2006 Articles

History of vascular disease and mild parkinsonian signs in community-dwelling elderly individuals

Louis, Elan D.; Luchsinger, Jose A.

Background: Mild parkinsonian signs (MPS) are commonly found during the clinical examination of older people. These signs could reflect the accumulation of vascular pathological changes in the brain. If the etiology were vascular, one could hypothesize that individuals with MPS would be more likely to have systemic vascular disease than would their counterparts without these signs. Objectives: To examine whether MPS are associated with a history of vascular disease and whether certain MPS (rigidity, changes in axial function) are more strongly associated with a history of vascular disease than are other MPS (tremor). Methods: Evaluation of older people without dementia in Washington Heights-Inwood, northern Manhattan, NY. The presence of vascular diseases was assessed with a structured health interview. Results: Mild parkinsonian signs were present in 375 (16.4%) of 2286 participants without dementia. Diabetes mellitus, heart disease, peripheral vascular disease, and stroke were more prevalent in participants with MPS than without MPS, whereas nonvascular diseases (cancer, thyroid disease) were not. In a logistic regression analysis that adjusted for age, sex, education, and depressive symptoms, the number of vascular diseases was associated with MPS (odds ratio, 1.31 [95% confidence interval, 1.18-1.46]; P<.001). The combination of diabetes mellitus and heart disease increased the odds of MPS by 70% and the combination of these with stroke increased the odds by 332%. Conclusions: The presence of MPS in elderly individuals might reflect, in part, the accumulation of vascular pathological changes in the basal ganglia or white matter regions caused by preventable vascular diseases. Prospective and pathological studies are needed to further explore this finding.