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April 29, 2014; 82 (17) Article

Modifiable cardiovascular risk factors and axial motor impairments in Parkinson disease

Vikas Kotagal, Roger L. Albin, Martijn L.T.M. Müller, Robert A. Koeppe, Kirk A. Frey, Nicolaas I. Bohnen
First published March 28, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000356
Vikas Kotagal
From the Departments of Neurology (V.K., R.L.A., K.A.F., N.I.B.) and Radiology (M.L.T.M.M., R.A.K., K.A.F., N.I.B.), University of Michigan; and the Neurology Service and GRECC (R.L.A., N.I.B.), VAAAHS, Ann Arbor, MI.
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Roger L. Albin
From the Departments of Neurology (V.K., R.L.A., K.A.F., N.I.B.) and Radiology (M.L.T.M.M., R.A.K., K.A.F., N.I.B.), University of Michigan; and the Neurology Service and GRECC (R.L.A., N.I.B.), VAAAHS, Ann Arbor, MI.
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Martijn L.T.M. Müller
From the Departments of Neurology (V.K., R.L.A., K.A.F., N.I.B.) and Radiology (M.L.T.M.M., R.A.K., K.A.F., N.I.B.), University of Michigan; and the Neurology Service and GRECC (R.L.A., N.I.B.), VAAAHS, Ann Arbor, MI.
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Robert A. Koeppe
From the Departments of Neurology (V.K., R.L.A., K.A.F., N.I.B.) and Radiology (M.L.T.M.M., R.A.K., K.A.F., N.I.B.), University of Michigan; and the Neurology Service and GRECC (R.L.A., N.I.B.), VAAAHS, Ann Arbor, MI.
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Kirk A. Frey
From the Departments of Neurology (V.K., R.L.A., K.A.F., N.I.B.) and Radiology (M.L.T.M.M., R.A.K., K.A.F., N.I.B.), University of Michigan; and the Neurology Service and GRECC (R.L.A., N.I.B.), VAAAHS, Ann Arbor, MI.
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Nicolaas I. Bohnen
From the Departments of Neurology (V.K., R.L.A., K.A.F., N.I.B.) and Radiology (M.L.T.M.M., R.A.K., K.A.F., N.I.B.), University of Michigan; and the Neurology Service and GRECC (R.L.A., N.I.B.), VAAAHS, Ann Arbor, MI.
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Citation
Modifiable cardiovascular risk factors and axial motor impairments in Parkinson disease
Vikas Kotagal, Roger L. Albin, Martijn L.T.M. Müller, Robert A. Koeppe, Kirk A. Frey, Nicolaas I. Bohnen
Neurology Apr 2014, 82 (17) 1514-1520; DOI: 10.1212/WNL.0000000000000356

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Abstract

Objective: Cardiovascular comorbidities associate with neurodegeneration in the elderly and may contribute to extranigral pathologies and medically refractory axial motor features in Parkinson disease (PD).

Methods: We explored differences in the estimated rate of axial motor feature accrual between patients with PD with and without elevated cardiovascular risk factors as estimated by the Framingham General Cardiovascular Disease risk-scoring algorithm in a cross-sectional cohort study. All participants underwent motor evaluations with the Movement Disorders Society revised Unified Parkinson's Disease Rating Scale (MDS-UPDRS), [11C]dihydrotetrabenazine (DTBZ) monoaminergic brain PET imaging, and MRI.

Results: Participants with PD with elevated Framingham risk (FR) scores (n = 63, 74.1%) showed higher unadjusted rates of total MDS-UPDRS (t = 3.60, p = 0.0006) and axial motor scores (t = 3.98, p = 0.0001) per estimated year of motor symptoms compared to participants with normal-range risk scores (n = 22, 25.9%). After controlling for sex, Montreal Cognitive Assessment score, frontal leukoaraiosis severity, and striatal DTBZ activity, elevated risk factor status was associated with the rate of accrual of axial motor impairments (R2 = 0.206; t = 2.62, p = 0.011) but not with total MDS-UPDRS motor score (R2 = 0.198; t = 1.51, p = 0.135). Frontal leukoaraiosis was associated with the rate of axial and total MDS-UPDRS scores per year of symptoms and also with elevated systolic blood pressure (R2 = 0.291; t = 2.30, p = 0.024) in a separate risk-factor model.

Conclusion: Cardiovascular risk factors may contribute to axial motor features in PD. Early modification of cardiovascular risk factors, including hypertension, deserves further study as a novel disease-modifying strategy in PD.

GLOSSARY

BMI=
body mass index;
DR=
dopamine-resistant;
DTBZ=
dihydrotetrabenazine;
DVR=
distribution volume ratio;
FLAIR=
fluid-attenuated inversion recovery;
FR=
Framingham risk;
MDS-UPDRS=
Movement Disorders Society revised Unified Parkinson's Disease Rating Scale;
MLR=
multivariable linear regression;
MoCA=
Montreal Cognitive Assessment;
PD=
Parkinson disease;
VOI=
volume of interest

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 1488

  • Received July 12, 2013.
  • Accepted in final form January 2, 2014.
  • © 2014 American Academy of Neurology
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