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Cerebrovascular pathologies may be unrecognized common etiologies of mild parkinsonian signs
Buchman A. Stroke. 2011;doi:10.1161/STROKEAHA.111.623462.
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Macroscopic infarcts, microinfarcts and arteriolosclerosis are common and may be unrecognized etiologies of mild parkinsonian signs in old age, according to a study.
Researchers studied 418 brain autopsies from deceased participants in the Rush Religious Order Study. Participants did not have dementia at the time of enrollment. They underwent evaluation of parkinsonian signs, and their brains were evaluated for macroscopic and microinfarcts and the severity of arteriolosclerosis. Researchers also predetermined four parkinsonian sign scores: parkinsonian gait, bradykinesia, rigidity and tremor. Medical history, neurological examination and neuropsychological performance tests were performed each year for clinical evaluation. All collected clinical data were reviewed at the time of death.
Macroscopic infarcts were shown in more than 35% of cases (n=149), and almost 30% of cases without macroscopic infarcts showed microinfarcts (n=33), arteriolosclerosis (n=62) or both (n=24). Researchers found that macroscopic infarcts were strongly related to both microinfarcts (OR=3.12; P<.001) and arteriolosclerosis (OR=2.4; P<.001), whereas arteriolosclerosis and microinfarcts were not related (OR=1.32; P=.319). When it came to global parkinsonian sign scores before death, macroscopic infarcts had cortical (P=.041) and subcortical (P=.008) that showed separate associations with a higher score. For microinfarcts, cortical but not subcortical were associated with a higher global parkinsonian score (P=.039). Researchers found that although microinfarcts showed a trend for an association with global parkinsonian, the effect was no longer significant when controlling for macroscopic infarcts, and arteriolosclerosis was associated but no longer significant after accounting for infarcts.
When cerebrovascular pathologies were examined to find relation with individual parkinsonian signs, researchers found that macroscopic infarcts (P=.009), microscopic infarcts (P=.047) and atherosclerosis (P<.001) were associated more with parkinsonian gait vs. bradykinesia and tremor. Macroscopic infarcts were associated with a higher level of gait impairment in subcortical (P<.001) but not cortical macroscopic infarcts (P=.306). Increased parkinsonian gait score was more related to multiple subcortical microinfarcts (P=.004) vs. cortical microinfarcts. Researchers found that, after controlling for both macroscopic and microinfarcts, atherosclerosis had a separate effect on parkinsonian gait.
“Often the mild motor symptoms are considered an expected part of aging,” Aron S. Buchman, MD, associate professor of neurological sciences at Rush University Medical Center in Chicago, said in a press release. “We shouldn’t accept this as normal aging. We should try to fix it and understand it. If there is an underlying cause, we can intervene and perhaps lessen the impact.”
Disclosure: Dr. Buchman reports no relevant financial disclosures.
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