Health comorbidities and cognition in 1948 patients with idiopathic Parkinson's disease

Jones, Jacob D.; Malaty, Irene A.; Price, Catherine C.; Okun, Michael S.; Bowers, Dawn

doi:10.1016/j.parkreldis.2012.06.004

Cited by 33 publications

(44 citation statements)

References 31 publications

(45 reference statements)

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“…Our findings of independent DM-related contributions to cognitive impairment in PD adds to the emerging literature that medical comorbidities can aggravate the clinical course of primary neurodegenerative disorders, such as PD (32, 33). Cognitive impairment in PD likely reflects the cumulative effects of heterogeneous processes, including independent effects of nigrostriatal dopaminergic and forebrain cholinergic denervations (18).…”

Section: Discussionsupporting

confidence: 64%

Diabetes mellitus is independently associated with more severe cognitive impairment in Parkinson disease

Bohnen

Kotagal

Müller

et al. 2014

Parkinsonism & Related Disorders

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Background There is increasing interest in interactions between metabolic syndromes and neurodegeneration. Diabetes mellitus (DM) contributes to cognitive impairment in the elderly but its effect in Parkinson disease (PD) is not well studied. Objective To investigate effects of comorbid DM on cognition in PD independent from PD-specific primary neurodegenerations. Methods Cross-sectional study. Patients with PD (n=148; age 65.6±7.4 years, Hoehn and Yahr stage 2.4±0.6, with (n=15) and without (n=133) comorbid type II DM, underwent [11C]methyl-4-piperidinyl propionate (PMP) acetylcholinesterase (AChE) PET imaging to assess cortical cholinergic denervation, [11C]dihydrotetrabenazine (DTBZ) PET imaging to assess nigrostriatal denervation, and neuropsychological assessments. A global cognitive Z-score was calculated based on normative data. Analysis of covariance was performed to determine cognitive differences between subjects with and without DM while controlling for nigrostriatal denervation, cortical cholinergic denervation, levodopa equivalent dose and education covariates. Results There were no significant differences in age, gender, Hoehn and Yahr stage or duration of disease between diabetic and non-diabetic PD subjects. There was a non-significant trend toward lower years of education in the diabetic PD subjects compared with non-diabetic PD subjects. PD diabetics had significantly lower mean (±SD) global cognitive Z-scores (−0.98±1.01) compared to the non-diabetics (−0.36±0.91; F=7.78, P=0.006) when controlling for covariate effects of education, striatal dopaminergic denervation, and cortical cholinergic denervation (total model F=8.39, P<0.0001). Conclusion Diabetes mellitus is independently associated with more severe cognitive impairment in PD likely through mechanisms other than diseasespecific neurodegenerations.

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Section: Discussionsupporting

confidence: 64%

Diabetes mellitus is independently associated with more severe cognitive impairment in Parkinson disease

Bohnen

Kotagal

Müller

et al. 2014

Parkinsonism & Related Disorders

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“…A high nocturnal blood pressure is also associated with an increased prevalence of end-organ damage (Berganzo et al, 2013). Moreover, a large cross-sectional study with a cohort of PD patients provided evidence for an influence of specific comorbidities, particularly heart/circulatory comorbidities and diabetes, on general measures of cognition (Jones et al, 2012). The onset of OSAS may probably help to explain the increased risk of cardiovascular disease and CVD in PD and parkinsonism patients.…”

Section: F Crosta Et Almentioning

confidence: 99%

Obstructive sleep apnea syndrome in Parkinson�s disease and other parkinsonisms

Crosta¹,

Desideri²,

Marini³

2017

Functional Neurology

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SummaryAn association of obstructive sleep apnea syndrome (OSAS) and other sleep-disordered breathing (SDB) with Parkinson's disease (PD) has been reported in some small studies. In the present study we investigated the occurrence of SDB in a large consecutive outpatient series. This is a case-control study in subjects attending a neurological clinic where all patients were screened for SDB by means of sleep-wake history, Epworth Sleepiness Scale, and full-night polysomnography, when indicated. 3194 patients were recruited. Of these, 194 were affected by PD and 77 by other parkinsonisms. Snoring, excessive daytime sleepiness and OSAS were more common in patients with PD or parkinsonisms (40.59, 5.9, and 4.06%) than in controls (35.58, 2.19, and 2.09%). Our study suggests an increased frequency of OSAS and other SDB in PD and parkinsonisms. Early detection and management of these disorders may have a substantial impact on quality of life and survival in these patients.

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“…The US Centers for Disease Control and prevention (CDC) estimate a national prevalence of diabetes of 9.4% [15]. A cross-sectional study of PD patients ( n = 1948) receiving care at non-VA National Parkinson Foundation Clinical Centers of Excellence is in line with this estimate showed a 9% prevalence of Diabetes and an overall 36.3% prevalence of “heart/circulation” comorbidities [2]. A similar survey conducted in large national VA PD sample ( n = 14,530) showed a self-reported prevalence of Diabetes to be much higher (22.3%).…”

Section: Discussionmentioning

confidence: 86%

“…Cardiovascular risk factors are common comorbidities in PD [2] and are a leading source of chronic disability worldwide. We previously reported that diabetes in PD associates with postural instability and gait difficulty as well as cognitive impairment [3, 4].…”

Section: Introductionmentioning

confidence: 99%

“…Using existing data from a cross-sectional observational study that recruited PD subjects from similar referral clinics at both a local VA specialty referral clinic and a University-affiliated medical center, we sought to explore differences in the burden of CVRFs between Veteran and non-Veteran PD subjects. Based on studies in previous VA and non-VA PD populations [2, 8], we hypothesized that a greater burden of cardiovascular risk factors would be present in Veteran subjects.…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Risk Factor Burden in Veterans and Non-Veterans with Parkinson Disease

Kotagal

Albin

Müller

et al. 2018

JPD

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Background Medical comorbidities, including cardiovascular risk factors such as hypertension and diabetes, influence disease progression in Parkinson disease (PD) and may be variably present in different clinical populations. Objective/Methods We conducted a retrospective nested case-control study of 29 Veterans with PD and 29 non-Veteran PD controls. The groups were matched for age, gender, and disease duration. Both groups underwent clinical and imaging testing as part of their participation in a larger cross-sectional PD observational study at our research center. Veterans were recruited primarily from movement disorders neurology clinics at the Ann Arbor Veterans Affairs (VA) Health System. Non-Veterans were recruited primarily from analogous clinics at the University of Michigan Health System. We explored differences in cardiovascular risks factor burden between the groups. Results Veterans with PD showed higher scores on the simplified Framingham 10-year general cardiovascular disease risk calculator (FR score; 27.3% (11.5) vs. 20.7% (6.8); t = −2.66, p = 0.011) and fewer years of self-reported education (14.5 (2.5) vs. 16.7 (2.6); t = 3.33, p = 0.002). After adjusting for age, disease duration, education, and the use of antihypertensive medications, Veterans showed higher FR scores (t = 2.95, p = 0.005) and a higher intra-subject ratio of FR score to age-and-gender normalized FR score (t = 2.49, p = 0.016), representing an elevated component of modifiable cardiovascular risk factor burden. Conclusion Cardiovascular comorbidities are common in Veterans with PD and may be more severe than in non-Veteran PD populations. These findings merit replication in other representative cohorts. Veterans may be a preferred population for clinical trials evaluating cardiovascular risk factor management on PD progression.

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Health comorbidities and cognition in 1948 patients with idiopathic Parkinson's disease

Cited by 33 publications

References 31 publications

Diabetes mellitus is independently associated with more severe cognitive impairment in Parkinson disease

Diabetes mellitus is independently associated with more severe cognitive impairment in Parkinson disease

Obstructive sleep apnea syndrome in Parkinson�s disease and other parkinsonisms

Cardiovascular Risk Factor Burden in Veterans and Non-Veterans with Parkinson Disease

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