Cerebrovascular disease pathology and parkinsonian signs in old age.
Cerebrovascular disease pathology and parkinsonian signs in old age.
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DOI：
10.1161/strokeaha.111.623462
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发表时间：
2011-11
期刊：
影响因子：
8.3
通讯作者：
Schneider JA
中科院分区：
文献类型：
--
作者：
Buchman AS;Leurgans SE;Nag S;Bennett DA;Schneider JA
包括帕金森症状在内的轻度运动症状在老年人中很常见，但其潜在的神经病理学尚不清楚。我们检验了脑血管病变与帕金森病症状相关的假设。我们研究了来自宗教团体研究的 418 名已故参与者的脑部尸检，他们接受了帕金森病症状统一评估量表 (mUPDRS) 运动部分的修改版本的评估。评估大脑的宏观和微观梗塞以及动脉硬化的严重程度。采用回归分析来检查脑血管病理与帕金森病体征的关联。超过 35% 的病例 (N=149) 显示肉眼可见的梗塞。近 30% 没有肉眼可见梗塞的病例显示出传统脑成像无法检测到的病理：微梗塞（N=33，7.9%）；动脉硬化 (N=62, 14.8%) 或两者兼而有之 (N=24, 5.7%)。宏观梗塞，特别是多发性皮质和一个或多个皮质下宏观梗塞与较高的整体帕金森评分相关。多发性和皮质微梗塞的存在与总体帕金森病评分相关。动脉硬化与整体帕金森病评分相关，但在考虑到梗塞后，这种影响减弱并且不再显着。 3 种病理学中的每一种都分别与帕金森步态[宏观梗塞（估计= 0.552；SE=0.210；p=0.009）；微梗死（估计值= 0.424；SE=0.213；p=0.047）；动脉硬化（估计值 = 0.191；SE=0.056；p<0.001）]。进一步的分析表明，皮质下宏观和微观梗塞与帕金森步态的严重程度有特定的相关性。脑血管病变，包括肉眼可见的梗塞、微梗塞和动脉硬化，在老年人中很常见，并且可能是老年轻度帕金森病体征，尤其是帕金森病步态的常见病因，但未被认识到。
Mild motor symptoms including parkinsonian signs are common in old age but their underlying neuropathology is unclear. We tested the hypothesis that cerebrovascular pathologies are related to parkinsonian signs. We studied brain autopsies from 418 deceased participants from the Religious Order Study, who underwent evaluation of parkinsonian signs with a modified version of the motor section of the Unified Parkinson's Disease Rating Scale (mUPDRS). Brains were evaluated for macroscopic and microinfarcts and the severity of arteriolosclerosis. Regression analyses were employed to examine the association of cerebrovascular pathologies with parkinsonian signs. More than 35% of cases (N=149) showed macroscopic infarcts. Almost 30% of cases without macroscopic infarcts, showed pathologies not detected by conventional brain imaging: microinfarcts (N=33, 7.9%); arteriolosclerosis (N=62, 14.8%) or both (N=24, 5.7%). Macroscopic infarcts, specifically multiple cortical and one or more subcortical macroscopic infarcts were related to higher global parkinsonian scores. The presence of multiple and cortical microinfarcts were associated with global parkinsonian score. Arteriolosclerosis was associated with global parkinsonian score but this effect was attenuated and no longer significant after accounting for infarcts. Each of the 3 pathologies were separately associated with parkinsonian gait [macroscopic infarcts (Estimate= 0.552; SE=0.210; p=0.009); microinfarcts (Estimate= 0.424; SE=0.213; p=0.047); arteriolosclerosis (Estimate= 0.191; SE=0.056; p<0.001)]. Further analyses showed that subcortical macroscopic and microinfarcts were specifically associated with the severity of parkinsonian gait. Cerebrovascular pathologies, including macroscopic infarcts, microinfarcts and arteriolosclerosis, are common in older persons and may be unrecognized common etiologies of mild parkinsonian signs, especially parkinsonian gait, in old age.