Vascular prevention in patients with parkinson’s disease
Vascular prevention is appropriate for patients with a vascular history (secondary prevention) and increased risk (primary prevention). Cerebrovascular disease adds to gait and cognitive problems in patients with Parkinson’s disease (PD).
A convenience cross-sectional sample of consecutive PD patients attending the Neurology Movement Disorder clinic was assessed, and QRISK3 scored when appropriate (cases without vascular events, age <85 years). Results Of 100 cases, mean age 66.5 (SD 9.0) years, 52.0% male, with PD duration 8.3 (SD 5.5) years, 15 had a vascular history meriting statin therapy, of whom 12 (80.0%) were prescribed statins. 22 had a high vascular risk (QRISK3 >20%), mean QRISK3 28.6 (SD 7.7) of whom 2 (9.1%) were prescribed statins. We are now actively assessing QRISK3 and recommending statin therapy where appropriate.
Secondary vascular prevention with statins is more commonly implemented than primary prevention, in patients with PD. In patients without a vascular diagnosis, vascular risk should be assessed and statin therapy offered where appropriate, noting that around one-fifth of patients have a high vascular risk and are not on statin treatment.
Conference: Association of British Neurologists 2018, Poster session
Title: THUR 116 Vascular prevention in patients with parkinson’s disease
Authors: Kempe Isla, Grosset Katherine A, Grosset Donald G
Citation: Isla K, A GK, G GD THUR 116 Vascular prevention in patients with parkinson’s disease J Neurol Neurosurg Psychiatry 2018;89:A12.
The L-DOPA response in pathologically confirmed parkinson’s disease
l-dopa is the standard treatment for Parkinson’s disease, but the response is variable.
Systematic review of papers reporting the l-dopa response (motor response and/or complications) in pathologically confirmed Parkinson’s disease.
467 cases of pathologically confirmed Parkinson’s were identified: 60.2% male, age at disease onset 63.3 years (SD 10.3), age at death 76.7 years (SD 7.8). Data on a graded l-dopa response were available in 411 cases (88.0% of 467). The motor response was excellent in 148/411 cases (36.0%), good in 179/411 (43.6%), moderate in 51/411 (12.4%) and poor/absent in 33/411 (8.0%). Data about motor complications were available for 161 patients: 71/161 (44.1%) had motor fluctuations and 89/161 (55.3%) had dyskinesia. Comorbid brain pathology was evaluated in 251/411 cases (61.1%), and was present in 148/251 (59.0%): cerebrovascular in 65/148 (43.9%), Alzheimer’s in 55/148 (37.2%), amyloid angiopathy in 18/148 (12.2%), and diffuse Lewy body disease in 10/148 (6.8%). Data linking the graded l-dopa response to comorbid pathologies were available in only 17 cases, of whom 8/17 (47.1%) had a good/excellent response.
There is variation in the l-dopa response in pathologically confirmed Parkinson’s disease. The limited available information suggests a possible association of motor response to comorbid brain pathology.
Citation: Pitz V, Malek N, Grosset KA, et al THUR 117 The L-DOPA response in pathologically confirmed parkinson’s disease J Neurol Neurosurg Psychiatry 2018;89:A12-A13.
Genetic associations of ICD in parkinson’s disease
Impuse Control Disorders (ICD) are a potentially devastating side-effect of dopaminergic therapy in Parkinson’s disease (PD). We explore the genetic factors associated with ICD in Tracking Parkinson’s/PRoBaND – a UK-wide cohort of early-stage PD.
Participants were diagnosed with PD within 3 years and had longitudinal assessment including the Questionnaire for ICD in Parkinson’s (QUIP) for up to 5 years. We defined cases as having any positive response to the QUIP (lax criteria) or 2 positive responses in any domain (strict criteria). We performed a candidate-gene analysis based on systematic review, followed by a genome-wide association study. We used age at onset, gender, and three significant principle components as covariates.
After clinical and genetic quality control steps, we analysed 1602 participants. Prevalence was significantly affected by classification criteria (strict/lax): ICD – 26.8%/11.1%, IRB 29.3%/27.2%, any 31.7%/41.9%. Six SNPs in dopamine, glutamate and adreno- receptor genes achieved nominal significance (p<0.05) in the candidate study. We have identified several SNPs in the GWAS that approach genome wide significance (p<5 × 10–7).
This work is the first genome-wide study of genetic determinants of ICD. Our findings support the hypothesis of genetic determinants of ICD in Parkinson’s and further work will allow understanding of the biology of ICD.
Citation: Richard R, Leon H, Yoav B, et al 297 Genetic associations of ICD in parkinson’s disease J Neurol Neurosurg Psychiatry 2018;89:A47.