Background
Methods
Motor and non-motor assessments
MRI brain assessment
Vascular and substania nigra ultrasound assessments
Statistical analysis
Results
Parkinson’s disease (No. = 48) | Vascular parkinsonism (No. = 27) | Control (No. = 29) | Chi-square test | ||
---|---|---|---|---|---|
Frequency (%) | Frequency (%) | Frequency (%) | P value | ||
Age (Mean /SD) ^ | 58.6 (6.2) | 63.1 (10.3) | 58.86 (8.2) | 0.054 | |
Gender(Male/female) | 36 / 12 (75% / 25%) | 21 / 6 (77.8%/ 22.2%) | 16 / 13 (55.2%/ 44.8%) | 0.111 | |
Functioning | Non-functioning | 5 (10.4%) | 5 (18.5%) | 0 (0.0%) | 0.027* |
Functioning | 29 (60.4%) | 8 (29.6%) | 16 (55.2%) | ||
Retired | 14 (29.2%) | 14 (51.9%) | 13 (44.8%) | ||
Number of vascular risk factors | 0 | 26 (54.2%) | 0 (0.0%) | 29 (100%) | < 0.001* |
1 | 14 (29.2%) | 1 (3.7%) | 0 (0.0%) | ||
2 | 6 (12.5%) | 15 (55.6%) | 0 (0.0%) | ||
3 | 2 (4.2%) | 8 (29.6%) | 0 (0.0%) | ||
4 | 0 (0.0%) | 3 (11.1%) | 0 (0.0%) | ||
Smoking | Non-smoker | 32 (66.7%) | 11 (40.7%) | 25 (86.2%) | < 0.001* |
Smoker | 6 (12.5%) | 16 (59.3%) | 4 (13.8%) | ||
Ex-smoker | 10 (20.8%) | 0 (0.0%) | 0 (0.0%) | ||
Years of educationτ(median/range) | 6 (0–18) | 8 (0–13) | 7 (0–16) | 0.613 | |
Substance abuse | 2 (4.2%) | 0 (0.0%) | 0 (0.0%) | 0.304 | |
Diabetes mellitus | 9 (18.8%) | 7 (25.9%) | 0 (0.0%) | 0.018* | |
Hypertension | 13 (27.1%) | 25 (92.6%) | 0 (0.0%) | < 0.001* | |
Hepatitis C virus | 1 (2.1%) | 0 (0.0%) | 0 (0.0%) | 0.555 | |
Ischemic heart disease | 8 (16.7%) | 9 (33.3%) | 0 (0.0%) | 0.003* | |
Hyperlipidemia | 2 (4.2%) | 27 (100.0%) | 0 (0.0%) | < 0.001* | |
Consanguinity | 14 (29.2%) | 1 (3.7%) | 0 (0.0%) | < 0.001* | |
Family History of Neuropsychiatric Illness | No | 35 (72.9%) | 26 (96.3%) | 29 (100.0%) | 0.025* |
Parkinson’s disease | 12 (25%) | 1 (3.7%) | 0 (0.0%) | ||
Psychiatric | 1 (2.1%) | 0 (0.0%) | 0 (0.0%) | ||
Dementia | 1 (2.1%) | 0 (0.0%) | 0 (0.0%) |
Motor characteristics of PD and VaP
Parkinson’s disease (No. =48) | Vascular parkinsonism (No. =27) | Mann Whitney U test / Chi-square test^ | |||
---|---|---|---|---|---|
Median (IQR/Range) | Median (IQR/Range) | z/ x | p | ||
AOO (years) | 53.25(40–74) | 65 (41–71) | -3.552 | < 0.001* | |
DOI (years) | 5 (1.50–14) | 3 (1–10) | -2.693 | 0.007* | |
Onset ^ | Gradual | 48 (100%) | 17 (63%) | ||
Acute | 0 (0%) | 10 (37%) | |||
Motor subtypes | Tremor dominant | 37 (77.1%) | 7 (25.9%) | 20.867 | < 0.001* |
PIGD | 6 (12.5%) | 16 (59.3%) | |||
Indeterminate subtype | 5 (10.4%) | 4 (14.8%) | |||
Parkinson Asymmetry^ | 9 (18.75%) | 2 (7.40%) | -5.21 | < 0.001* | |
Symmetry index^ (Asymmetrical subjects) | 34 (70.4%) | 7 (25.9%) | 14.062 | < 0.001* | |
Lower parkinsonism^ | 6 (12.5%) | 11 (40.7%) | 7.862 | 0.005* | |
MDS-UPDRS total score OFF | 80.50 (61) | 79 (21) | -0.574 | 0.566 | |
MDS-UPDRS total score ON | 61 (42) | 71(21) | -1.512 | 0.130 | |
MDS-UPDRS part I | 16.5 (10) | 16 (5) | -0.746 | 0.455 | |
MDS-UPDRS Part II | 16 (17) | 18(8) | -0.519 | 0.604 | |
MDS-UPDRS Part III –OFF | 51(31) | 45 (14) | -1.016 | 0.310 | |
MDS-UPDRS Part III –ON | 27 (21) | 39 (10) | -3.038 | 0.002* | |
Rigidity OFF | 8 (6) | 8 (3) | -0.577 | 0.564 | |
Rigidity ON | 4.50 (5) | 7(3) | -3.825 | < 0.001* | |
Bradykinesia OFF | 17 (16) | 16 (6) | -0.017 | 0.987 | |
Bradykinesia ON | 8.50 (10) | 14 (7) | -2.113 | 0.035* | |
PIGD OFF | 6.50 (10) | 9 (2) | -1.881 | 0.060 | |
PIGD ON | 4 (7) | 9 (2) | -3.543 | < 0.001* | |
Axial OFF | 12.50 (12) | 16 (4) | -2.195 | 0.028* | |
Axial Score ON | 7 (9) | 15 (4) | -5.066 | < 0.001* | |
Tremor score OFF | 14 (11) | 5 (13) | -4.418 | < 0.001* | |
Tremor score ON | 9 (7) | 5 (8) | -3.310 | < 0.001* | |
Constancy of rest tremors off | 2 (2) | 0 (2) | -4.477 | < 0.001* | |
Constancy of rest tremors on | 1 (1) | 0 (2) | -2.709 | 0.007* | |
H&Y OFF | 2.5 (1.5-4) | 3 (2–5) | -3.373 | < 0.001* | |
H&Y ON | 2 (1–3) | 3 (2–5) | -4.758 | < 0.001* | |
S&E ADL OFF | 80 (17.50) | 60 (10) | -4.208 | < 0.001* | |
S&E ADL ON | 90 (10) | 60 (20) | -5.254 | < 0.001* | |
Motor complication total score | 5 (8) | 4 (2) | -1.272 | 0.203 | |
NFOG-Q OFF | 26 (54.2%) | 5 (18.5%) | 9.056 | 0.003* | |
NFOG-Q ON | 21(43.8%) | 5 (18.5%) | 4.857 | 0.028* | |
BBS OFF | 47.50 (14) | 33 (9) | -4.541 | < 0.001* | |
BBS ON | 54 (9) | 36 (12) | -5.505 | < 0.001* | |
TUG OFF | 12.90 (12.25) | 16.12 (9.74) | -1.761 | 0.078 | |
TUG ON | 10.65 (6.16) | 13.55 (8.31) | -2.936 | 0.003* | |
10-MWT, Comfortable speed OFF (meter/sec) | 0.797 (0.435) | 0.712 (0.347) | -1.496 | 0.135 | |
10-MWT, Comfortable speed ON (meter/sec) | 0.91 (0.412) | 0.83 (0.389) | -1.887 | 0.059 | |
Urine incontinence scale | 1 (3) | 2 (1) | 2.463 | 0.014* | |
IPAQ total score | 1790 (1283.3) | 417 (954) | 5.603 | < 0.001* | |
LEDD Mean (SD)** | 631.48 (398.76) | 415.74 (126.94) | 3.45 | < 0.001* | |
Dopa responsive (%)^ | 44 (91.7%) | 7 (25.9%) | 34.321 | < 0.001* |
Non-motor symptoms, quality of life and cognitive functions of PD and VaP
Parkinson’s disease (No. =48) | Vascular parkinsonism (No.=27) | Control (No. =29) | Kruskal-Wallis Test | Parkinson’s disease vs. Vascular parkinsonisma | Parkinson’s disease vs. controla | Vascular 541 vs. controla | |
---|---|---|---|---|---|---|---|
Median (Range/ IQR) | Median (Range/ IQR) | Median (Range/ IQR) | P | P | P | p | |
Non-motor Symptoms Sclae | |||||||
NMSS total score | 55 (4-205/ 47) | 39 (10–100/ 30) | 7 (1–33/ 6) | < 0.001* | 0.030* | < 0.001* | < 0.001* |
Cardiovascular | 1 (2) | 2(3) | 0(0) | < 0.001* | 0.688 | < 0.001* | < 0.001* |
Sleep/fatigue | 8 (8) | 6 (6) | 0 (1) | < 0.001* | 0.031* | < 0.001* | < 0.001* |
Mood/Cognition | 12 (16) | 6 (4) | 3 (2) | < 0.001* | 0.006* | < 0.001* | < 0.001* |
Perceptual problems/ hallucinations | 0 (1) | 0 (0) | 0 (0) | 0.102 | |||
Attention/memory | 6 (10) | 6 (9) | 1 (1) | < 0.001* | 0.820 | < 0.001* | < 0.001* |
Gastrointestinal tract | 5 (8) | 4 (8) | 0 (1) | < 0.001* | 0.319 | < 0.001* | < 0.001* |
Urinary | 5.50 (11) | 12 (6) | 0 (1) | < 0.001* | 0.037* | < 0.001* | < 0.001* |
Sexual functions | 2 (4) | 2 (0) | 0 (0) | < 0.001* | 0.652 | < 0.001* | < 0.001* |
Miscellaneous | 5.50 (7) | 1 (2) | 0 (1) | < 0.001* | < 0.001* | < 0.001* | 0.003* |
BDI total score | 17 (0–39) | 16.00 (5–33) | 4.50 (2–9) | < 0.001* | 0.675 | < 0.001* | < 0.001* |
PDQ-39 | |||||||
PDQ total score^ | 38.72 (30.10) | 31.25 (14.95) | 7.60 (3.56) | < 0.001* | 0.047* | < 0.001* | < 0.001* |
Mobility | 42.50 (36.88) | 60.00 (35.00) | 2.50 (3.75) | < 0.001* | 0.055 | < 0.001* | < 0.001* |
ADL | 50.00 (53.12) | 45.83 (29.17) | 0.00 (0.00) | < 0.001* | 0.103 | < 0.001* | < 0.001* |
Emotional wellbeing | 39.58 (37.50) | 29.17 (20.83) | 20.83 (8.33) | < 0.001* | 0.044* | < 0.001* | < 0.001* |
Stigma | 68.75 (48.44) | 31.25 (50.00) | 0.00 (0.00) | < 0.001* | < 0.001* | < 0.001* | < 0.001* |
Social support | 16.66 (37.50) | 0.00 (8.33) | 0.00 (0.00) | < 0.001* | < 0.001* | < 0.001* | 0.002* |
Cognition | 25.00 (31.25) | 37.50 (18.75) | 12.50 (18.75) | < 0.001* | 0.266 | < 0.001* | < 0.001* |
Communication | 33.33 (39.59) | 25.00 (25.07) | 0.00 (0.00) | < 0.001* | 0.388 | < 0.001* | < 0.001* |
Bodily discomfort | 41.66 (25.00) | 33.33 (16.67) | 25.00 (16.73) | < 0.001* | 0.003* | < 0.001* | 0.651 |
Cognitive Scales | |||||||
MOCA total score | 22(6–29) | 19.00 (12–24) | 24 (17–27) | < 0.001* | 0.015* | 0.014* | < 0.001* |
FAB total score | 13 (2–17) | 9.00 (6–14) | 13.50 (9–17) | < 0.001* | 0.001* | 0.091 | < 0.001* |
WMS total score | 41.75 (11.4) | 38 (13.0) | 47 (10.3) | < 0.001* | 0.006* | 0.040* | < 0.001* |
Verbal fluency of ACE-III | 1 (3) | 0 (0) | 1 (1) | < 0.001* | < 0.001* | 0.974 | < 0.001* |
Clock drawing of ACE-III | 3 (3) | 3 (2) | 5(2) | < 0.001* | 0.602 | < 0.001* | < 0.001* |
Acute versus insidious VaP
Laboratory differences between PD and VaP
Neuroimaging differences between PD and VaP
Parkinson Disease | Vascular Parkinsonism | Control | Kruskal-Wallis Test | PD vs. VaP | PD vs. control | VaP vs. control | |
---|---|---|---|---|---|---|---|
Median (Range) | Median (Range) | Median (Range) | P | P | P | p | |
Carotid Duplex | |||||||
Number | 47 | 24 | 29 | ||||
Right CCA IMT | 0.91 (0.30) | 1.10 (0.56) | 0.80 (0.20) | < 0.001* | 0.011* | 0.004* | < 0.001* |
Left CCA IMT | 1 (0.35) | 1.15 (0.40) | 0.8 (0.20) | < 0.001* | 0.011* | < 0.001* | < 0.001* |
Right ICA PSV | 33.20 (15.7) | 29.35 (12.8) | 41.70 (15.8) | 0.012* | 0.253 | 0.022* | 0.006* |
Left ICA PSV | 34.40 (18.8) | 28.10 (9.40) | 39.90 (16.9) | 0.004* | 0.049* | 0.054 | 0.001* |
Carotid Plaques | 5 (10.4%) | 4 (14.8%) | 0 (0.0%) | 0.120 | |||
Transcranial colour-coded doppler | |||||||
Number (poor widow) | 47 (1) | 24 (3) | 29 (0) | ||||
Mean Flow Velocity (MFV) | |||||||
Average MFV | 52.64 (72.45) | 45.95 (88.83) | 59.30 (28.65) | 0.002* | 0.038* | 0.019* | 0.002* |
Right MCA MFV | 60.80 (22.1) | 59.60 (29.2) | 63.10 (11.60) | 0.373 | |||
Left MCA MFV | 68.60 (29.3) | 56.90 (24.7) | 67 (25.6) | 0.066 | |||
Right PCA MFV | 40.90 (11.7) | 41.45 (15.0) | 47.70 (9.4) | 0.002* | 0.666 | < 0.001* | 0.035* |
Left PCA MFV | 42 (16.6) | 34.30 (16.3) | 50.20 (18.9) | < 0.001* | 0.038* | 0.004* | < 0.001* |
Pulsatility Index | |||||||
Right MCA pulsatility index | 0.80 (0.36) | 0.99 (0.43) | 0.77 (0.19) | 0.016* | 0.031* | 0.410 | 0.004* |
Left MCA pulsatility Index | 0.86 (0.35) | 0.80 (0.45) | 0.74 (0.23) | 0.152 | |||
Right PCA pulsatility index | 0.75 (0.34) | 0.89 (0.42) | 0.69 (0.26) | 0.012* | 0.076 | 0.094 | 0.004* |
Left PCA pulsatility Index | 0.84 (0.40) | 0.87 (0.46) | 0.71 (0.16) | 0.012* | 0.511 | 0.010* | 0.011* |
Breath Holding Index (BHI) | |||||||
Right MCA BHI | -0.86 (1.39) | -0.60 (0.99) | -0.14 (0.69) | 0.036* | 0.261 | 0.012* | 0.195 |
Left MCA BHI | -0.89 (1.07) | -0.65 (1.25) | -0.13 (0.72) | < 0.001* | 0.084 | < 0.001* | 0.110 |
Right PCA BHI | -0.80 (0.99) | -0.72 (1.36) | -0.02 (0.32) | < 0.001* | 0.947 | < 0.001* | < 0.001* |
Left PCA BHI | -0.65 (1.96) | -0.39 (0.63) | -0.15(1.26) | 0.007* | 0.282 | 0.004* | 0.019* |
Substantia nigra hyperechogenicity | 43 (91.5%) | 5 (20.8%) | 3 (10.3%) | < 0.001* | < 0.001* | < 0.001* | 0.288 |
Correlations of motor, non-motor symptoms and quality of life in PD and VaP
MDS -UPDRS III Off | MoCA | NMSS | PDQ | ||
---|---|---|---|---|---|
Vascular Parkinsonism | |||||
Age | Spearman | 0.417 | -0.159 | 0.412 | 0.141 |
P-value | 0.031 | 0.427 | 0.033 | 0.482 | |
AOO | Spearman | 0.366 | -0.181 | 0.311 | 0.061 |
P-value | 0.061 | 0.365 | 0.114 | 0.764 | |
DOI | Spearman | 0.406 | -0.082 | 0.362 | 0.179 |
P-value | 0.036 | 0.684 | 0.064 | 0.372 | |
BDI | Spearman | 0.362 | -0.382 | 0.791 | 0.529 |
P-value | 0.064 | 0.049 | < 0.001 | 0.005 | |
MDS-UPDRS III OFF | Spearman | -0.252 | 0.442 | 0.429 | |
P-value | 0.205 | 0.021 | 0.025 | ||
H&Y OFF | Spearman | 0.136 | -0.314 | 0.357 | 0.477 |
P-value | 0.499 | 0.111 | 0.067 | 0.012 | |
FAB | Spearman | -0.261 | 0.659 | -0.397 | -0.328 |
P-value | 0.189 | < 0.001 | 0.041 | 0.095 | |
Number of vascular risk factors | Spearman | 0.514 | -0.360 | 0.225 | 0.232 |
P-value | 0.006 | 0.065 | 0.259 | 0.245 | |
Fazekas total score | Spearman | -0.040 | 0.136 | 0.088 | 0.054 |
P-value | 0.842 | 0.500 | 0.662 | 0.787 | |
Schelten total score | Spearman | -0.143 | 0.007 | -0.161 | 0.057 |
P-value | 0.477 | 0.973 | 0.424 | 0.776 | |
Parkinson’s disease | |||||
Age | Spearman | -0.031 | -0.134 | 0.060 | -0.071 |
P-value | 0.836 | 0.362 | 0.683 | 0.634 | |
AOO | Spearman | -0.203 | -0.02 | -0.041 | -0.259 |
P-value | 0.166 | 0.893 | 0.780 | 0.075 | |
DOI | Spearman | 0.470 | -0.063 | 0.320 | 0.472 |
P-value | < 0.001 | 0.675 | 0.028 | 0.001 | |
BDI | Spearman | 0.587 | -0.334 | 0.673 | 0.723 |
P-value | < 0.001 | 0.020 | < 0.001 | < 0.001 | |
MDS-UPDRS III OFF | Spearman | -0.318 | 0.604 | 0.778 | |
P-value | 0.028 | < 0.001 | < 0.001 | ||
H&Y OFF | Spearman | 0.843 | -0.33 | 0.433 | 0.688 |
P-value | < 0.001 | 0.022 | 0.002 | < 0.001 | |
FAB | Spearman | -0.353 | 0.7 | -0.243 | -0.309 |
P-value | 0.015 | < 0.001 | 0.099 | 0.034 | |
Number of vascular risk factors | Spearman | -0.016 | 0.041 | 0.274 | 0.164 |
P-value | 0.914 | 0.78 | 0.059 | 0.265 | |
Fazekas total score | Spearman | 0.007 | -0.113 | 0.085 | -0.158 |
P-value | 0.962 | 0.445 | 0.566 | 0.283 | |
Schelten total score | Spearman | -0.099 | -0.028 | 0.083 | -0.169 |
P-value | 0.502 | 0.852 | 0.575 | 0.250 |