The Combination of Homocysteine and C-Reactive Protein Predicts the Outcomes of Chinese Patients with Parkinson's Disease and Vascular Parkinsonism

Lijuan Yang,Cansheng Zhu,Joe Z Tsien,Xiaohong Chen,Limin Zhang,Junqiang Yan,Yunqi Xu,Qing Wang,Lianfang Bian,Ying Jiang,Ling Long

doi:10.1371/journal.pone.0019333

Abstract

BackgroundThe elevation of plasma homocysteine (Hcy) and C-reactive protein (CRP) has been correlated to an increased risk of Parkinson's disease (PD) or vascular diseases. The association and clinical relevance of a combined assessment of Hcy and CRP levels in patients with PD and vascular parkinsonism (VP) are unknown.Methodology/Principal FindingsWe performed a cross-sectional study of 88 Chinese patients with PD and VP using a clinical interview and the measurement of plasma Hcy and CRP to determine if Hcy and CRP levels in patients may predict the outcomes of the motor status, non-motor symptoms (NMS), disease severity, and cognitive declines. Each patient's NMS, cognitive deficit, disease severity, and motor status were assessed by the Nonmotor Symptoms Scale (NMSS), Mini-Mental State Examination (MMSE), the modified Hoehn and Yahr staging scale (H&Y), and the unified Parkinson's disease rating scale part III (UPDRS III), respectively. We found that 100% of patients with PD and VP presented with NMS. The UPDRS III significantly correlated with CRP (P = 0.011) and NMSS (P = 0.042) in PD patients. The H&Y was also correlated with Hcy (P = 0.002), CRP (P = 0.000), and NMSS (P = 0.023) in PD patients. In VP patients, the UPDRS III and H&Y were not significantly associated with NMSS, Hcy, CRP, or MMSE. Strong correlations were observed between Hcy and NMSS as well as between CRP and NMSS in PD and VP.Conclusions/SignificanceOur findings support the hypothesis that Hcy and CRP play important roles in the pathogenesis of PD. The combination of Hcy and CRP may be used to assess the progression of PD and VP. Whether or not anti-inflammatory medication could be used in the management of PD and VP will produce an interesting topic for further research.

Highlights

Idiopathic Parkinson’s disease (PD) is the second most common neurodegenerative disorder following Alzheimer’s disease; attention has recently been drawn to vascular parkinsonism (VP)
To the best of our knowledge, this report is the first to evaluate the association between motor/non-motor effects and C-reactive protein (CRP)/Hcy in Chinese patients with PD and VP using unified and integrated scales (NMSS, Hoehn and Yahr staging scale (H&Y), and Mini-Mental State Examination (MMSE))
We found that non-motor symptoms (NMS) were very common in Chinese patients with PD and VP, with a prevalence of NMS in the group being 100%, and the Nonmotor Symptoms Scale (NMSS) for PD was consistent with a previous report [15]

Summary

Introduction

Idiopathic Parkinson’s disease (PD) is the second most common neurodegenerative disorder following Alzheimer’s disease; attention has recently been drawn to vascular parkinsonism (VP). Several lines of research have shown that serum oxidative stress and pro-inflammatory cytokines such as interleukin (IL)-1b, IL-2, IL-6, HLA-DRB1, phospholipase A(2), tumor necrosis factor (TNF)-a, and TNF-a receptors are elevated in the brain and cerebral spinal fluid of PD patients [1,2,3,4]. In addition to those inflammatory related mediators, plasma Creactive protein (CRP) and homocysteine (Hcy) levels have recently attracted wide clinical attention as predictive of PD progression. The association and clinical relevance of a combined assessment of Hcy and CRP levels in patients with PD and vascular parkinsonism (VP) are unknown

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