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

Naveed Malek; Michael A Lawton; Diane M A Swallow; Katherine A Grosset; Sarah L Marrinan; Nin Bajaj; Roger A Barker; David J Burn; John Hardy; Huw R Morris; Nigel M Williams; Nicholas Wood; Yoav Ben-Shlomo; Donald G Grosset; PRoBaND Clinical Consortium

doi:10.1002/mds.26698

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

Naveed Malek, Michael A Lawton, Diane M A Swallow, Katherine A Grosset, Sarah L Marrinan, Nin Bajaj, Roger A Barker, David J Burn, John Hardy, Huw R Morris, Nigel M Williams, Nicholas Wood, Yoav Ben-Shlomo, Donald G Grosset, PRoBaND Clinical Consortium

Applied Health Sciences

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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 = .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).

CONCLUSION: 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.

Original language	English
Pages (from-to)	1518-1526
Number of pages	9
Journal	Movement Disorders
Volume	31
Issue number	10
Early online date	21 Jun 2016
DOIs	https://doi.org/10.1002/mds.26698
Publication status	Published - Oct 2016

Bibliographical note

Funded by
Parkinson's UK
National Institute for Health Research (NIHR) DeNDRoN network
NIHR Newcastle Biomedical Research Unit
Newcastle University
NIHR funded Biomedical Research Centre in Cambridge

Keywords

Parkinson's disease
gender
phenotype
diabetes
cerebrovascular

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/mds.26698Licence: CC BY

Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease
© 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. https://creativecommons.org/licenses/by/4.0/
Final published version, 312 KBLicence: CC BY

Diane Swallow
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Senior Clinical Lecturer
Person: Clinical Academic

Cite this

Malek, N., Lawton, M. A., Swallow, D. M. A., Grosset, K. A., Marrinan, S. L., Bajaj, N., Barker, R. A., Burn, D. J., Hardy, J., Morris, H. R., Williams, N. M., Wood, N., Ben-Shlomo, Y., Grosset, D. G., & PRoBaND Clinical Consortium (2016). Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease. Movement Disorders, 31(10), 1518-1526. https://doi.org/10.1002/mds.26698

Malek, N, Lawton, MA, Swallow, DMA, Grosset, KA, Marrinan, SL, Bajaj, N, Barker, RA, Burn, DJ, Hardy, J, Morris, HR, Williams, NM, Wood, N, Ben-Shlomo, Y, Grosset, DG & PRoBaND Clinical Consortium 2016, 'Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease', Movement Disorders, vol. 31, no. 10, pp. 1518-1526. https://doi.org/10.1002/mds.26698

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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 = .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).CONCLUSION: Vascular comorbidity is significantly associated with cognitive and gait impairment in patients with early PD, which may have prognostic and treatment implications. {\textcopyright} 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.",

keywords = "Parkinson's disease, gender , phenotype, diabetes , cerebrovascular ",

author = "Naveed Malek and Lawton, {Michael A} and Swallow, {Diane M A} and Grosset, {Katherine A} and Marrinan, {Sarah L} and Nin Bajaj and Barker, {Roger A} and Burn, {David J} and John Hardy and Morris, {Huw R} and Williams, {Nigel M} and Nicholas Wood and Yoav Ben-Shlomo and Grosset, {Donald G} and {PRoBaND Clinical Consortium}",

note = "Funded by Parkinson's UK National Institute for Health Research (NIHR) DeNDRoN network NIHR Newcastle Biomedical Research Unit Newcastle University NIHR funded Biomedical Research Centre in Cambridge",

year = "2016",

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doi = "10.1002/mds.26698",

language = "English",

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T1 - Vascular disease and vascular risk factors in relation to motor features and cognition in early Parkinson's disease

AU - Malek, Naveed

AU - Lawton, Michael A

AU - Swallow, Diane M A

AU - Grosset, Katherine A

AU - Marrinan, Sarah L

AU - Bajaj, Nin

AU - Barker, Roger A

AU - Burn, David J

AU - Hardy, John

AU - Morris, Huw R

AU - Williams, Nigel M

AU - Wood, Nicholas

AU - Ben-Shlomo, Yoav

AU - Grosset, Donald G

AU - PRoBaND Clinical Consortium

N1 - Funded by Parkinson's UK National Institute for Health Research (NIHR) DeNDRoN network NIHR Newcastle Biomedical Research Unit Newcastle University NIHR funded Biomedical Research Centre in Cambridge

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N2 - 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 = .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).CONCLUSION: 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.

AB - 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 = .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).CONCLUSION: 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.

KW - Parkinson's disease

KW - gender

KW - phenotype

KW - diabetes

KW - cerebrovascular

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DO - 10.1002/mds.26698

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SN - 0885-3185

VL - 31

SP - 1518

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JO - Movement Disorders

JF - Movement Disorders

IS - 10

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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Diane Swallow

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