Progress and Prospects in Parkinson's Research/Causes/Trauma/Vascular PD

" Vascular Parkinsonism is the term used to identify PD cases brought about through circulatory problems such as micro-infarcts. "

Background
Vascular Parkinson's Disease accounts for between 2.5% and 5% of PD cases and is caused by ''ischaemic cerebrovascular disease. ''. Gupta and Kuruvilla have offered the following diagnostic criteria for this variant of the disease:-


 * presentation with postural instability and falls rather than resting tremor or bradykinesia.
 * short,shuffling parkinsonian gait accomppanied by a wider base of stance and variable stride length,
 * absence of festination,
 * poor response to levodopa,
 * frequent appearance of pyramidal signs,
 * early sub-cortical dementia.

Research
2001

Kai-Yuan et al used SPECT scans to try to differentiate cases of VP using 14 VP patients, 30 PD patients and 26 controls. Their conclusion:-

"Our findings clearly show that, for VP patients, 99mTc-TRODAT-1 SPECT is a reliable method to differentiate VP from Parkinson’s disease. Further studies, including those to differentiate Parkinson’s disease from arteriosclerotic parkinsonism and patients with both VP and Parkinson’s disease, are needed to help rule out the possibility of Parkinson’s disease as early as possible."

2012

Lehman et al analysed the mortality causes of of 3,439 National Football League players with at least 5 pension-credited playing seasons from 1959 to 1988 and compared them with external US mortality sources.

"The neurodegenerative mortality of this cohort is 3 times higher than that of the general US population; that for 2 of the major neurodegenerative subcategories, AD and ALS, is 4 times higher. These results are consistent with recent studies that suggest an increased risk of neurodegenerative disease among football players."

Glass et al evaluated the clinical symptoms of 28 diagnosed VPD patients.

The mean age of onset was 70.6 years and mean duration 10.5 years. The observed symptoms were:- bradykinesia 100% rigidity 96%, falls 76%, pyramidal signs 54%, urinary incontinence 50% dementia 39%.Visual hallucinations 0%. Two-thirds had an insidious onset and a relentless rather than stepwise progression of disability. Compared with other Parkinsonian syndromes, VP had an older age of onset. Their conclusions:-

" In comparison with other Parkinsonian syndromes the patients were older and had an extremely low frequency of visual hallucinations compared with Parkinson's disease. "

Rektor et al studied the effect of brain-vessel pathology on mortality in 57 PD patients over 4 years and concluded:-

"This study provides evidence that comorbid atherosclerosis and otherwise subclinical impairment of brain vessels may contribute to mortality in PD. "

Guan et al carrid out a comparison of brain tissues of PD patients and age-matched controls.

They found that compared to the control cases, the capillaries of PDs were less in number, shorter in length, and larger in diameter with obvious damage to the capillary network evidenced by less branching. Vessel degeneration associated with PD was found in multiple brain regions, but particularly in the substantia nigra, middle frontal cortex and brain stem nuclei. They concluded:-

"The data suggest that vascular degeneration could be an additional contributing factor to the progression of PD. Thus, treatments that prevent vascular degeneration and improve vascular remodelling may be a novel target for the treatment of PD."

Harris et al studied 403 PD cases and 405 controls in British Columbia and found that people who had an occupational exposure to whole body vibration had a statistically greater risk of contracting PD.

 Further Research