The relationship between cerebral vascular disease and parkinsonism: The VADO study

A. Antonini, C. Vitale, P. Barone, R. Cilia, A. Righini, U. Bonuccelli, G. Abbruzzese, S. Ramat, A. Petrone, R. Quatrale, R. Marconi, R. Ceravolo, A. Stefani, L. Lopiano, M. Zappia, L. Capus, L. Morgante, F. Tamma, M. Tinazzi, C. ColosimoU. P. Guerra, Franco Valzania, Giorgio Fagioli, Angela Distefano, Antonio Bagnato, Luciano Feggi, S. Anna, Teresa Rosaria De Cristofaro Maria Teresa Rosaria De Cristofaro, Flavio Nobili, Nicola Mazzuca, Sergio Baldari, Roberto Eleopra, Alberto Bestetti, Riccardo Benti, Andrea Varrone, Duccio Volterrani, Rita Massa, Fabrizio Stocchi, Orazio Schillaci, Franca Dore, Maurizio Zibetti, Giancarlo Castellano, S. Giovanni Battista, Giorgio Giorgetti

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The observation of gait abnormalities, parkinsonism and vascular lesions in elderly patients is often reported as vascular parkinsonism (VP). However the status of striatal dopamine transporter (DAT) and the effects of brain vascular lesions on motor features and levodopa responsiveness are poorly defined. Methods: We recorded clinical features, chronic response to levodopa and vascular risk factors in a cross-sectional cohort of consecutive elderly patients with possible Parkinson's disease (PD) or VP recruited in 20 centers in Italy. Results: We included a total of 158 patients. Onset of motor symptoms was asymmetric in 93 (59%) and symmetric in 65 patients (41%). Symmetric motor onset was associated with greater disease severity. Chronic levodopa response was positive in 75 (47.8%) and negative in 82 patients (52.2%). A negative response to levodopa was associated with greater frequency of symmetric onset of motor symptoms, worst disease severity, absence of dyskinesia and greater number of vascular risk factors. Frontal lobe showed largest vascular load. Striatal DAT was normal in 48 (30.4%) and abnormal in 110 (69.6%) patients. Patients with normal DAT binding showed higher vascular load at MRI. Significant predictive factors of worst disease severity and negative response to levodopa were hypertension, vascular lesions in basal ganglia/periventricular regions, and normal DAT uptake. Conclusions: Multiple cerebral vascular lesions modify clinical presentation and severity in patients with parkinsonism and this is underlined by specific risk factors primarily hypertension. Striatal DAT assessment is helpful in identifying patients where therapy benefit is less likely.

Original languageEnglish
Pages (from-to)775-780
Number of pages6
JournalParkinsonism and Related Disorders
Volume18
Issue number6
DOIs
Publication statusPublished - Jul 2012

Keywords

  • Dopamine transporter SPECT imaging
  • MR imaging
  • Parkinson's disease
  • Vascular parkinsonism

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology

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