Department of Neurological-Psychiatric Nursing, St. Adalbert Hospital, Gdańsk, Poland.
Neurodegener Dis. 2013;12(1):1-12. doi: 10.1159/000338610. Epub 2012 Jul 20.
The role of white matter hyperintensities (WMH) and homocysteine (Hcy) and other vascular risk factors in the pathogenesis of Parkinson's disease (PD) dementia (PDD) remains unclear.
The aim of the study was to assess the impact of WMH, Hcy and other biochemical and vascular risk factors on PDD.
A total of 192 patients with PD and 184 age- and sex-matched healthy controls were included. A semistructured interview was used to assess demographic and clinical variables with respect to vascular risk factors (arterial hypertension, diabetes mellitus, atrial fibrillation, ischemic heart disease, obliterative atherosclerosis, hypercholesterolemia, smoking, alcohol intake). Unified Parkinson's Disease Rating Scale score, Hoehn-Yahr staging and the Schwab-England activities of daily living scale were used to assess motor abilities and activities of daily living. A complex neuropsychological examination with a battery of tests was used to classify patients into a group with dementia (PDD) and a group without dementia (PD). Neuroradiological examination of MRI scans included visual rating scales for WMH (according to the Wahlund and Erkinjunntti rating scales) and the Scheltens scale for hippocampal atrophy. Blood samples for Hcy, folate, vitamin B12, fibrinogen, lipids, glucose, creatinine, transaminases and thyroid stimulating hormone (TSH) were examined.
Among all patients, 57 (29.7%) fulfilled the diagnostic criteria for dementia. Significantly higher Hcy plasma levels were noted in PD and PDD groups compared to controls (p < 0.05) and in PDD when compared to PD (p < 0.05). According to multivariate regression analysis, WMH (Erkinjuntti scale), high Hcy, low vitamin B12 and folate plasma levels were independent risk factors for PDD. Vascular risk factors did not play any role in the pathogenesis of PDD and WMH.
WMH along with Hcy, folate and vitamin B12 may impact cognition in PD. Therapy with vitamin B12, folate and catechol-O-methyltransferase inhibitors may play a potential protective role against PDD.
脑白质高信号（WMH）和同型半胱氨酸（Hcy）及其他血管危险因素在帕金森病（PD）痴呆（PDD）发病机制中的作用仍不清楚。
本研究旨在评估 WMH、Hcy 和其他生化及血管危险因素对 PDD 的影响。
共纳入 192 例 PD 患者和 184 例年龄和性别匹配的健康对照者。采用半结构化访谈评估血管危险因素（高血压、糖尿病、心房颤动、缺血性心脏病、闭塞性动脉粥样硬化、高胆固醇血症、吸烟、饮酒）的人口统计学和临床变量。采用统一帕金森病评定量表评分、Hoehn-Yahr 分期和 Schwab-England 日常生活活动量表评估运动能力和日常生活活动。采用成套神经心理学测试对患者进行认知评估，分为痴呆（PDD）和非痴呆（PD）两组。磁共振成像（MRI）检查的神经影像学评估包括 WMH 的视觉评分量表（根据 Wahlund 和 Erkinjuntti 评分量表）和海马萎缩的 Scheltens 量表。检测 Hcy、叶酸、维生素 B12、纤维蛋白原、血脂、血糖、肌酐、转氨酶和促甲状腺激素（TSH）的血样。
在所有患者中，57 例（29.7%）符合痴呆诊断标准。PD 和 PDD 组的 Hcy 血浆水平明显高于对照组（p<0.05），且 PDD 组高于 PD 组（p<0.05）。多变量回归分析显示，WMH（Erkinjuntti 量表）、高 Hcy、低维生素 B12 和叶酸血浆水平是 PDD 的独立危险因素。血管危险因素在 PDD 和 WMH 的发病机制中不起作用。
WMH 以及 Hcy、叶酸和维生素 B12 可能对 PD 患者的认知产生影响。维生素 B12、叶酸和儿茶酚-O-甲基转移酶抑制剂的治疗可能对 PDD 具有潜在的保护作用。
