Abstract
Recent epidemiological studies have revealed a correlation between atypical features and worse functional outcomes in Parkinson's disease (PD) patients with cerebrovascular disease (CVD). We aimed to evaluate the brain hemodynamics of PD patients with risk factors for CVD using Doppler ultrasonography. In this prospective pilot study, we randomly included 27 outpatients diagnosed with PD. Transcranial color-coded sonography (TCCS) examinations were performed, obtaining measurements of middle cerebral artery mean flow velocities (Vm), the resistance index (RI), and the pulsatility index (PI). The breath-holding index (BHI) was used to assess cerebrovascular reactivity (cVR). Standardized functional scales (UPDRS III, Hoehn & Yahr scale, and MoCA) were administered. The patients were divided into two groups: those with two or more vascular risk factors (PDvasc) and those with fewer than two vascular risk factors (PDnvasc). Patients in the PDvasc group showed higher PI (1.00 vs. 0.85; p=0.020), RI (0.59 vs. 0.5; p=0.05), H&Y mean (2.4 vs. 1.4; p=0.036), higher frequency of altered cVR (90.9% vs. 25.0%; p=0.001), and lower BHI (0.46 vs. 1.01; p=0.027). We also divided the patients in other two groups: one with patients with classical and another with akinetic-rigid PD clinical type. Patients with the akinetic-rigid type of PD had significantly higher RI (0.60 vs. 0.51; p=0.03), PI (0.99 vs. 0.77; p=0.03), higher frequency of altered cVR (80% vs. 35%; p=0.02), and lower BHI (0.48 vs. 0.96; p=0.05) than patients with classic-type PD. We concluded that TCCS displays impaired cerebrovascular reactivity and a more severe disease pattern in Parkinsonian patients with two or more risk factors for CVD and in the akinetic-rigid type. Doppler ultrasonography may be a useful tool in a clinical setting to investigate PD patients.
Highlights
Parkinson’s disease (PD) is a complex neurodegenerative disease first described two centuries ago and still intensively investigated. e degeneration of dopaminergic neurons in the mesencephalic substantia nigra with Lewy body inclusions is the hallmark of this disease
We found that individuals in the PDvasc group had lower breath-holding index (BHI) and higher pulsatility index (PI) and resistance index (RI), in addition to a higher rate of changes in cerebrovascular reactivity (cVR), indicating brain vascular pathology
We observed that the median H&Y scale score was significantly higher in individuals in the PDvasc group, suggesting a possible influence of vascular risk factors on the clinical severity of PD. ese data agree with previous studies that found that patients with PD and cerebrovascular disease (CVD) risk factors were more prone to rapid deterioration and suffered increased mortality [4, 5, 26]
Summary
Parkinson’s disease (PD) is a complex neurodegenerative disease first described two centuries ago and still intensively investigated. e degeneration of dopaminergic neurons in the mesencephalic substantia nigra with Lewy body inclusions is the hallmark of this disease. E degeneration of dopaminergic neurons in the mesencephalic substantia nigra with Lewy body inclusions is the hallmark of this disease. As no biological marker for PD has yet been identified, the disease has been diagnosed based on clinical criteria [1]. E brains of patients with vascular Parkinsonism (VP), that is, without Lewy body pathology, were found to be severely affected by a small-vessel disease (SVD) associated pathological state, in contrast to the findings in age-matched. Parkinson’s Disease controls with vascular risk factors such as hypertension and heart disease [3].
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