2.: The relationship between small vessel disease, vascular risk factors and motor and cognitive impairment in Parkinson’s disease: A clinicopathological study

Abstract

The aim of this study is to assess whether small vessel disease (SVD) pathology and vascular risk factors (VRF) are associated with the severity of motor and cognitive impairment in Parkinson’s disease (PD). Seventy-seven PD patient samples with autopsy-confirmed PD recruited by the Sydney Brain Bank from 1995 to 2006 were selected for study. The Hoehn and Yahr scale and the Clinical Dementia Rating scale were used to assess motor and cognitive function, respectively. SVD pathology was assessed by one investigator (R.S.) blinded to the clinical details of each case. Significant correlations between VRF and SVD pathology in subcortical white matter and basal ganglia with motor and cognitive impairment in PD brains were determined using multiple stepwise logistic regression analyses (Statistical Package for the Social Sciences version 19; SPSS Inc., Chicago, IL, USA). There was a significant correlation between the severity of globus pallidus internus pallor and Hoehn and Yahr stage, as well as a significant correlation between VRF overall, hypertension in particular, and the presence of dementia in PD. No significant correlation could be demonstrated between the severity of SVD pathology and the presence of dementia in PD. To the best of our knowledge, this is the first study to demonstrate a significant correlation between SVD pathology and motor impairment in a cohort of autopsy-proven PD brains. The data presented show a significant correlation between hypertension and dementia severity in this cohort. These findings support the view that management of VRF may be helpful in patients with PD, especially in relation to their motor and cognitive impairment. The aim of this study is to assess whether small vessel disease (SVD) pathology and vascular risk factors (VRF) are associated with the severity of motor and cognitive impairment in Parkinson’s disease (PD). Seventy-seven PD patient samples with autopsy-confirmed PD recruited by the Sydney Brain Bank from 1995 to 2006 were selected for study. The Hoehn and Yahr scale and the Clinical Dementia Rating scale were used to assess motor and cognitive function, respectively. SVD pathology was assessed by one investigator (R.S.) blinded to the clinical details of each case. Significant correlations between VRF and SVD pathology in subcortical white matter and basal ganglia with motor and cognitive impairment in PD brains were determined using multiple stepwise logistic regression analyses (Statistical Package for the Social Sciences version 19; SPSS Inc., Chicago, IL, USA). There was a significant correlation between the severity of globus pallidus internus pallor and Hoehn and Yahr stage, as well as a significant correlation between VRF overall, hypertension in particular, and the presence of dementia in PD. No significant correlation could be demonstrated between the severity of SVD pathology and the presence of dementia in PD. To the best of our knowledge, this is the first study to demonstrate a significant correlation between SVD pathology and motor impairment in a cohort of autopsy-proven PD brains. The data presented show a significant correlation between hypertension and dementia severity in this cohort. These findings support the view that management of VRF may be helpful in patients with PD, especially in relation to their motor and cognitive impairment.