Cardiovascular physiology in premotor Parkinson's disease: A neuroepidemiologic study

Abstract

Changes in cardiovascular physiology in Parkinson's disease (PD) are common and may occur prior to diagnostic parkinsonian motor signs. We investigated associations of electrocardiographic (ECG) abnormalities, orthostasis, heart rate variability, and carotid stenosis with the risk of PD diagnosis in the Cardiovascular Health Study, a community‐based cohort of older adults. ECG abnormality, orthostasis (symptomatic or asymptomatic), heart rate variability (24‐hour Holter monitoring), and any carotid stenosis (≥1%) by ultrasound were modeled as primary predictors of incident PD diagnosis using multivariable logistic regression. Incident PD cases were identified by at least 1 of the following: self‐report, antiparkinsonian medication use, and ICD‐9. If unadjusted models were significant, they were adjusted or stratified by age, sex, and smoking status, and those in which predictors were still significant (P ≤ .05) were also adjusted for race, diabetes, total cholesterol, low‐density lipoprotein, blood pressure, body mass index, physical activity, education level, stroke, and C‐reactive protein. Of 5888 participants, 154 incident PD cases were identified over 14 years of follow‐up. After adjusting models with all covariates, those with any ECG abnormality (odds ratio [OR], 1.45; 95% CI, 1.02–2.07; P = .04) or any carotid stenosis (OR, 2.40; 95% CI, 1.40–4.09; P = .001) at baseline had a higher risk of incident PD diagnosis. Orthostasis and heart rate variability were not significant predictors. This exploratory study suggests that carotid stenosis and ECG abnormalities occur prior to motor signs in PD, thus serving as potential premotor features or risk factors for PD diagnosis. Replication is needed in a population with more thorough ascertainment of PD onset. © 2012 Movement Disorder Society

Validation of Secondary Data Sources to Identify Parkinson Disease Against Clinical Diagnostic Criteria

“…However, our results are applicable to large population-based prospective cohort studies that, although not designed to examine PD, have nonetheless been used to examine multiple potential risk factors and their interactions. These include the Cardiovascular Health Study (14)(15)(16), the Atherosclerosis in Communities Study (17), the Honolulu Asia Aging Study (18)(19)(20)(21)(22), the Leisure World Cohort Study (23), the Nurses' Health Study, and the Health Professionals Follow-up Study (24)(25)(26)(27). Many of the initial epidemiologic studies of PD were limited by sample size or methodology that compromised interpretation of results, and the present study is no exception.…”

“…The etiology for most sporadic cases remains unknown, as genetic variants account for only approximately 10% of cases (2). PD has a low incidence (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) per 100,000 person-years), and it is impractical to conduct a prospective, longitudinal epidemiologic study on a condition that relies on a clinical examination for a diagnosis because there is no biomarker or simple laboratory test that can confirm a PD diagnosis except autopsy. Registries for PD that cover large populations do not exist.…”

PR Prolongation and Cardiac ¹²³I-MIBG Uptake Reduction in Parkinson's Disease

“…In 19 PD patients with PR prolongation, 17 patients also had abnormal MIBG findings, and the other 2 showed normal MIBG. Conclusions: The PR prolongation Cardiovascular physiological analyses in the premotor stage PD showed electrocardiography (ECG) abnormalities prior to motor signs, which indicates that ECG abnormalities could be a potential premotor feature for PD diagnosis [6] . The ECG abnormalities, however, included a variety of abnormal findings such as ventricular conduction defect, ST-T wave changes, atrial fibrillation, and atrioventricular block [6] .…”

“…Conclusions: The PR prolongation Cardiovascular physiological analyses in the premotor stage PD showed electrocardiography (ECG) abnormalities prior to motor signs, which indicates that ECG abnormalities could be a potential premotor feature for PD diagnosis [6] . The ECG abnormalities, however, included a variety of abnormal findings such as ventricular conduction defect, ST-T wave changes, atrial fibrillation, and atrioventricular block [6] . Because the previous study did not analyze their details [6] , it remains to be determined whether or not the heart conduction pathways are involved in PD.…”

“…The ECG abnormalities, however, included a variety of abnormal findings such as ventricular conduction defect, ST-T wave changes, atrial fibrillation, and atrioventricular block [6] . Because the previous study did not analyze their details [6] , it remains to be determined whether or not the heart conduction pathways are involved in PD. A few studies reported rate-corrected QT (QTc) prolongation in PD [7] , and the degree of the prolongation related with the severity of PD symptoms [8] .…”