Objective: To examine the contributions of systemic factors to clinically relevant cognitive decline in Parkinson’s disease (PD), we studied the impact of cardiometabolic and inflammatory factors on cognitive status and on risk of conversion from normal cognition (NC) to mild cognitive impairment (MCI).

Background: Cognitive impairment in PD may  be influenced by medical co-morbidities, including vascular impairment and metabolic and inflammatory factors[1,2,3]. The extent to which the contribution of these  co-morbidities is clinically relevant  is unclear.

Method: Medical history, vascular risk (QRISK2 –  age, gender,  cholesterol, blood pressure, diabetes, smoking, body mass index, and kidney disease )  [4]; metabolic factors, and brain vessel ultrasonographic examinations were collected in fifty-eight PD patients at baseline. Patients were classified as normal cognition (NC) or MCI [5]

Results: Forty patients had NC and 18 patients had MCI at baseline.  The baseline MCI group were older, less educated and displayed increased intima-medial thickness of the right carotid artery, higher complement C3 and interleukin 6 blood levels, and had folic acid below normal range more frequently. After correction for multiple comparisons, education, age, C3, and IL-6 remained statistically significant. Patients with NC at baseline were classified into two groups: patients who remained cognitively normal (non-converters, n=23) and patients who progressed to MCI (converters, n=11). Vascular and metabolic factors deteriorated along with clinical status over a two-year period. A combination of higher QRISK2, lower uric acid levels, and worse ADL functions had high accuracy (82.4%) in predicting conversion to MCI.

Conclusion: Co-morbidities contribute to clinically relevant cognitive deterioration in PD.    A model predicting the decline from NC to MCI over a two-year period could be constructed. Our results  make it is increasingly clear that potentially treatable medical factors or co-morbidities are clinically relevant for  cognitive decline in PD. We propose that a careful evaluation of the general health status (not only from a strict neurological perspective) of patients with PD should performed and effectively managed in routine clinical practice.Management of co-morbidities may be an important treatment strategy for preventing and reducing cognitive decline in PD.

References: [1]Rektor I, Goldemund D, Sheardová K, Rektorová I, Michálková Z, Dufek M. Vascular pathology in patients with idiopathic Parkinson’s disease. Parkinsonism Relat Disord 2009;15(1):24–29. [2]Rektor I, Goldemund D, Bednařík P, et al. Impairment of brain vessels may contribute to mortality in patients with Parkinson’s disease. Mov Disord 2012;27(9):1169–1172. [3]Veselý B, Dufek M, Thon V, et al. Interleukin 6 and complement serum level study in Parkinson’s disease. J Neural Transm 2018;125(5):875–881. [4]QRISK®2-2016 risk calculator, dowloaded on 31st January 2016 from https://qrisk.org/2016/ [5]Litvan I, Goldman JG, Tröster AI, et al. Diagnostic criteria for mild cognitive impairment in Parkinson’s disease: Movement Disorder Society Task Force guidelines. Mov Disord 2012;27(3):349–356.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-contribution-of-cerebrovascular-risk-factors-metabolic-and-inflammatory-changes-to-cognitive-decline-in-parkinsons-disease/