Correlation Between Carotid Atherosclerosis And Cognitive Impairment In Parkinson’s Disease

PurposeParkinson’s disease(PD)is the second most common age-related neurodegenerative disease worldwide.Cognitive impairment is highly prevalent,disabling and fatal,which is one of the most important non-motor symptoms in PD.The development of cognitive impairment in PD patients may be related to vascular-related factors.Carotid atherosclerosis has been associated with cognitive dysfunction in community populations,vascular dementia and Alzheimer’s disease,while less research has been done in PD cognitive impairment.This study aimed to analyze the disease characteristics of patients with PD cognitive impairment,to observe the changes in several indicators of carotid atherosclerosis in patients with PD cognitive impairment,and to explore the correlation between carotid atherosclerosis and PD cognitive impairment.MethodsIn this study,324 patients with primary PD in Northern Jiangsu People’s Hospital from October 2020 to November 2022 were collected.Based on the inclusion and exclusion criteria,225 patients with PD were finally included.The Montreal Cognitive Assessment Scale(MOCA)was used to assess the cognitive function of PD patients.Patients with MOCA score ≥26 were divided into the Parkinson’s disease with normal cognition(PD-NC)group,patients with 20 < MOCA score < 26 were divided into the Parkinson’s disease mild cognitive impairment(PD-MCI)group,and patients with MOCA score ≤20 were divided into the Parkinson’s disease dementia(PDD)group.PD patients were divided into 41 cases in the PD-NC group,76 cases in the PD-MCI group,and 108 cases in the PDD group according to the MOCA score.Carotid ultrasonography was performed on PD patients included in this clinical study to record carotid intima-media thickness(CIMT),carotid plaque,carotid plaque vulnerability score,internal carotid artery peak systolic velocity(ICA-PSV)and end-diastolic velocity(ICA-EDV).Baseline information was collected from patients,including age,sex,height,weight,duration of disease,years of education,history of smoking,history of alcohol consumption,history of pesticide exposure,family history,type and dose of anti-PD drugs,systolic blood pressure(SBP)and diastolic blood pressure(DBP),body mass index(BMI)and levodopa equivalent dose(LEDD)were calculated.Patients’ Unified Parkinson’s Disease Rating Scale(UPDRS),Hoehn and Yahr(H&Y)staging,Hamilton Anxiety scale(HAMA),Hamilton Depression scale(HAMD),Pittsburgh Sleep Quality Index(PSQI),Epworth Sleepiness Scale(ESS),Non-Motor Symptom Questionnaire(NMSQ),Scales for Outcomes in Parkinson’s disease for Autonomic Symptoms(SCOPA-AUT)were collected.Data on the patient’s blood indicators were collected.Differences in baseline information,motor and non-motor symptom scores,blood indicators and carotid ultrasound indicators were compared between the PD-NC,PD-MCI and PDD groups.Spearman correlation analysis was used to explore the correlation between baseline information,motor and non-motor symptoms,blood indicators,carotid ultrasound indicators and MOCA score in PD patients,and to explore the correlation between CIMT,carotid plaque vulnerability score and various domains of cognitive function in PD.The independent influences of cognitive impairment in PD were analyzed using multiple linear regression.Results1.The differences in years of education between the PD-NC,PD-MCI and PDD groups were statistically significant(P<0.05).The comparison between groups suggested that the years of education in the PD-MCI and PDD groups were significantly lower than those in the PD-NC group(P=0.042,P<0.001),and the years of education in the PDD group were significantly lower than those in the PD-MCI group(P<0.001).There were no significant differences between the three groups in age,sex,disease duration,BMI,LED,SBP,DBP,history of smoking,history of alcohol consumption,family history and history of pesticide exposure(P>0.05).2.Statistically significant differences were found between the PD-NC,PD-MCI and PDD groups in H&Y staging,UPDRS total score,UPDRS-Ⅲ score,HAMD score,PSQI score and Cystatin C level(P<0.05).Comparison between groups suggested that the H&Y staging(P=0.003,P=0.016),UPDRS total score(P<0.001,P<0.001),UPDRS-Ⅲ score(P<0.001,P=0.002),HAMD score(P=0.001,P=0.004),PSQI score(P=0.001,P=0.019)and Cystatin C level(P=0.033,P=0.034)in the PDD group were significantly higher than those in the PD-NC and PD-MCI groups.There was no significant difference between the PD-NC and PD-MCI groups in H&Y staging,UPDRS total score,UPDRS-Ⅲ score,HAMD score,PSQI score and Cystatin C level(P > 0.05).3.The differences in CIMT,carotid plaque detection rate and carotid plaque vulnerability score between the PD-NC,PD-MCI and PDD groups were statistically significant(P<0.05).There was no significant difference in ICA-PSV and ICA-EDV between the PD-NC,PD-MCI and PDD groups(P>0.05).Comparison between groups suggested that the CIMT(P<0.001,P<0.001)and carotid plaque vulnerability score(P=0.020,P=0.006)were significantly greater in the PD-MCI and PDD groups than in the PD-NC group,and the CIMT was significantly greater in the PDD group than in the PD-MCI group(P=0.016).The detection rate of carotid plaque was significantly higher in the PDD group(75.0%)than in the PD-NC group(51.2%),P=0.005.4.Spearman correlation analysis showed that the total MOCA score was positively correlated with years of education,and negatively correlated with H&Y staging,UPDRS total score,UPDRS-Ⅲ score,HAMD score,PSQI score,Cystatin C,CIMT,carotid plaque and carotid plaque vulnerability score.CIMT in PD patients was negatively correlated with visuospatial and executive function,naming ability,attention,verbal ability,abstraction ability,delayed recall ability and orientation,with visuospatial and executive function(r=-0.383,P<0.001),attention(r=-0.267,P<0.001)and delayed recall ability(r=-0.462,P<0.001)were more strongly correlated.Carotid plaque vulnerability score was negatively correlated with visuospatial and executive function(r=-0.161,P=0.024)and delayed recall ability(r=-0.209,P=0.003).5.Multiple linear regression results indicated that higher years of education(B=0.738,t=7.535,P<0.001)was an independent protective factor for cognitive impairment in PD patients,thickened CIMT(B=-0.770,t=-3.167,P=0.002)and higher H&Y staging(B=-2.387,t=-3.559,P=0.001)were independent risk factors for cognitive impairment in PD patients.Conclusions1.PD patients with cognitive impairment are characterized by lower years of education,higher motor and non-motor symptoms and thickened CIMT.2.Several indicators of carotid atherosclerosis correlates with cognitive function and various cognitive subdomains in PD patients,and visuospatial function,executive function and delayed recall ability were most strongly correlated.3.Higher years of education is an independent protective factor for cognitive impairment in PD patients,while thickened CIMT is an independent risk factor for cognitive impairment in PD patients.