Author response: Incident parkinsonism in older adults without Parkinson disease

Buchman, Aron S.; Bennett, David A.

doi:10.1212/wnl.0000000000003674

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…Therefore as we have done in prior studies, we leveraged the successful approach which led to the reclassification of pathologic AD to characterize the clinical heterogeneity of LB pathology in the spinal cord. (16–18, 20, 21, 23) As illustrated in Figures 2 and 3, to avoid truncating the distribution of the clinical spectrum of parkinsonism associated with LB pathology, we included all cases and did not exclude cases based on their postmortem findings. Nonetheless, to focus our primary analyses on prodromal PD, as we and others have done in prior studies, we excluded cases with a clinical diagnosis of PD.…”

Section: Discussionmentioning

confidence: 99%

Spinal Lewy body pathology in older adults without an antemortem diagnosis of Parkinson's disease

et al. 2017

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To test the hypothesis that Lewy body pathology (LBs) is present in the spinal cord of older community-dwelling adults without a clinical diagnosis of Parkinson's disease (PD). We studied 162 prospective autopsies from older adults with PD (N = 6) and without PD (N = 156). We documented the presence of LBs in cerebrum and brainstem structures from each of the six regions used for Braak PD staging and four spinal cord levels (C5/6, T7, L4/5 and S4/5). Parkinsonism proximate to death was based on a previously validated measure present if two or more of the four signs of parkinsonism were present based on a modified version of the Unified Parkinson's Disease Rating Scale (UPDRS). Fifty-three of 156 individuals without PD (34%) had LBs in a least one site within the CNS. About half of cases with LBs in the cerebrum or brainstem, (25/53, 47%) also had spinal LBs. Almost 90% (22/25, 88%) of cases with spinal LBs had LBs in the cerebrum (Braak stages 4-6) and about 10% (3/25, 12%) had only brainstem LBs (Braak stages 1-3). Four of six cases with PD showed LBs in cerebrum, brainstem and spinal cord. Individuals with LBs in the spinal cord were more likely to have clinical parkinsonism proximate to death compared to individuals with LBs in brainstem and cerebrum alone (52% vs. 32%; Chi-Square x = 5.368, d.f. = 1, P = 0.0.021) and more severe nigral neuronal loss (48% vs. 11%; Chi-Square x = 9.049, d.f. = 1, P = 0.003). These findings were unchanged when we included cases with a history of PD. Older community-dwelling adults without a clinical diagnosis of PD have evidence of LBs throughout the CNS including the spinal cord which is associated with parkinsonism and more severe nigral neuronal loss.

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Section: Discussionmentioning

confidence: 99%

Spinal Lewy body pathology in older adults without an antemortem diagnosis of Parkinson's disease

et al. 2017

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“…1 Accumulating evidence suggests that factors that contribute to parkinsonism in adults without Parkinson disease (PD) are likely to contribute to and exacerbate parkinsonism in adults with a clinical diagnosis of PD. 2,3 This study focuses on older adults without a clinical diagnosis of PD and suggests that statin treatment is associated with reduced incident parkinsonism during the past decade of life through its association with brain atherosclerosis, but not due to PD or other neurodegenerative pathologies. However, most of the decedents in our study had mixed-brain pathologies.…”

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Author Response: Association of Statins With Cerebral Atherosclerosis and Incident Parkinsonism in Older Adults

Oveisgharan¹,

Bennett²,

Buchman³

2022

Neurology

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I read this study with interest, which found that statin use by the elderly was associated with a reduced risk of developing vascular parkinsonism. 1 Past studies have found that the risk of neurodegenerative Parkinson disease (PD) is inversely associated with serum levels of lowdensity lipoprotein cholesterol. 2 Recently, a large prospective randomized controlled clinical trial determined that PD progression did not differ significantly between patients with early PD who were randomized to receive simvastatin or placebo. 3 Thus, patients with neurodegenerative PD do not seem to benefit from statin use, but vascular parkinsonism is associated with benefit from statin use. This marked difference in the response to statin therapy increases the importance of correctly classifying in each patient the underlying cause of parkinsonism-vascular or neurodegenerative. 1.Oveisgharan S, Yu L, Barnes LL, et al. Association of statins with cerebral atherosclerosis and incident parkinsonism in older adults.

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Author response: Incident parkinsonism in older adults without Parkinson disease

Cited by 2 publications

References 5 publications

Spinal Lewy body pathology in older adults without an antemortem diagnosis of Parkinson's disease

Spinal Lewy body pathology in older adults without an antemortem diagnosis of Parkinson's disease

Author Response: Association of Statins With Cerebral Atherosclerosis and Incident Parkinsonism in Older Adults

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