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 journalArticle

39 Citations (Scopus)

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

Fingerprint

Parkinsonian Disorders
Vascular Diseases
Blood Vessels
Dopamine Plasma Membrane Transport Proteins
Levodopa
Corpus Striatum
Hypertension
Dopamine Agents
Dyskinesias
Frontal Lobe
Basal Ganglia
Gait
Italy
Parkinson Disease
Observation
Brain

Keywords

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

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology

Cite this

Antonini, A., Vitale, C., Barone, P., Cilia, R., Righini, A., Bonuccelli, U., ... Giorgetti, G. (2012). The relationship between cerebral vascular disease and parkinsonism: The VADO study. Parkinsonism and Related Disorders, 18(6), 775-780. https://doi.org/10.1016/j.parkreldis.2012.03.017

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

In: Parkinsonism and Related Disorders, Vol. 18, No. 6, 07.2012, p. 775-780.

Research output: Contribution to journalArticle

Antonini, A, Vitale, C, Barone, P, Cilia, R, Righini, A, Bonuccelli, U, Abbruzzese, G, Ramat, S, Petrone, A, Quatrale, R, Marconi, R, Ceravolo, R, Stefani, A, Lopiano, L, Zappia, M, Capus, L, Morgante, L, Tamma, F, Tinazzi, M, Colosimo, C, Guerra, UP, Valzania, F, Fagioli, G, Distefano, A, Bagnato, A, Feggi, L, Anna, S, Maria Teresa Rosaria De Cristofaro, TRDC, Nobili, F, Mazzuca, N, Baldari, S, Eleopra, R, Bestetti, A, Benti, R, Varrone, A, Volterrani, D, Massa, R, Stocchi, F, Schillaci, O, Dore, F, Zibetti, M, Castellano, G, Battista, SG & Giorgetti, G 2012, 'The relationship between cerebral vascular disease and parkinsonism: The VADO study', Parkinsonism and Related Disorders, vol. 18, no. 6, pp. 775-780. https://doi.org/10.1016/j.parkreldis.2012.03.017
Antonini, A. ; Vitale, C. ; Barone, P. ; Cilia, R. ; Righini, A. ; Bonuccelli, U. ; Abbruzzese, G. ; Ramat, S. ; Petrone, A. ; Quatrale, R. ; Marconi, R. ; Ceravolo, R. ; Stefani, A. ; Lopiano, L. ; Zappia, M. ; Capus, L. ; Morgante, L. ; Tamma, F. ; Tinazzi, M. ; Colosimo, C. ; Guerra, U. P. ; Valzania, Franco ; Fagioli, Giorgio ; Distefano, Angela ; Bagnato, Antonio ; Feggi, Luciano ; Anna, S. ; Maria Teresa Rosaria De Cristofaro, Teresa Rosaria De Cristofaro ; Nobili, Flavio ; Mazzuca, Nicola ; Baldari, Sergio ; Eleopra, Roberto ; Bestetti, Alberto ; Benti, Riccardo ; Varrone, Andrea ; Volterrani, Duccio ; Massa, Rita ; Stocchi, Fabrizio ; Schillaci, Orazio ; Dore, Franca ; Zibetti, Maurizio ; Castellano, Giancarlo ; Battista, S. Giovanni ; Giorgetti, Giorgio. / The relationship between cerebral vascular disease and parkinsonism : The VADO study. In: Parkinsonism and Related Disorders. 2012 ; Vol. 18, No. 6. pp. 775-780.
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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.",
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T1 - The relationship between cerebral vascular disease and parkinsonism

T2 - The VADO study

AU - Antonini, A.

AU - Vitale, C.

AU - Barone, P.

AU - Cilia, R.

AU - Righini, A.

AU - Bonuccelli, U.

AU - Abbruzzese, G.

AU - Ramat, S.

AU - Petrone, A.

AU - Quatrale, R.

AU - Marconi, R.

AU - Ceravolo, R.

AU - Stefani, A.

AU - Lopiano, L.

AU - Zappia, M.

AU - Capus, L.

AU - Morgante, L.

AU - Tamma, F.

AU - Tinazzi, M.

AU - Colosimo, C.

AU - Guerra, U. P.

AU - Valzania, Franco

AU - Fagioli, Giorgio

AU - Distefano, Angela

AU - Bagnato, Antonio

AU - Feggi, Luciano

AU - Anna, S.

AU - Maria Teresa Rosaria De Cristofaro, Teresa Rosaria De Cristofaro

AU - Nobili, Flavio

AU - Mazzuca, Nicola

AU - Baldari, Sergio

AU - Eleopra, Roberto

AU - Bestetti, Alberto

AU - Benti, Riccardo

AU - Varrone, Andrea

AU - Volterrani, Duccio

AU - Massa, Rita

AU - Stocchi, Fabrizio

AU - Schillaci, Orazio

AU - Dore, Franca

AU - Zibetti, Maurizio

AU - Castellano, Giancarlo

AU - Battista, S. Giovanni

AU - Giorgetti, Giorgio

PY - 2012/7

Y1 - 2012/7

N2 - 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.

AB - 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.

KW - Dopamine transporter SPECT imaging

KW - MR imaging

KW - Parkinson's disease

KW - Vascular parkinsonism

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