Parkinson's disease is related to an increased risk of ischemic stroke-a population-based propensity score-matched follow-up study

Causal Relationship between Parkinson's Disease with Heart and Vascular Disease: A Two-Sample Mendelian Randomization Study

INTRODUCTION

The aim of this study was to investigate the causal relationship between Parkinson's disease (PD) and myocardial infarction (MI), atrial fibrillation and flutter (AF), and venous thromboembolism (VTE) by Mendelian randomization (MR) analysis.

METHODS

By using data from publicly available genome-wide association studies from databases, single nucleotide polymorphisms were screened as instrumental variables, and the MR analysis was finished by inverse-variance weighted (IVW), MR-egger, weighted median methods.

RESULTS

The primary IVW method showed a negative association between genetically predicted PD and risk of MI (OR = 0.9989; 95% CI: 0.9980-0.9998; p = 0.02). However, PD was not significantly associated with AF or VTE.

CONCLUSION

This study suggests a negative association between PD with MI, which implies that PD has a protective effect on MI.

Impaired neuronal activity as a potential factor contributing to the underdeveloped cerebrovasculature in a young Parkinson's disease mouse model

Misfolding of α-synuclein (α-Syn) in the brain causes cellular dysfunction, leading to cell death in a group of neurons, and consequently causes the progression of Parkinson's disease (PD). Although many studies have demonstrated the pathological connections between vascular dysfunction and neurodegenerative diseases, it remains unclear how neuronal accumulation of α-Syn affects the structural and functional aspects of the cerebrovasculature to accelerate early disease progression. Here, we demonstrated the effect of aberrant α-Syn expression on the brain vasculature using a PD mouse model expressing a familial mutant form of human α-Syn selectively in neuronal cells. We showed that young PD mice have an underdeveloped cerebrovasculature without significant α-Syn accumulation in the vasculature. During the early phase of PD, toxic α-Syn was selectively increased in neuronal cells, while endothelial cell proliferation was decreased in the absence of vascular cell death or neuroinflammation. Instead, we observed altered neuronal activation and minor changes in the activity-dependent gene expression in brain endothelial cells (ECs) in young PD mice. These findings demonstrated that neuronal expression of mutant α-Syn in the early stage of PD induces abnormal neuronal activity and contributes to vascular patterning defects, which could be associated with a reduced angiogenic potential of ECs.

Association between Parkinson's disease and the risk of adverse cardiovascular events: a systematic review and meta-analysis

Background

This review aims to examine the association of Parkinson's disease (PD) with the increased risk of cardiovascular events.

Methods

PubMed, Embase, CENTRAL, and Scopus databases were electronically searched for papers published up to 5 May 2023. Studies reporting the association between PD and the subsequent risks of stroke, myocardial infarction (MI), and cardiovascular mortality were included.

Results

Sixteen studies were included in this review. The clinical data of 101,712 PD patients were compared with that of the control group of 204,901 patients without PD in the included studies. Meta-analysis showed that PD patients had an increased risk of stroke compared with patients without PD (odds ratio (OR): 1.49; 95% confidence interval (CI): 1.30, 1.72; I2 = 76%). The pooled analysis demonstrated no significant increase in the risk of MI (OR: 1.16; 95% CI: 0.85, 1.59; I2 = 82%) and cardiovascular mortality (OR: 1.20; 95% CI: 0.93, 1.54; I2 = 65%) in PD patients. However, data from cohort studies indicated a possibility of higher risk of MI (OR: 1.36; 95% CI: 1.01, 1.84; I2 = 80%) and cardiovascular mortality (OR: 1.22; 95% CI: 1.00, 1.60; I2 = 62%) in patients with PD.

Conclusion

Patients with PD may have an increased risk of stroke as compared with the age- and gender-matched general population. While our results show that PD does not increase the overall risk of MI and cardiovascular mortality, analysis of cohort studies alone demonstrated that these risks may be higher in patients with PD. The current evidence is of very low quality. Further prospective cohort studies from different countries that would account for important cardiovascular risk factors are needed to improve the current evidence.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD42023421924).

Relationship between Parkinson's disease and cardio-cerebrovascular diseases: a Mendelian randomized study

Parkinson's disease (PD) and cardio-cerebrovascular diseases are related, according to earlier studies, but these studies have some controversy. Our aim was to assess the impact of PD on cardiocerebrovascular diseases using a Mendelian randomization (MR) method. The data for PD were single nucleotide polymorphisms (SNPs) from a publicly available genome-wide association study (GWAS) dataset containing data on 482,730 individuals. And the outcome SNPs data is were derived from five different GWAS datasets. The basic method for MR analysis was the inverse variance weighted (IVW) approach. We use the weighted median method and the MR-Egger method to supplement the MR analysis conclusion. Finally, We used Cochran's Q test to test heterogeneity, MR-PRESSO method and leave-one-out analysis method to perform sensitivity analysis. We used ratio ratios (OR) to assess the strength of the association between exposure and outcome, and 95% confidence intervals (CI) to show the reliability of the results. Our findings imply that PD is linked to a higher occurrence of coronary artery disease (CAD) (OR = 1.055, 95% CI 1.020-1.091, P = 0.001), stroke (OR = 1.039, 95% CI 1.007-1.072, P = 0.014). IVW analyses for stroke's subgroups of ischemic stroke (IS) and 95% CI 1.007-1.072, P = 0.014). IVW analyses for stroke's subgroups of ischemic stroke (IS) and cardioembolic stroke (CES) also yielded positive results, respectively (OR = 1.043, 95% CI 1.008-1.079, P = 0.013), (OR = 1.076, 95% CI 1.008-1.149, P = 0.026). There is no evidence of a relationship between PD and other cardio-cerebrovascular diseases. Additionally, sensitivity analysis revealed reliable outcomes. Our MR study analysis that PD is related with an elevated risk of CAD, stroke, IS, and CES.

Incidence of cardiovascular morbidity among Parkinson's disease patients; a large-scale cohort study in a 16-year time window around disease onset

OBJECTIVES

To examine the risk of any or specific types of cardiovascular diseases (CVDs) in patients with Parkinson's disease (PD), in the 16 years around disease onset, and to compare it to that in the general population.

METHODS

This is a large-scale population-based retrospective cohort study of newly diagnosed PD patients, members of Maccabi Health Services (MHS), who started taking anti-parkinsonian drugs (APD) between 1/1/2000-31/12/2019 (study period). We collected information about CVD incidence (Congestive heart failure-CHF, Myocardial infarction-MI, Stroke) from MHS-CVD registry. We applied Cox regression to estimate adjusted-HR and 95%CI of CVD risks. We calculated Standardized-Incidence-Ratio (SIR) comparing CVD risks in the PD cohort to that of MHS population.

RESULTS

The PD cohort comprised 10,840 patients. During a mean follow up of 16.3 ± 4.3y around disease onset, 20.7% (n = 2241) were diagnosed with any CVD: 7.9% with CHF; 6.7% with MI, and 10.5% with stroke. Risks were higher for men: HR = 1.95 (95%CI 1.58-2.40), and for above age 75y at first APD treatment, HR = 2.00 (95% CI 1.65-2.43). Compared to the MHS population, the PD cohort exhibited a significantly lower risk for CVDs, especially for men: SIRmen = 0.21 (95%CI 0.20-0.22), SIRwomen = 0.29 (95% CI 0.27-0.31). These trends were similar for the specific CVDs.

CONCLUSIONS

The findings suggest that the risks that PD patients and particularly men, will develop any type of CVD are lower than those of the general population. Further studies are needed to confirm this finding and examine the underlying mechanisms.

Machine learning models for diagnosis and prognosis of Parkinson's disease using brain imaging: general overview, main challenges, and future directions

Parkinson's disease (PD) is a progressive and complex neurodegenerative disorder associated with age that affects motor and cognitive functions. As there is currently no cure, early diagnosis and accurate prognosis are essential to increase the effectiveness of treatment and control its symptoms. Medical imaging, specifically magnetic resonance imaging (MRI), has emerged as a valuable tool for developing support systems to assist in diagnosis and prognosis. The current literature aims to improve understanding of the disease's structural and functional manifestations in the brain. By applying artificial intelligence to neuroimaging, such as deep learning (DL) and other machine learning (ML) techniques, previously unknown relationships and patterns can be revealed in this high-dimensional data. However, several issues must be addressed before these solutions can be safely integrated into clinical practice. This review provides a comprehensive overview of recent ML techniques analyzed for the automatic diagnosis and prognosis of PD in brain MRI. The main challenges in applying ML to medical diagnosis and its implications for PD are also addressed, including current limitations for safe translation into hospitals. These challenges are analyzed at three levels: disease-specific, task-specific, and technology-specific. Finally, potential future directions for each challenge and future perspectives are discussed.

Stroke in Parkinson's disease: a review of epidemiological studies and potential pathophysiological mechanisms

Parkinson's disease (PD) is the fastest growing neurological disorder and one of the leading neurological causes of disability worldwide following stroke. An overall aging global population, as well as general changes in lifestyle associated with mass industrialization in the last century, may be linked to both increased incidence rates of PD and an increase in cumulative cardiovascular risk. Recent epidemiological studies show an increased risk of stroke, post-stroke complications, and subclinical ischemic insults in PD. PD patients have a host of characteristics that might contribute to increasing the risk of developing ischemic stroke including motor impairment, dysautonomia, and sleep disorders. This increases the urgency to study the interplay between PD and other neurological disorders, and their combined effect on mortality, morbidity, and quality of life. In this review, we provide a comprehensive overview of the studied etiological factors and pathological processes involved in PD, specifically with regard to their relationship to stroke. We hope that this review offers an insight into the relationship between PD and ischemic stroke and motivates further studies in this regard.

Acupuncture Is Effective at Reducing the Risk of Stroke in Patients with Migraines: A Real-World, Large-Scale Cohort Study with 19-Years of Follow-Up

Migraines are common headache disorders and risk factors for subsequent strokes. Acupuncture has been widely used in the treatment of migraines; however, few studies have examined whether its use reduces the risk of strokes in migraineurs. This study explored the long-term effects of acupuncture treatment on stroke risk in migraineurs using national real-world data. We collected new migraine patients from the Taiwan National Health Insurance Research Database (NHIRD) from 1 January 2000 to 31 December 2017. Using 1:1 propensity-score matching, we assigned patients to either an acupuncture or non-acupuncture cohort and followed up until the end of 2018. The incidence of stroke in the two cohorts was compared using the Cox proportional hazards regression analysis. Each cohort was composed of 1354 newly diagnosed migraineurs with similar baseline characteristics. Compared with the non-acupuncture cohort, the acupuncture cohort had a significantly reduced risk of stroke (adjusted hazard ratio, 0.4; 95% confidence interval, 0.35-0.46). The Kaplan-Meier model showed a significantly lower cumulative incidence of stroke in migraine patients who received acupuncture during the 19-year follow-up (log-rank test, p < 0.001). Acupuncture confers protective benefits on migraineurs by reducing the risk of stroke. Our results provide new insights for clinicians and public health experts.

Prevalence of Cardio-Embolic Brain Complications in Permanent and Paroxysmal Atrial Fibrillation Patients

Background: Atrial fibrillation (AF) is the most frequent of all cardiac arrhythmias, with an increasing prevalence in the last 20 years. Cardio-embolic brain complications (CEBC) related to AF often occur or recur, even following appropriate treatment. Method: We conducted a retrospective study and analyzed the presence of stroke, dementia, and Parkinson’s disease (PD) in both paroxysmal and permanent AF patients. The records of 1111 consecutive admitted patients with primary diagnosis of AF at the Municipal Emergency University Hospital, Timisoara, between 2015 and 2016 were examined. Statistical analysis was performed on the patients included in the study based on the inclusion and exclusion criteria. Results: A significant statistical difference was noted among the permanent AF group for stroke (48.75% vs. 26.74%, p < 0.001) and dementia (10.25% vs. 3.86%, p < 0.001) compared to paroxysmal AF patients. Permanent AF patients presented a higher risk of developing stroke, dementia, and PD compared to patients with paroxysmal AF. Meanwhile, male gender and an increase in age showed an increase in the odds of having cardio-embolic brain complications in patients with paroxysmal AF. Conclusion: Based on the results obtained, it can be concluded that the risk of cardio-cerebral embolic complications is greater in permanent AF patients compared to paroxysmal AF cases. Ischemic stroke and dementia are more frequent in the permanent AF group, but analyzing the data regarding the age of onset paroxysmal AF is critical due to the fact that it involves a younger population. Prompt diagnosis and treatment can help significantly in saving stroke patients.

Long Short-Term Memory-Based Deep Learning Models for Screening Parkinson's Disease Using Sequential Diagnostic Codes

BACKGROUND AND PURPOSE

It is challenging to detect Parkinson's disease (PD) in its early stages, which has prompted researchers to develop techniques based on machine learning methods for detecting PD. However, previous studies did not fully incorporate the slow progression of PD over a long period of time nor consider that its symptoms occur in a time-sequential manner. Contributing to the literature on PD, which has relied heavily on cross-sectional data, this study aimed to develop a method for detecting PD early that can process time-series information using the long short-term memory (LSTM) algorithm.

METHODS

We sampled 926 patients with PD and 9,260 subjects without PD using medical-claims data. The LSTM algorithm was tested using diagnostic histories, which contained the diagnostic codes and their respective time information. We compared the prediction power of the 12-month diagnostic codes under two different settings over the 4 years prior to the first PD diagnosis.

RESULTS

The model that was trained using the most-recent 12-month diagnostic codes had the best performance, with an accuracy of 94.25%, a sensitivity of 82.91%, and a specificity of 95.26%. The other three models (12-month codes from 2, 3, and 4 years prior) were found to have comparable performances, with accuracies of 92.27%, 91.86%, and 91.81%, respectively. The areas under the curve from our data settings ranged from 0.839 to 0.923.

CONCLUSIONS

We explored the possibility that PD specialists could benefit from our proposed machine learning method as an early detection method for PD.

Genetic predisposition to neurodegenerative diseases and risk of stroke: A Mendelian randomization study

Background

Traditional epidemiological studies suggested that Neurodegenerative diseases (ND) might correlate with stroke. We intend to explore whether the two most common neurodegenerative diseases [Alzheimer’s disease (AD) and Parkinson’s disease (PD)] are causally associated with stroke and its subtypes.

Methods

Two-sample Mendelian Randomization (MR) method was used to explore the causal relationships. Candidate genetic instrumental variables (IVs) for AD and PD were collected from the genome-wide association studies (GWAS) in European populations. The inverse-variance weighted (IVW) method was the primary method of MR analysis, and the weighted median method was supplementary. In addition, the MR-Egger method and the MR-PRESSO test were used as well.

Results

We found no causal effects of AD on stroke, Ischemic stroke (IS), or Intracerebral hemorrhage (ICH). As for PD and stroke, our preliminary results showed PD could causally influence the risk of stroke [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.02–1.07; P = 0.001 by the IVW method], although the alternative method did not support this result. We identified the positive causal relationship between PD and the risk of IS (OR = 1.04; 95% CI: 1.02–1.07; P = 0.001 by the IVW method), and the alternative MR methods produced similar results. The present study found there was no causal relationship between PD and ICH.

Conclusion

This study found a causal relationship between genetic susceptibility to PD and the incidence of stroke (especially IS) in the European population; however, there was no causal relation between AD and stroke risk.

Nutrition Education Programs for Adults with Neurological Diseases Are Lacking: A Scoping Review

The nutrition recommendation for most common neurological diseases is to follow national dietary guidelines. This is to mitigate malnutrition, reduce the risk of diet-related diseases, and to help manage some common symptoms, including constipation. Nutrition education programs can support people in adhering to guidelines; hence the aim of this scoping review was to explore what programs have been implemented for adults with neurological diseases. We conducted this review according to a published a priori protocol. From 2555 articles screened, 13 were included (dementia n = 6; multiple sclerosis n = 4; stroke survivors n = 2; Parkinson’s n = 1). There were no programs for epilepsy, Huntington’s, and motor neurone disease. Program duration and number of sessions varied widely; however, weekly delivery was most common. Just over half were delivered by dietitians. Most did not report using a behavior change theory. Commonly used behavior change techniques were instruction on how to perform a behavior, credible source, and behavioral practice/rehearsal. Evidence of nutrition education programs for adults with neurological diseases is lacking. Of those that are published, many do not meet best practice principles for nutrition education regarding delivery, educator characteristics, and evaluation. More programs aligning with best practice principles are needed to assess characteristics that lead to behavior change.

Neuroimaging cerebrovascular biomarkers in Parkinson's disease

BACKGROUND AND PURPOSE

The cardiovascular risk in Parkinson's disease (PD) remains uncertain and controversial. Some studies suggest PD patients present an increased risk of cerebrovascular disease. We aimed to study the prevalence of neuroimaging cerebrovascular biomarkers in PD patients compared to controls, using an accurate and complete magnetic resonance (MR) imaging evaluation.

MATERIAL AND METHODS

Neuroimaging sub-study within a larger cross-sectional case-control study. An enriched subgroup of PD patients (≤10 years since diagnosis) with at least a moderate cardiovascular mortality risk based on a Systematic COronary Risk Evaluation (SCORE) was compared to community-based controls regarding neuroimaging biomarkers. Patients underwent a high-resolution T1-weighted MR imaging sequence at 3.0 T to visualize neuromelanin. A 3D SWI FFE, sagittal 3D T1-weighted, axial FLAIR and diffusion-weighted image sequences were obtained.

RESULTS

The study included 47 patients, 24 with PD and 23 controls. PD patients presented a reduced area and signal intensity of the substantia nigra and locus coeruleus on neuromelanin-sensitive MR. The median SCORE was 5% in both groups. No significant differences regarding white matter hyperintensities (OR 4.84, 95% CI 0.50, 47.06), lacunes (OR 0.43, 95% CI 0.07, 2.63), microbleeds (OR 0.64, 95% CI 0.13, 3.26), or infarcts (0.95, 95% CI 0.12, 7.41) was found. The frequency of these neuroimaging biomarkers was very low in both groups.

CONCLUSION

The present study does not support an increased prevalence of neuroimaging cerebrovascular biomarkers in PD patients.

Genetic predisposition to Parkinson's disease and risk of cardio and cerebrovascular disease: a Mendelian randomization study

BACKGROUND

Observational studies suggest that Parkinson's disease (PD) is related with the risk of cardio and cerebrovascular disease. However, the causality is not yet fully established. Therefore, we employed Mendelian randomization to assess whether PD is related to risk of ischemic stroke (IS), IS subtypes, coronary artery disease (CAD) and myocardial infarction (MI).

METHODS

Eighty-eight and eleven single nucleotide polymorphisms associated with PD at the genome-wide significance level, were used as instrumental variables for PD in European and East Asian population respectively. Using a 2-sample MR, we examined associations with IS, IS related subtypes, CAD and MI in European population. We also assessed the causal association of PD with IS and CAD in East Asian population. The primary MR analyses were performed by using the random-effects inverse variance weighted approach.

RESULTS

In European population, genetic predisposition to PD was related to higher risk of IS (odds ratio [OR], 1.03 per doubling in odds of PD; 95% confidence interval [CI], 1.01-1.05; P = 0.002) and cardioembolic stroke (OR, 1.08 per doubling in odds of PD; 95% CI, 1.04-1.12; P = 1.29 × 10^-4), but not large artery stroke, small vessel stroke, CAD and MI. In East Asian population, we found no evidence of causal effect of PD on the risk of IS and CAD.

CONCLUSIONS

This study found that genetic predisposition to PD is related to higher risk of IS and cardioembolic stroke in European population.

Association of Parkinson's disease with ischemic stroke in Korea: A nationwide longitudinal cohort study in Korea

OBJECTIVE

The aim of this nationwide age- and sex- matched longitudinal follow up study is to determine the risk of Parkinson's disease (PD) associated with ischemic stroke in Korea.

METHODS

Patient data were collected from the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS). PD was identified using the International Classification of Diseases (ICD) 10-CM code G 20. In total, 6,475 patients were enrolled in the PD group from the NHISS. After subtracting 1,039 patients who underwent hospitalization less than once or those who visited an outpatient clinic less than two times, 5,259 patients who were diagnosed after January 1, 2004 ultimately participated in this study. After case-control match was done through 1:5 age- and sex- stratified matching, 26,295 individuals were chosen as control. Kaplan-Meier method and Cox proportional hazard regression analysis were performed to evaluate the risk of ischemic stroke in PD.

RESULTS

The hazard ratio of ischemic stroke in the PD group was 3.848 (95% confidence interval (confidence interval [CI]): 3.14-4.70) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in PD group was 3.885 (95% CI: 3.17-4.75) after adjusting for comorbidities. According to subgroup analysis, in male and female and non-diabetes and diabetes and non-hypertension and hypertension and dyslipidemia and non-dyslipidemia subgroups, ischemic stroke incidence rates were significantly higher in the PD group than those in the control group.

CONCLUSIONS

This nationwide longitudinal study suggests an increased risk of ischemic stroke in PD patients.

Cardiovascular and cerebrovascular risk markers in Parkinson's disease: Results from a case-control study

BACKGROUND

The relationship between Parkinson's disease (PD) and cardiovascular and cerebrovascular disease is not yet well established. Recent data suggest an increased risk of myocardial infarction and stroke in PD patients. Therefore, we designed a study to assess surrogate markers of cardiovascular and cerebrovascular risk in PD.

METHODS

We conducted a case-control study comparing PD patients recruited from a Movement Disorders Unit with controls randomly invited from a primary healthcare center. All participants underwent a detailed clinical evaluation, including medical history, physical assessment, carotid ultrasound, blood and urine analysis, and 24-h ambulatory blood pressure monitoring. The primary outcome was the carotid intima-media thickness (CIMT).

RESULTS

We included 102 participants in each study arm. No significant difference was found in the CIMT among groups (MD: 0.01, 95% CI: -0.02, 0.04). Carotid plaques were more frequent in PD patients (OR: 1.90, 95% CI: 1.02, 3.55), although the lipid profile was more favorable in this group (LDL MD: -18.75; 95% CI: -10.69, -26.81). Nocturnal systolic blood pressure was significantly higher in PD patients (MD: 4.37, 95% CI: 0.27, 8.47) and more than half of the PD patients were non-dippers or reverse dippers (OR: 1.83, 95% CI: 1.04, 3.20).

CONCLUSION

We did not find a difference in CIMT between PD and controls. A higher frequency of carotid plaques and abnormal dipper profile supports the hypothesis that PD patients are not protected from cardiovascular and cerebrovascular disease.

Non-Coding RNAs in the Brain-Heart Axis: The Case of Parkinson's Disease

Parkinson's disease (PD) is a complex and heterogeneous disorder involving multiple genetic and environmental influences. Although a wide range of PD risk factors and clinical markers for the symptomatic motor stage of the disease have been identified, there are still no reliable biomarkers available for the early pre-motor phase of PD and for predicting disease progression. High-throughput RNA-based biomarker profiling and modeling may provide a means to exploit the joint information content from a multitude of markers to derive diagnostic and prognostic signatures. In the field of PD biomarker research, currently, no clinically validated RNA-based biomarker models are available, but previous studies reported several significantly disease-associated changes in RNA abundances and activities in multiple human tissues and body fluids. Here, we review the current knowledge of the regulation and function of non-coding RNAs in PD, focusing on microRNAs, long non-coding RNAs, and circular RNAs. Since there is growing evidence for functional interactions between the heart and the brain, we discuss the benefits of studying the role of non-coding RNAs in organ interactions when deciphering the complex regulatory networks involved in PD progression. We finally review important concepts of harmonization and curation of high throughput datasets, and we discuss the potential of systems biomedicine to derive and evaluate RNA biomarker signatures from high-throughput expression data.

Dietary education programs for adults with neurological diseases: a scoping review protocol

OBJECTIVE

The objective of this review is to identify and map the evidence on the types of dietary education programs that have been implemented and evaluated in any setting for adults with neurological diseases. This review will also examine program characteristics, including program duration, length, and number of sessions, and common behavior change techniques used.

INTRODUCTION

Up to 1 billion people are affected by neurological diseases, most commonly Alzheimer's disease and dementias, epilepsy, Huntington's disease, motor neurone disease, multiple sclerosis, Parkinson's disease, and stroke. Dietary recommendations for most of these diseases follow national dietary guidelines. Dietary education programs are recommended by the World Health Organization to promote adherence to a healthy diet, but it is not clear which dietary education programs have been conducted for adults with neurological diseases or the characteristics of such programs.

INCLUSION CRITERIA

This review will consider qualitative and intervention studies (randomized controlled trials, non-randomized controlled trials, and pre-post studies) evaluating dietary education programs for adults with neurological diseases. Programs can be any format in any setting, and may include a comparator group (waitlist control, treatment as usual, or another intervention) or have no comparator group.

METHODS

CINAHL, Cochrane Database of Systematic Reviews, Emcare, MEDLINE, ProQuest (ProQuest Central and ProQuest Dissertations & Theses), PsycINFO, Cochrane Central Register of Controlled Trials, and Google Scholar will be searched for publications in English. Neurological organizations will be contacted for unpublished literature. Titles and abstracts will be screened, and full texts accessed for final inclusion. Intervention details, study outcomes, behavior change techniques, and findings will be extracted. Results will be presented in a table with accompanying description.

Parkinson's disease and patient related outcomes in stroke: A matched cohort study

OBJECTIVE

To evaluate post-stroke outcomes in patients with Parkinson's disease (PD).

METHODS

A matched cohort study was performed. Stroke patients with PD and non-PD controls were extracted from the Thailand Universal Insurance Database. Logistic regressions were used to evaluate the association between PD and in-hospital outcomes (mortality and complications). The PD-associated long-term mortality was evaluated using Royston-Parmar models.

RESULTS

A total of 1967 patients with PD were identified between 2003 and 2015 and matched to controls (1:4) by age, sex, admission year, and stroke type. PD patients had decreased odds of in-hospital death: OR (95% CI) 0.66 (0.52 - 0.84) and 0.61 (0.43 - 0.85) after ischaemic and haemorrhagic strokes, respectively. PD was associated with a length-of-stay greater than median (4 days) after both stroke types: 1.37 (1.21 - 1.56) and 1.45 (1.05 - 2.00), respectively. Ischaemic stroke patients with PD also had increased odds of developing pneumonia, sepsis and AKI: 1.52 (1.2 - 1.83), 1.54 (1.16 - 2.05), and 1.33 (1.02 - 1.73). In haemorrhagic stroke patients, PD was associated with pneumonia: 1.89 (1.31 - 2.72). Survival analyses showed that PD was protective against death in the short term (HR=0.66; 95% CI 0.53-0.83 ischaemic, and HR=0.50; 95% CI 0.37 - 0.68 haemorrhagic stroke), but leads to an increased mortality risk approximately 1 and 3 months after ischaemic and haemorrhagic stroke, respectively.

CONCLUSION

PD is associated with a reduced mortality risk during the first 2-4 weeks post-admission but an increased risk thereafter, in addition to increased odds of in-hospital complications and prolonged hospitalisation.

Diabetes, a Contemporary Risk for Parkinson's Disease: Epidemiological and Cellular Evidences

Diabetes mellitus (DM), a group of diseases characterized by defective glucose metabolism, is the most widespread metabolic disorder affecting over 400 million adults worldwide. This pathological condition has been implicated in the pathogenesis of a number of central encephalopathies and peripheral neuropathies. In further support of this notion, recent epidemiological evidence suggests a link between DM and Parkinson’s disease (PD), with hyperglycemia emerging as one of the culprits in neurodegeneration involving the nigrostriatal pathway, the neuroanatomical substrate of the motor symptoms affecting parkinsonian patients. Indeed, dopaminergic neurons located in the mesencephalic substantia nigra appear to be particularly vulnerable to oxidative stress and degeneration, likely because of their intrinsic susceptibility to mitochondrial dysfunction, which may represent a direct consequence of hyperglycemia and hyperglycemia-induced oxidative stress. Other pathological pathways induced by increased intracellular glucose levels, including the polyol and the hexosamine pathway as well as the formation of advanced glycation end-products, may all play a pivotal role in mediating the detrimental effects of hyperglycemia on nigral dopaminergic neurons. In this review article, we will examine the epidemiological as well as the molecular and cellular clues supporting the potential susceptibility of nigrostriatal dopaminergic neurons to hyperglycemia.

"New methods of assessing autonomic disorders in Parkinson disease patients: skin-galvanic reaction"

The aim of this study was to assess quantitatively sweating in PD patients. In the study, the galvanic-skin reaction (GSR) was used. The GSR was tested using eSense Skin Reaction device. The results show that sweating in patients with Parkinson's disease on drugs (PD ON) and control patients is similar, while patients with PD without levodopa (PD OFF) have higher perspiration.

Does Parkinson's disease increase the risk of cardiovascular events? A systematic review and meta-analysis

BACKGROUND AND PURPOSE

The impact of Parkinson's disease (PD) on the risk of cardiovascular disease is poorly known. The aim was to systematically review observational studies evaluating the association between PD and cardiovascular events.

METHODS

MEDLINE through PubMed, the Web of Science and Cochrane Central Register of Controlled Trials with conference proceedings were searched from inception to 4 July 2019. Two reviewers independently selected studies comparing cardiovascular events between Parkinson's disease and control groups. Ischaemic stroke, myocardial infarction and cardiovascular mortality were the outcomes of interest. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were derived by random effects meta-analysis. Heterogeneity was assessed using the I² test. The study protocol was registered at PROSPERO: CRD42017076527.

RESULTS

Eleven studies were included: nine cohort studies and two case-control studies. PD was associated with a significantly increased risk of stroke (nine studies: OR 1.66, 95% CI 1.19, 2.34; I²  = 50%). No significant differences were detected regarding myocardial infarction risks (eight studies: OR 1.15, 95% CI 0.72, 1.83; I²  = 76%) nor cardiovascular mortality risks (seven studies: OR 1.11, 95% CI 0.85, 1.45; I²  = 47%) in PD patients.

CONCLUSIONS

The best evidence available showed an association between PD and increased risk of stroke. The risk of myocardial infarction and cardiovascular mortality was not different in PD and non-PD individuals.

Cardiovascular risk factors and Parkinson's disease in 500,000 Chinese adults

OBJECTIVE

The objectives of this study were to compare the risks of Parkinson's disease among those with versus those without prior stroke or heart disease at baseline in a prospective study of 0.5 million adults in China, and to examine associations of cardiovascular disease risk factors (cigarette smoking, hypertension, diabetes, obesity) with risk of Parkinson's disease.

METHODS

During an average of 11.5 years of follow-up of 503,497 middle-aged participants in the China Kadoorie Biobank study, 603 incident cases were hospitalized with a diagnosis of Parkinson's disease. Cox proportional hazards models were used to assess associations of history of heart disease or stroke with Parkinson's disease in all participants, and of cardiovascular disease risk factors with Parkinson's disease in a subset without prior cardiovascular disease.

RESULTS

In this population the incidence rate of Parkinson's disease (mean [SD] age of cases, 61 [10] years) was 13.3 (95% confidence interval: 12.3-14.4) per 100,000 person-years. Incidence increased with age, and was higher in men than in women, and in urban than in rural residents. Prior stroke was associated with about twofold higher risk of Parkinson's disease (hazard ratio 1.94; 1.39-2.69). After adjustment for confounders in those without prior cardiovascular disease, a 5 kg/m2 higher body mass index was associated with 17% (1.17; 1.03-1.34: P = 0.019) higher risk of Parkinson's disease, but neither hypertension, diabetes, nor current cigarette smoking was significantly associated with Parkinson's disease.

INTERPRETATION

Prior stroke and adiposity were each associated with higher risks of Parkinson's disease, but none of the other cardiovascular disease risk factors were significantly associated with Parkinson's disease in this population.

Stroke in Parkinson's disease

BACKGROUND

The association between Parkinson's disease (PD) and stroke remains completely understood.

AIM

We aimed to investigate stroke risk and post-stroke outcomes in patients with PD.

DESIGN

The retrospective cohort study included 1303 patients aged ≥ 40 years with new-diagnosed PD and 5212 non-PD adults were selected by frequency matching with age and sex in 2000-05. Both two groups were followed up until the end of 2013. Another nested stroke cohort study of 17 678 patients with stroke hospitalization in 2002-09 was conducted to compare the admission outcome in patients with and without PD history.

METHODS

We collected patients' characteristics and medical conditions in the present two studies from claims data of Taiwan's National Health Insurance. Incidences and risks of stroke in people with and without PD during the follow-up period were calculated by adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) in the Cox proportional hazard model. Complications and mortality during the stroke admission associated with PD were analysed by calculating adjusted odds ratios (ORs) and 95% CIs in the logistic regressions.

RESULTS

Incidences of stroke for people with and without PD were 19.8 and 9.93 per 1000 person-years, respectively, with corresponding HR of 1.96 (95% CI 1.67-2.30). History of PD was associated with post-stroke gastrointestinal bleeding (OR 1.25, 95% CI 1.05-1.49), epilepsy (OR 1.64, 95% CI 1.32-2.04), pneumonia (OR 1.34, 95% CI 1.20-1.49), urinary tract infection (OR 1.33, 95% CI 1.21-1.45) and mortality (OR 1.35, 95% CI 1.13-1.62).

CONCLUSION

PD increases stroke risk and influences post-stroke outcomes.

Identification of Shared Genes Between Ischemic Stroke and Parkinson's Disease Using Genome-Wide Association Studies

Ischemic stroke (IS) and Parkinson's disease (PD) are two neurological diseases that often strike individuals of advanced age. Although thought of as a disease of old age, PD can occur in younger patients. In many of these cases, genetic mutations underlie the disease. As with PD, stroke can also have a genetic component. Although many of the risk factors for IS are considered to be modifiable, a significant portion is not, suggesting that some of stroke risk factors may have a genetic origin. Large-scale genome-wide association studies (GWAS) have identified several IS and PD gene variants recently. Converging epidemiologic and pathological evidence suggests that IS and PD may be linked. However, it is still unclear whether these two conditions share a common mechanism. Here, we sought to determine the genetic mechanism underlying the possible association between IS and PD. We conducted a multi-step systemic analysis comprising (1) identification of IS and PD variants validated by known GWAS, (2) two separate gene-based tests using Versatile Gene-based Association Study 2 (VEGAS2) and PLINK, (3) a transcriptome-wide association study (TWAS), and (4) analyses of gene expression using an online tool in Gene Expression Omnibus. Our investigation revealed that IS and PD have in common five shared genes: GPX7, LBH, ZCCHC10, DENND2A, and NUDT14, which pass gene-based tests. Functionally, these genes are expressed differentially in IS and PD patients compared to neurologically healthy control subjects. This genetic overlap may provide clues on how IS and PD are linked mechanistically. This new genetic insight into these two diseases may be very valuable for narrowing the focus of future studies on the genetic basis of IS and PD and for developing novel therapies.

Chinese herbal medicine reduced the risk of stroke in patients with Parkinson's disease: A population-based retrospective cohort study from Taiwan

Parkinson’s disease (PD) is associated with a significantly increased risk of stroke. Traditional Chinese medicine (TCM) has long been used in Asia to treat stroke, but there are no large-scale clinical data to confirm its efficacy in protecting PD patients against stroke. Herein, we analyzed a cohort of 1,000,000 records from Taiwan’s National Health Insurance Research Database for the period 1997–2011, and identified 1,882 patients with new-onset PD. We matched 290 patients who received Chinese herbal medicine (CHM) by age, sex, year of CHM prescription, and year of PD diagnosis with 290 patients who did not use CHM as control. Both cohorts were followed until the end of 2013 for the incidence of new-onset stroke. In a multivariable Cox proportional hazard model adjusted for potential comorbidities, the incidence of stroke was lower among PD patients using CHM compared with non-CHM users (11.10 per 100 person-years vs 23.15 per 100 person-years; Hazard ratio: 0.56; 95% confidence interval:  0.44 to 0.72). The probability curve generated from our follow-up data showed that PD patients receiving CHM treatment had a decreased risk of stroke compared with those not receiving CHM treatment (P <0.001). The analysis on the prescription pattern of CHM revealed that Danshen is the most common single herb and Ma Zi Ren Wan is the most common herbal formula. Although the analysis are limited by a lack of analytic information regarding lifestyle patterns, biochemical profiles, and levels of PD severity in database, this population-based study suggest that CHM may be an complementary therapy to reduce the risk of stroke in PD patients.

Prevalent cerebrovascular and cardiovascular disease in people with Parkinson's disease: a meta-analysis

Background

People with Parkinson's disease (PwP) are speculated to be at a low risk of cerebrovascular and cardiovascular disease (CVD) because they have fewer vascular risk factors and lower smoking rate. However, emerging evidence suggests that PwP are at higher risk of CVD, which introduces controversy to the notion that there is no association between Parkinson's disease (PD) and CVD. Hence, we conducted a meta-analysis to analyze the risk of CVD in PwP.

Methods

Electronic databases were searched using terms related to PD and CVD. Articles were included in the meta-analysis only if they employed clear diagnostic criteria for PD and CVD. The reference lists of the relevant articles were reviewed to identify eligible studies not found during the keyword search.

Results

The enrolled studies were categorized into case-control and cohort studies, and the former was further divided into postmortem (three) and clinical (four) studies. In the clinical case-control studies group, PD was more associated with CVD (OR: 2.89, 95% CI: 1.36-6.13). Three studies were enrolled in the cohort studies group, and the merged results demonstrated that PwP were at higher risk of CVD during the follow-up period (HR: 1.84, 95% CI: 1.34-2.54).

Conclusion

PD is associated with CVD, which may be due to the shared pathogeneses between the two diseases or PD-related effects. PwP should be more aware of the risk of CVD despite having fewer traditional vascular risk factors.

Would you like to leave Beijing, Shanghai, or Shenzhen? An empirical analysis of migration effect in China

This study aims to estimate the migration effect of the overall samples and different flowing scales for the floating population from the perspective of personal wages. Although we used both the OLS and PSM methods to estimate the migration effect, we found that the PSM method was preferred in the study of migration as a result of the selection bias. The empirical results show that there is a significant difference in wage before and after migration. In fact, migration increased wages by 15.18% to 23.63% overall. Additionally, wages were increased by 44.96% to 59.20%, 23.06% to 26.18%, and 10.89% to 15.08% respectively for these three migration patterns: flowing into the three largest megacities, inter-provincial migration, and inter-city migration within a province, but for this pattern of inter-district migration within a city, the migration effect is not significant. We concluded that the floating population removing policies of the largest megacities maybe are effective because of the administrative power of their government. On the other hand, for these policies of non-largest megacities to attract labor and local employment and local urbanization near the floating population's place of origin, they were not effective enough as a result of the lack of significant migration effect in these cities.

Alpha-synuclein deregulates the expression of COL4A2 and impairs ER-Golgi function

Alpha-synuclein (aSyn) is the major protein component of Lewy bodies and Lewy neurites, the typical pathological hallmarks in Parkinson's disease (PD) and Dementia with Lewy bodies. aSyn is capable of inducing transcriptional deregulation, but the precise effect of specific aSyn mutants associated with familial forms of PD, remains unclear. Here, we used transgenic mice overexpressing human wild-type (WT) or A30P aSyn to compare the transcriptional profiles of the two animal models. We found that A30P aSyn promotes strong transcriptional deregulation and increases DNA binding. Interestingly, COL4A2, a major component of basement membranes, was found to be upregulated in both A30P aSyn transgenic mice and in dopaminergic neurons expressing A30P aSyn, suggesting a crucial role for collagen related genes in aSyn-induced toxicity. Finally, we observed that A30P aSyn alters Golgi morphology and increases the susceptibility to endoplasmic reticulum (ER) stress in dopaminergic cells. In total, our findings provide novel insight into the putative role of aSyn on transcription and on the molecular mechanisms involved, thereby opening novel avenues for future therapeutic interventions in PD and other synucleinopathies.

Assessment of Atrial Conduction Times in Patients with Newly Diagnosed Parkinson's Disease

Background

An increased risk of ischemic stroke has been reported in patients with Parkinson's disease (PD). Atrial fibrillation (AF) is strongly associated with ischemic stroke. Prolonged atrial electromechanical delay (EMD) is an independent predictor for the development of AF.

Aims

The aim of the present study was to evaluate the atrial conduction parameters in patients with PD and to assess their relation with the severity of PD.

Study design

We prospectively enrolled 51 consecutive patients with newly diagnosed PD and 31 age- and sex-matched non-PD subjects.

Methods

To assess atrial electromechanical coupling (PA), the time intervals from the onset of p wave on ECG to the late diastolic wave at the septal (PAs) and lateral (PAl) mitral annulus and lateral tricuspid annulus (PAt) were measured on Tissue Doppler Echocardiography (TDE). The difference between PAs-PAl, PAs-PAt, and PAl-PAt were defined as left intra-atrial, right intra-atrial, and interatrial EMD, respectively. P-wave dispersion (PWD) was calculated from the 12-lead ECG.

Results

PWD, PAs, PAl, and PAt durations were significantly prolonged in the PD group (all p < 0.001). Interatrial, right, and left intra-atrial EMD were also significantly longer in PD patients (p < 0.001, p < 0.001 and p=0.002, resp.). There were significant positive correlations between disease severity (UPDRS score) and PWD (r=0.34, p=0.041), left intra-atrial (r=0.39, p=0.005), and interatrial EMD (r=0.35, p=0.012). By multivariate analysis, PWD (OR: 1.13, 95% CI: 1.02–1.25; p=0.017), LA volume index (OR: 1.19, 95% CI: 1.02–1.37; p=0.021), left intra-atrial (OR: 1.12, 95% CI: 1.01–1.24; p=0.041), and interatrial EMD (OR: 1.08, 95% CI: 1.01–1.16; p=0.026) were found as independent predictors of PD.

Conclusion

Atrial conduction times were longer and correlated with the severity of disease in PD patients. Prolonged inter- and intra-atrial-EMD intervals were also found as independent correlates of PD. These findings may suggest an increased predisposition to atrial fibrillation in PD.

Stroke and Coronary Artery Disease Are Associated With Parkinson’s Disease

Background: The relationship between vascular disease and Parkinson’s disease (PD) is controversial. We performed a cross-sectional study to investigate the association of two common vascular diseases (stroke and coronary artery disease [CAD]) with Parkinson’s disease. Methods: We identified 63 and 62 PD cases in two population-based cohorts (Malu rural community and Wuliqiao urban community) and collected information of PD and non-PD by means of questionnaires. Logistic regression analysis was used to investigate the association between stroke, coronary artery disease and PD, after adjusting for age, sex, hypertension, diabetes mellitus, hypercholesterolemia, smoking status, alcohol consumption, tea consumption and body mass index. Results: After adjustment for potential confounders, we found that CAD and stroke were associated with PD in the Malu rural community (CAD: odds ratio [OR]=7.11, 95% confidence intervals [CI]: 3.09-16.40, p<0.001; stroke: OR=6.77, 95% CI: 3.09-14.81, p<0.001) and stroke was associated with PD in the Wuliqiao urban community (OR=2.58, 95% CI: 1.36-4.89, p=0.004), especially in women. In a subgroup analysis of PD with age- and sex-matched controls, the results were similar in the Malu rural community (CAD: OR=12.72, 95% CI: 2.92-55.32, p=0.001; stroke: OR=6.26, 95% CI: 1.83-21.42, p=0.003), whereas in the Wuliqiao urban community the results were different in that CAD (but not stroke) was found to be associated with PD (CAD: OR=2.44, 95% CI: 1.09-5.47, p=0.03; stroke: OR=1.79, 95% CI: 0.77-4.17, p=0.18). Conclusions: Our study suggested that stroke and CAD are associated with PD in two Chinese population-based cohorts, indicating a probable vascular component in the pathogenesis of PD.

Molecular and Clinical Issues about the Risk of Venous Thromboembolism in Older Patients: A Focus on Parkinson's Disease and Parkinsonism

Venous thromboembolism (VTE) is a common and potentially life-threatening condition which includes both deep-vein thrombosis (DVT) and pulmonary embolism (PE). VTE has a significant clinical and epidemiological impact in the elderly, and its incidence increases to more than 1% per year in older patients, suggesting the presence of specific age-related risk factors in this population. Immobilization seems to predominate as the main cause in patients admitted for medical acute illness in medicine wards, and there is evidence of a high risk in older patients with immobilization resulting from advanced forms of Parkinson’s disease (PD), regardless of the presence of an acute medical condition. In this review, we would to discuss the recent evidence on clinical, molecular and epidemiological features of VTE in older frail subjects focusing on patients with PD and parkinsonism. We also discuss some therapeutic issues about the risk prevention and we suggest a thorough comprehensive geriatric assessment that can represent an optimal strategy to identify and prevent the VTE risk in these patients.

The Effect of Associated Parkinsonism on Rehabilitation in Stroke Patients: A Case Series

Stroke and Parkinson’s disease are 2 major causes of movement impairment and a decreased ability to perform daily activities. The aim of this case series was to demonstrate the difficulty of rehabilitation in stroke patients with accompanying parkinsonism. Four stroke patients with parkinsonism who underwent rehabilitation at the Physical Medicine and Rehabilitation Clinic between March and May of 2016 were evaluated. The Standardized Mini-Mental State Examination (SMMSE), the Functional Independence Measure (FIM), the Barthel Index (BI), the Berg Balance Scale (BBS), and the Stroke Impact Scale version 3.0 (SIS) were used in the assessment. Of the 4 patients, 3 were female, and the mean age was 74.5±9.3 years. The mean hospital stay was 19±5.3 days. The initial test scores recorded were low, and they remained low at the time of discharge. After rehabilitation, the mean FIM score in the group was 42% of the maximum possible score, the mean SMMSE was 55%, the BI was 18%, the BBS was 0.08%, and the SIS was 25%. Three patients required a wheelchair, and 1 patient could ambulate with a walker at discharge. A stroke accompanied by parkinsonism negatively affects mobility and functional status, primarily through the deterioration of balance. In this study, cognitive function was reduced to half of the maximum, and the balance and function loss was more than 50%. Barthel index; berg balance scale; functional independence measure; mini-mental state examination; parkinsonism; stroke; stroke impact scale.

An overview of sleep and circadian dysfunction in Parkinson's disease

Sleep and circadian alterations are amongst the very first symptoms experienced in Parkinson's disease, and sleep alterations are present in the majority of patients with overt clinical manifestation of Parkinson's disease. However, the magnitude of sleep and circadian dysfunction in Parkinson's disease, and its influence on the pathophysiology of Parkinson's disease remains often unclear and a matter of debate. In particular, the confounding influences of dopaminergic therapy on sleep and circadian dysfunction are a major challenge, and need to be more carefully addressed in clinical studies. The scope of this narrative review is to summarise the current knowledge around both sleep and circadian alterations in Parkinson's disease. We provide an overview on the frequency of excessive daytime sleepiness, insomnia, restless legs, obstructive apnea and nocturia in Parkinson's disease, as well as addressing sleep structure, rapid eye movement sleep behaviour disorder and circadian features in Parkinson's disease. Sleep and circadian disorders have been linked to pathological conditions that are often co-morbid in Parkinson's disease, including cognitive decline, memory impairment and neurodegeneration. Therefore, targeting sleep and circadian alterations could be one of the earliest and most promising opportunities to slow disease progression. We hope that this review will contribute to advance the discussion and inform new research efforts to progress our knowledge in this field.

Spinal cord injury and Alzheimer's disease risk: a population-based, retrospective cohort study

STUDY DESIGN

Propensity score-matched, retrospective cohort study.

OBJECTIVES

To determine the risk of developing Alzheimer's disease (AD) in patients with spinal cord injury (SCI).

SETTING

The present study used Taiwan's National Health Insurance Research Database.

METHODS

A total of 9257 patients who had ⩾2 ambulatory visits with a diagnosis of SCI in 2001 were included in the SCI group. The non-SCI group consisted of 37,028 propensity score-matched patients without a diagnosis of SCI. The cumulative incidence of AD was estimated for each of the two patient groups using the Kaplan-Meier method. Stratified Cox proportional hazard regression was then employed to assess the influence of SCI on the risk of AD.

RESULTS

During the follow-up period, 25 subjects in the SCI group and 57 in the non-SCI group developed AD. The cumulative incidence of AD in the SCI group was higher than in the non-SCI group (P = 0.0168); and the hazard ratio of AD for the SCI group, as compared to the non-SCI group, was 1.71 (95% CI 1.06-2.76, P = 0.0273).

CONCLUSIONS

This study suggests that patients with SCI have an increased risk of developing AD.

Parkinson's disease might increase the risk of cerebral ischemic lesions

BACKGROUND

Parkinson's disease (PD) is the second most common neurodegenerative disease in the elderly. Cerebrovascular diseases such as cerebral ischemic lesion (CIL) also commonly occur in elderly adults. However, previous studies on the relationship between PD and cerebrovascular disease have not found consistent results. Therefore, we conducted this study to evaluate whether or not PD is related to an increased prevalence of ischemic cerebrovascular lesions.

METHODS

This study recruited 241 patients with PD and 112 healthy controls (HCs). All subjects underwent brain magnetic resonance imaging and general neuropsychological tests. The motor severity of PD was evaluated according to the Hoehn and Yahr stage (HY stage), and the severity of CIL in all subjects was classified according to Fazekas grade. The PD patients were classified into two subgroups according to HY stage (Group 1 - HY 1, 2; Group 2 - HY 3 to 5).

RESULTS

Among all PD patients, 76% had small vessel disease, while 44% of all HCs had small vessel disease (p<0.001). Regarding the difference between the two subgroups according to motor severity, group 2 showed significantly higher Fazekas scale score and more severe CIL, indicating a higher prevalence of small vessel disease compared to group 1.

CONCLUSION

This study demonstrates that PD patients have a significantly higher prevalence of CIL compared to HCs. Therefore, although the present study is not a large-scale study, we cautiously suggest that PD can play an important role as a risk factor in the occurrence of ischemic cerebrovascular disease.

Increased risk of rheumatoid arthritis in patients with migraine: a population-based, propensity score-matched cohort study

Previous cross-sectional studies have suggested an association between migraine and rheumatoid arthritis (RA), but no longitudinal study has been performed to evaluate the temporal relationship between the two conditions. The purpose of the present population-based, propensity score-matched cohort study was to investigate whether migraineurs are at a higher risk of developing RA. A total of 58,749 subjects aged between 20 and 90 years with at least two ambulatory visits with a diagnosis of migraine were recruited in the migraine group. We fit a logistic regression model that included age, sex, comorbid conditions, and socioeconomic status as covariates to compute the propensity score. The non-migraine group consisted of 58,749 propensity score-matched, randomly sampled subjects without migraine. The RA-free survival curves were generated using the Kaplan-Meier method. Stratified Cox proportional hazard regression was used to estimate the effect of migraine on the risk of RA. During follow-up, 461 subjects in the migraine group and 220 in the non-migraine group developed RA. The incidence rate of RA was 3.18 (95% confidence interval [CI] 2.90-3.49) per 1000 person-years in the migraine group and 1.54 (95% CI 1.34-1.76) per 1000 person-years in the non-migraine group. Compared to the non-migraine group, the crude hazard ratio of RA for the migraine group was 2.15 (95% CI 1.82-2.56, P < 0.0001), and the multivariable-adjusted hazard ratio was 1.91 (95% CI 1.58-2.31, P < 0.0001). This study showed that patients with migraine had an increased risk of developing RA.

Elective Thoracolumbar Spine Fusion Surgery in Patients with Parkinson Disease

OBJECTIVE

Few data are available concerning clinical outcomes in patients with Parkinson disease who undergo elective thoracolumbar spine fusion surgery. The goal of this study is to elucidate complication and revision rates after posterior thoracolumbar fusion surgery in patients with Parkinson disease, with a focus on how Parkinson disease modifies these rates.

METHODS

The PearlDiver database (2005-2012) was queried for patients who underwent posterior approach thoracolumbar fusion from 2006 to 2011. Cohorts of patients with a previous diagnosis of Parkinson disease (n = 4816) and without (n = 280,702) were compared. Multivariate analysis that included various comorbidities and demographics was used to calculate effects of Parkinson disease on development of postoperative infection and major medical complications within 90 days and revision surgery within 1 year. For analyses, significance was set at P < 0.001.

RESULTS

Major medical complications were observed in 545 patients (11.3%) for 90 days after the index procedure. Postoperative infection was noted in 91 patients (1.9%) within 90 days, and revision surgeries were performed in 250 patients (5.2%) within 1 year. Multivariate analysis showed that Parkinson disease was significantly associated with an increased risk for medical complications (adjusted odds ratio, 1.22; 95% confidence interval, 1.11-1.34; P < 0.001) and revision surgery (adjusted odds ratio, 1.70; 95% confidence interval, 1.49-1.93; P < 0.001), but not postoperative infection (P = 0.02).

CONCLUSIONS

Patients with Parkinson disease are more likely to require revision surgery and have higher rates of adverse medical events postoperatively. Patients with Parkinson disease should be appropriately selected to ensure favorable clinical outcomes.

Migraine is related to an increased risk of Parkinson’s disease: A population-based, propensity score-matched, longitudinal follow-up study

Background

The association between migraine and Parkinson’s disease (PD) remains controversial. The purpose of the present population-based, propensity score-matched follow-up study was to investigate whether migraineurs are at a higher risk of developing PD.

Methods

A total of 41,019 subjects aged between 40 and 90 years with at least two ambulatory visits with a diagnosis of migraine in 2001 were enrolled in the migraine group. A logistic regression model that included age, sex, pre-existing comorbidities and socioeconomic status as covariates was used to compute the propensity score. The non-migraine group consisted of 41,019 propensity score-matched, randomly sampled subjects without migraine. The PD-free survival rate were estimated using the Kaplan–Meier method. Stratified Cox proportional hazard regression was used to estimate the effect of migraine on the risk of developing PD.

Results

During follow-up, 148 subjects in the migraine group and 101 in the non-migraine group developed PD. Compared to the non-migraine group, the hazard ratio of PD for the migraine group was 1.64 (95% confidence interval: 1.25–2.14, p = 0.0004). The PD-free survival rate for the migraine group was significantly lower than that for the non-migraine group ( p = 0.0041).

Conclusions

This study showed an increased risk of developing PD in patients with migraine.

Influenza Vaccination Reduces Hospitalization for Heart Failure in Elderly Patients with Chronic Kidney Disease: A Population-Based Cohort Study

BACKGROUND

Elderly patients with chronic kidney disease (CKD) are at a higher risk of hospitalization for cardiovascular diseases (CVD). Previous studies have reported the beneficial effects of the influenza vaccine in patients with CVD. However, the effects of influenza vaccination on the reduction of hospitalizations for heart failure (HF) in elderly patients with CKD remain unclear.

METHODS

This cohort study comprised elderly patients (≥ 55 years of age) with a recorded diagnosis of CKD (n = 4406) between January 1, 1999 and December 31, 2008. Each patient was followed-up until the end of 2008. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the first HF hospitalization were analyzed. In addition, the patients were categorized into four groups based on their vaccination status (unvaccinated and total number of vaccinations: 1, 2-3, and ≥ 4).

RESULTS

We found that elderly patients with CKD receiving influenza vaccination exhibited a lower risk of HF hospitalization (adjusted HR, 0.31; 95% CI, 0.26-0.39, p < 0.001). The protective effects of influenza vaccination remained consistent regardless of the age group (55-64, 65-74, ≥ 75), sex, and influenza seasonality. When the patients were stratified according to the total number of vaccinations, the adjusted HRs for HF hospitalization were 0.60 (0.47-0.77), 0.30 (0.23-0.41), and 0.10 (0.06-0.16) for patients who received 1, 2-3, and ≥ 4 vaccinations during the follow-up period, respectively.

CONCLUSIONS

The results revealed that elderly patients with CKD receiving annual influenza vaccination are at a lower risk of HF hospitalization.

Spinal cord injury and Parkinson's disease: a population-based, propensity score-matched, longitudinal follow-up study

OBJECTIVES

To investigate whether patients with spinal cord injury (SCI) are at an increased risk of developing Parkinson's disease (PD).

STUDY DESIGN

A population-based, propensity score-matched, longitudinal follow-up cohort study.

SETTING

The study was conducted using the National Health Insurance (NHI) Research Database.

METHODS

A total of 10 125 patients with at least 2 ambulatory visits with a diagnosis of SCI in 2001 were enrolled in the SCI group. The non-SCI group comprised 10 125 propensity score-matched patients without SCI. The propensity scores were computed using a logistic regression model that included age, sex, comorbidities and socioeconomic status. The PD-free survival rates of the two groups were estimated using the Kaplan-Meier method. Stratified Cox proportional hazard regression was used to estimate the effect of SCI on subsequent occurrence of PD.

RESULTS

During the 3-year follow-up period, 99 subjects in the SCI group and 59 in the non-SCI group developed PD. The hazard ratio of PD for the SCI group compared with the non-SCI group was 1.65 (95% confidence interval 1.16-2.33, P=0.0049). The PD-free survival rate for the SCI group was lower than that for the non-SCI group (P=0.0017).

CONCLUSIONS

This study shows that SCI is associated with a subsequent increased risk of PD. Further studies are needed to elucidate the mechanism underlying this association.

A comparative study of the amount of α-synuclein in ischemic stroke and Parkinson's disease

In the present study, we detected the level of oligomeric form of α-synuclein in the red blood cells of ischemic stroke, Parkinson's disease, and normal people and compared the differences to assess the diagnosis potential of α-synuclein in ischemic stroke patients. 86 ischemic stroke, 100 PD, and 102 healthy cases were enrolled in the present study. Total protein amount in the red blood cells were quantified by BCA assay using spectrophotometer. Levels of oligomeric form of α-synuclein were characterized by a sandwich ELISA. Analysis of correlation analysis and receiver operating characteristic curve were conducted. Significant differences were detected in the levels of oligomeric forms of α-synuclein in different samples' blood cells (P < 0.05); the levels of total protein in (188.1 ± 33.9 mmol/L) healthy people were significantly higher than that of PD (147.7 ± 45.0 mmol/L) and ischemic stroke groups (142.9 ± 43.0 mmol/L) (P < 0.05). There was no correlation between the age of patients and level of α-synuclein (R (2) = 0.216 in ischemic stroke group and -0.104 in PD group) and the receiver operating characteristic curve analysis showed a high sensitivity of α-synuclein in discriminating ischemic stroke (sensitivity was 63.7 % and specificity was 9.6 %) and PD (sensitivity was 44.1 % and specificity was 12.5 %) patients from the controls. The levels of oligomeric form of α-synuclein of red blood cells in ischemic stroke and Parkinson's disease patients were both significant higher than normal people. And the level of oligomeric form α-synuclein showed a potential for diagnosis of ischemic stroke in clinic.

Influenza Vaccination is Associated with Lower Risk of Acute Coronary Syndrome in Elderly Patients with Chronic Kidney Disease

Elderly patients with chronic kidney disease (CKD) are at a higher risk of hospitalization for cardiovascular diseases (CVD). Previous studies have showed that influenza vaccination could reduce the risk of recurrent major cardiovascular events in patients with CVD. However, the effects of influenza vaccination on the reduction of first hospitalizations for acute coronary syndrome (ACS) in elderly patients with CKD remain unknown.We conducted a cohort study using data from the Taiwan Longitudinal Health Insurance Database 1997 to 2008. This cohort study comprised elderly patients (ages ≥55 years) with a recorded diagnosis of CKD (n = 4406) between January 1, 1999, and December 31, 2007. Each patient was followed up until the end of 2008. To minimize the selection bias of vaccine therapy, a propensity score adjustment was applied. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the occurrence of first hospitalization for ACS was evaluated by Cox proportional hazards regression. We further categorized the patients into 4 groups according to their vaccination status (unvaccinated, and total number of vaccinations: 1, 2-3, and ≥4).We found that elderly CKD patients without prior CVD history receiving influenza vaccination exhibited a lower risk of hospitalization for ACS (adjusted HR = 0.35, 95% CI 0.30-0.42; P < 0.001). We observed consistent protective effects regardless of age groups (55-64, 65-74, and ≥75), gender, and seasonality of influenza. When the patients were stratified according to the total number of vaccinations, the adjusted HRs for first ACS hospitalization were 0.62 (95% CI 0.52-0.81), 0.35 (95% CI 0.28-0.45), and 0.13 (95% CI 0.09-0.19) for patients who received 1, 2 to 3, and ≥4 vaccinations. There was a significant trend of decreasing risk of ACS hospitalization with an increasing number of vaccinations.The results of our observational study could strengthen the annual vaccination policy and physicians should be aware of missed opportunities to vaccinate elderly patients with CKD against influenza. The potential public health impact of influenza vaccination, particularly in the elderly CKD patients without a history of CVD, who are at risk for ACS, should be further explored.

Recovery Potential After Acute Stroke

In acute stroke, the major factor for recovery is the early use of thrombolysis aimed at arterial recanalization and reperfusion of ischemic brain tissue. Subsequently, neurorehabilitative training critically improves clinical recovery due to augmention of postlesional plasticity. Neuroimaging and electrophysiology studies have revealed that the location and volume of the stroke lesion, the affection of nerve fiber tracts, as well as functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks are relevant biomarkers of post-stroke recovery. However, associated disorders, such as mood disorders, epilepsy, and neurodegenerative diseases, may induce secondary cerebral changes or aggravate the functional deficits and, thereby, compromise the potential for recovery.

Combination of acamprosate and baclofen as a promising therapeutic approach for Parkinson's disease

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterised by the loss of dopaminergic nigrostriatal neurons but which involves the loss of additional neurotransmitter pathways. Mono- or polytherapeutic interventions in PD patients have declining efficacy long-term and no influence on disease progression. The systematic analysis of available genetic and functional data as well as the substantial overlap between Alzheimer’s disease (AD) and PD features led us to repurpose and explore the effectiveness of a combination therapy (ABC) with two drugs – acamprosate and baclofen – that was already effective in AD animal models, for the treatment of PD. We showed in vitro that ABC strongly and synergistically protected neuronal cells from oxidative stress in the oxygen and glucose deprivation model, as well as dopaminergic neurons from cell death in the 6-hydroxydopamine (6-OHDA) rat model. Furthermore, we showed that ABC normalised altered motor symptoms in vivo in 6-OHDA-treated rats, acting by protecting dopaminergic cell bodies and their striatal terminals. Interestingly, ABC also restored a normal behaviour pattern in lesioned rats suggesting a symptomatic effect, and did not negatively interact with L-dopa. Our results demonstrate the potential value of combining repurposed drugs as a promising new strategy to treat this debilitating disease.

Spinal cord injury is related to an increased risk of multiple sclerosis: a population-based, propensity score-matched, longitudinal follow-up study

Multiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system (CNS). Trauma to the CNS has been postulated to play a role in triggering CNS autoimmune disease. Although the association between traumatic brain injury and MS has been suggested in previous studies, epidemiological data on the association between spinal cord injury (SCI) and MS is still lacking. The aim of the present population-based, propensity score-matched, longitudinal follow-up study was therefore to investigate whether patients with SCI were at a higher risk of developing MS. A total of 11,913 subjects ages between 20 and 90 years with at least two ambulatory visits with the principal diagnosis of SCI in 2001 were enrolled in the SCI group. We used a logistic regression model that included age, sex, pre-existing comorbidities, and socioeconomic status as covariates to compute the propensity score. The non-SCI group consisted of 59,565 propensity score-matched, randomly sampled subjects without SCI. Stratified Cox proportional hazard regression with patients matched by propensity score was used to estimate the effect of SCI on the risk of developing subsequent MS. During follow-up, five subjects in the SCI group and four in the non-SCI group developed MS. The incidence rates of MS were 17.60 (95% confidence interval [CI], 5.71-41.0) per 100,000 person-years in the SCI group and 2.82 (95% CI, 0.77-7.22) per 100,000 person-years in the non-SCI group. Compared with the non-SCI group, the hazard ratio of MS for the SCI group was 8.33 (95% CI, 1.99-34.87, p=0.0037). Our study therefore shows that patients with SCI have an increased risk of developing MS.

An overview on the correlation of neurological disorders with cardiovascular disease

Neurological disorders (NDs) are one of the leading causes of death especially in the developed countries. Among those NDs, Alzheimer's disease (AD) and Parkinson disease (PD) are heading the table. There have been several reports in the scientific literatures which suggest the linkage between cardiovascular disorders (CVDs) and NDs. In the present communication, we have tried to compile NDs (AD and PD) association with CVDs reported in the literature. Based on the available scientific literature, we believe that further comprehensive study needs to be done to elucidate the molecular linking points associated with the above mentioned disorders.

Eryptosis as a marker of Parkinson's disease

A major trend in recent Parkinson's disease (PD) research is the investigation of biological markers that could help in identifying at-risk individuals or to track disease progression and response to therapies. Central to this is the knowledge that inflammation is a known hallmark of PD and of many other degenerative diseases. In the current work, we focus on inflammatory signalling in PD, using a systems approach that allows us to look at the disease in a more holistic way. We discuss cyclooxygenases, prostaglandins, thromboxanes and also iron in PD. These particular signalling molecules are involved in PD pathophysiology, but are also very important in an aberrant coagulation/hematology system. We present and discuss a hypothesis regarding the possible interaction of these aberrant signalling molecules implicated in PD, and suggest that these molecules may affect the erythrocytes of PD patients. This would be observable as changes in the morphology of the RBCs and of PD patients relative to healthy controls. We then show that the RBCs of PD patients are indeed rather dramatically deranged in their morphology, exhibiting eryptosis (a kind of programmed cell death). This morphological indicator may have useful diagnostic and prognostic significance.