Objective: To evaluate the association between Parkinson’s disease (PD) severity (Hoehn & Yahr, H&Y; mild–moderate–severe) and metabolic syndrome (MetS) defined separately by NCEP-ATP III and IDF criteria. We further assessed the relationships between H&Y severity and individual MetS components, and explored whether MetS was associated with motor onset phenotype, MRI markers of cerebral small vessel disease (Fazekas grade and lacunes), and reproductive/hormonal history in women (n=74).

Background: MetS may influence PD severity beyond cardiovascular risk, but its relationships with motor phenotypes and CSVD markers are uncertain.

Method: Cross-sectional analysis of 229 PD patients. MetS was defined separately by NCEP-ATP III and IDF; components were coded present/absent. Severity was categorized as mild (H&Y 1-2), moderate (2.5-3), and severe (4-5). Motor onset phenotype was classified as tremor-dominant, rigidity-dominant, postural instability-gait difficulty (PIGD), or mixed. Fazekas grade and lacunes were extracted from MRI reports. Groups were compared using chi-square and appropriate parametric/nonparametric tests (p<0.05).

Results: Mean age was 66.26±10.50 years; 67.7% were men; BMI was 27.88±3.67. MetS prevalence was 51.1% (117/229) by NCEP-ATP III and 48.0% (110/229) by IDF. BMI was higher in MetS-positive patients (NCEP p=0.015; IDF p=0.001). MetS was strongly associated with higher H&Y stage (both p<0.001): MetS was present in 92.7% (38/41) with H&Y>=3 versus 42.0% (79/188) with H&Y<=2. With increasing H&Y severity, low HDL (p=0.016), elevated blood pressure (p=0.001), fasting glucose abnormality (p=0.006), and overweight/obesity (p=0.022) became more frequent. By the NCEP definition, MetS was more common in women (p=0.042). MetS was not associated with motor onset phenotype, Fazekas grade, or lacunes (all p>0.05). In women (n=74), reproductive/hormonal variables were not associated with MetS; data on oral contraceptives and hormone replacement therapy were insufficient.

Conclusion: MetS is common in PD and is robustly associated with greater disease severity, with clustering of blood pressure, glycemic, and HDL abnormalities as severity increases. The lack of association with motor phenotypes and MRI CSVD markers suggests mechanisms beyond overt small vessel disease. Longitudinal, multivariable analyses are needed.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/metabolic-syndrome-and-disease-severity-in-parkinsons-disease-association-with-clinical-phenotype-and-cerebral-small-vessel-disease/