ◽

3.0 T ◽

Neuroimaging Biomarkers

Background and Purpose The cardiovascular risk in Parkinson’s disease (PD) remains uncertain and controversial. Some studies suggest PD patients present an increased risk of cerebrovascular disease. We aimed to study the prevalence of neuroimaging cerebrovascular biomarkers in PD patients compared to controls, using an accurate and complete magnetic resonance (MR) imaging evaluation. Material and Methods Neuroimaging sub-study within a larger cross-sectional case–control study. An enriched subgroup of PD patients (≤10 years since diagnosis) with at least a moderate cardiovascular mortality risk based on a Systematic COronary Risk Evaluation (SCORE) was compared to community-based controls regarding neuroimaging biomarkers. Patients underwent a high-resolution T1-weighted MR imaging sequence at 3.0 T to visualize neuromelanin. A 3D SWI FFE, sagittal 3D T1-weighted, axial FLAIR and diffusion-weighted image sequences were obtained. Results The study included 47 patients, 24 with PD and 23 controls. PD patients presented a reduced area and signal intensity of the substantia nigra and locus coeruleus on neuromelanin-sensitive MR. The median SCORE was 5% in both groups. No significant differences regarding white matter hyperintensities (OR 4.84, 95% CI 0.50, 47.06), lacunes (OR 0.43, 95% CI 0.07, 2.63), microbleeds (OR 0.64, 95% CI 0.13, 3.26), or infarcts (0.95, 95% CI 0.12, 7.41) was found. The frequency of these neuroimaging biomarkers was very low in both groups. Conclusion The present study does not support an increased prevalence of neuroimaging cerebrovascular biomarkers in PD patients.

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