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Exploring the relationship between motor impairment, vascular burden and cognition in Parkinson’s disease

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Abstract

Objective

To determine frequency and type of cognitive disorders in cross-sectional analysis of a Parkinson’s disease (PD) cohort, and explore its relations to motor symptoms, modifiable vascular risk factors and white matter lesions (WML) volume.

Methods

In a group of 133 PD patients, mild cognitive impairment (PD-MCI) and dementia (PDD) were diagnosed according to Movement Disorders Society Task Force criteria (level 2 for PD-MCI). Detailed motor measurements were applied, including rigidity, axial, bradykinesia, tremor and postural instability gait disorders (PIGD) scores. Vascular risk was estimated by the Framingham General Cardiovascular Disease risk scoring algorithm and WML volume was measured for whole brain and frontal lobe.

Results

Sixty-one (46.9%) patients fulfilled criteria for PD-MCI, and 23 (17.7%) for PDD. Non-amnestic multiple domain MCI was most frequent (52% of PD-MCI patients). Motor scores were significantly higher in cognitively impaired patients, but only axial score discriminated between MCI and dementia. High vascular risk was related to impaired cognition, bradykinesia, axial, PIGD and freezing of gait (FOG) score, while whole brain WML volume was associated with PDD, FOG and attention deficits. Furthermore, high vascular risk was identified as a potential predictor of both MCI and dementia in PD. Additionally, age and bradykinesia score were independently associated with PD-MCI and age, axial score and whole brain WML volume with PDD.

Conclusion

Cognitive disorders in PD are associated with more severe, predominantly axial motor deficits and increased, but partly modifiable vascular burden, thus opening a possibility for development of preventive strategies in PD.

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Authors and Affiliations

  1. Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia

    Tanja Stojkovic, Elka Stefanova, Vladana Markovic, Iva Stankovic, Igor Petrovic & Vladimir Kostic

  2. Institute of Medical Statistics, Belgrade, Serbia

    Ivan Soldatovic

  3. School of Medicine, University of Belgrade, Belgrade, Serbia

    Tanja Stojkovic, Elka Stefanova, Ivan Soldatovic, Vladana Markovic, Igor Petrovic & Vladimir Kostic

  4. Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy

    Federica Agosta, Sebastiano Galantucci & Massimo Filippi

Authors
  1. Tanja Stojkovic
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  2. Elka Stefanova
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  3. Ivan Soldatovic
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  4. Vladana Markovic
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  5. Iva Stankovic
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  6. Igor Petrovic
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  7. Federica Agosta
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  8. Sebastiano Galantucci
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  10. Vladimir Kostic
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Corresponding author

Correspondence to Tanja Stojkovic.

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Conflicts of interest

T. Stojkovic has received speaker honoraria from Actavis and research grant from the Ministry of Education and Science, Republic of Serbia, as well as Alzheimer’s Association International Research Grant. E. Stefanova has received speaker honoraria from Novartis, Glaxo Smith Kline and Boehringer Ingelheim, research grant from the Ministry of Education and Science, Republic of Serbia, as well as Alzheimer’s Association International Research Grant. I. Soldatovic. Declarations of interest: none. V. Markovic has received research grants from the Ministry of Education and Science, Republic of Serbia. I. Stankovic has received research grants from the Ministry of Education and Science, Republic of Serbia. I Petrovic has received speaker honoraria from Boehringer Ingelheim, GSK, El pharma, Roche, Actavis and research grants from the Ministry of Education and Science, Republic of Serbia. F. Agosta is Section Editor of NeuroImage: Clinical; has received speaker honoraria from Biogen Idec, Novartis, and ExceMED—Excellence in Medical Education; and receives or has received research supports from the Italian Ministry of Health, AriSLA (Fondazione Italiana di Ricerca per la SLA), and the European Research Council. S. Galantucci. Declarations of interest: none. M. Filippi is Editor-in-Chief of the Journal of Neurology; serves on a scientific advisory board for Teva Pharmaceutical Industries; has received compensation for consulting services and/or speaking activities from Biogen Idec, ExceMED, Novartis, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Teva Pharmaceutical Industries, Novartis, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, Cure PSP, Alzheimer’s Drug Discovery Foundation (ADDF), the Jacques and Gloria Gossweiler Foundation (Switzerland), and ARiSLA (Fondazione Italiana di Ricerca per la SLA). V. Kostic serves on the editorial board of the Journal of Neurology; has received research grants from Ministry of Education and Science, Republic of Serbia, and the Serbian Academy of Science and Arts; and receives research support from Valeant, Stada, Novartis, and Boehringer Ingelheim, and speaker honoraria from Novartis and Boehringer Ingelheim.

Ethical standards

The local Ethical Committee (School of Medicine, University of Belgrade, Serbia) approved the study protocol and all participants signed written informed consent.

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Stojkovic, T., Stefanova, E., Soldatovic, I. et al. Exploring the relationship between motor impairment, vascular burden and cognition in Parkinson’s disease. J Neurol 265, 1320–1327 (2018). https://doi.org/10.1007/s00415-018-8838-3

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  • DOI: https://doi.org/10.1007/s00415-018-8838-3

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