Stroke and its modification in Parkinson's disease.

Abstract

Previous studies have not agreed on the incidence of ischemic stroke in persons with Parkinson's disease. There are epidemiologic and neurochemical facets of Parkinson's disease that might confer some benefit or protection against ischemic stroke. We used a case-control method to determine the lifetime history of ischemic stroke in 200 patients with Parkinson's disease and 200 controls of a similar age range. Analysis was also carried out for myocardial infarction as a marker of generalized atherosclerotic disease and for stroke risk factors. The cumulative incidence of ischemic stroke was significantly less in the patients with Parkinson's disease than in the controls, as was the cumulative incidence of myocardial infarction. Among risk factors, significantly fewer patients with Parkinson's disease used tobacco than controls. The decreased incidence of ischemic stroke in the patients with Parkinson's disease appears to be related to their less severe generalized atherosclerosis, possibly due to their lower incidence of tobacco use. In view of the known potential for dopamine to exacerbate experimental ischemic tissue damage, the possibility that the dopamine deficiency in the central nervous system of persons with Parkinson's disease confers an additional specific protective benefit against ischemic stroke cannot be excluded and requires further study. (Stroke 1990;21:1395-1399) I schemic stroke and Parkinson's disease (PD) are common disorders, both occurring with the greatest incidence among individuals over the age of 55 years. This suggests that the appearance of both conditions in the same patient should be common. However, there are epidemiologic and neuropharmacologic facets of PD that might reduce the severity or incidence of ischemic stroke in the population with PD. Among the few studies that have attempted to evaluate the incidence of stroke in patients with PD there have been conflicting results. Some studies have found a similar incidence of cerebral vascular disease 1 or stroke 2 in PD patients and controls, while others have found a higher 3 or lower 4 incidence of stroke in PD patients. Moreover, these studies were performed before the era of modern neuroimaging techniques and prior to the advent of widely accepted clinical criteria for the diagnosis of stroke.No recent systematic investigation of the incidence of ischemic stroke in patients with PD has been carried out. If there is a reduced incidence of isch- Received March 16, 1990; accepted June 5, 1990. emic stroke in PD patients, it is important to attempt to explain the reduction in light of current understanding of the physiology and pharmacology of these two disorders and to determine whether it is due to less severe generalized atherosclerotic vascular disease or to localized protective mechanisms peculiar to the central nervous system (CNS) of PD patients.To address these questions we used a case-control method to compare the cumulative incidence of ischemic stroke in PD patients with that in controls undergoing surgical removal of...

Stroke and Parkinson's disease.

“…The present study shows similar and disparate features from the work of Struck et al 2 In terms of demographics, the present study shows a group of PD patients of mean age 68.5 years (versus 66.9 years in the study of Struck et al) and a disease duration of 7.3 years (versus 7.7 years). Severity of PD is also comparable between studies: stage 1 patients in the present study represent 23.5% versus 20.5% in that of Struck et al 2 ; stage II, 48.7% versus 46.0%; stage III, 12.6% versus 23.5%; stage IV, 12.6% versus 8.5%; and stage V, 2.5% versus 1.5%.…”

“…Data were compiled to make a direct comparison with those in the recent retrospective study at the University of Iowa Hospitals and Clinics. 2 The study continued from 1982 through 1990. Patients with PD included those with a presumptive etiology of "idiopathic," and all diagnoses were reconfirmed by either the attending neurologist or a review of subsequent outpatient follow-up records.…”

“…2 Specific criteria were required to establish the diagnosis of ischemic stroke 2 and included documentation by the attending or consulting neurologist of prolonged or permanent neurological deficit, clinical history of ischemic stroke with computed tomography scan or magnetic resonance imaging confirmation, and no evidence of cerebral hemorrhage on neuroimages.…”

“…In reference to the recent work of Struck et al, 2 we report a case-control retrospective study of the incidence of ischemic stroke in a Veterans Affairs (VA) hospital patient population. Some previous studies have found a higher incidence of ischemic stroke in PD patients compared with control subjects, 3 some a lower incidence, 2 -4 and some a similar incidence.…”

Selective effects of low doses of apomorphine on spatiotemporal contrast sensitivity in healthy volunteers: a double‐blind placebo‐ controlled study.

“…Subjects were extensively trained (four sessions) with this method during the week preceding the study and 15 min of adaptation to the ambiant illumination level was allowed before testing. All tests were performed at the same time of the day since circardian variations of contrast sensitivity have been reported at least in Parkinson patients (Struck et al, 1990).…”