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  • Review Article
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Parkinson disease and comorbid cerebrovascular disease

Nature Reviews Neurology volume 5, pages 533–541 (2009)Cite this article

Abstract

Optimal management of chronic diseases not only requires tackling of the primary disease processes, but also necessitates timely recognition and treatment of comorbid conditions. In this article, we illustrate this two-pronged approach for two common age-related disorders: Parkinson disease (PD) and cerebrovascular disease (CVD). We first discuss the pathophysiological mechanisms that could provide a link between PD and CVD. Patients with PD have a series of risk factors that could promote development of CVD, but also have several protective factors. We then review the available clinical, radiological and neuropathological evidence to support an association between these two conditions. We conclude by discussing the potential implications for clinical practice, highlighting how comorbid CVD could alter the clinical presentation of PD and reviewing the possibilities for prevention and secondary prophylaxis. Additional research will be needed to fully evaluate the prevalence and clinical relevance of comorbid CVD in PD. Pending further evidence, we recommend that cerebral neuroimaging should be considered if patients with initially uncomplicated PD develop—either acutely or chronically—prominent and/or treatment-resistant gait impairment, postural instability, depression, cognitive decline, or urinary incontinence. Finding comorbid CVD in such patients could have prognostic implications, and could necessitate treatment to arrest further progression of CVD.

Key Points

  • Patients with Parkinson disease (PD) could have an increased risk of developing comorbid cerebrovascular disease (CVD), although systematic research is lacking

  • The pathophysiology underlying the relationship between PD and CVD is complex and multifactorial, with both risk factors and protective mechanisms at play

  • Comorbid CVD usually presents not as overt acute stroke, but by producing or exacerbating symptoms such as postural instability, gait impairment, falls, depression, cognitive decline, or urinary incontinence

  • Neuroimaging should be considered when patients with PD develop any of these symptoms, particularly early in the disease process

  • If patients with PD develop a clinically manifest transient ischemic attack or ischemic stroke, they should be treated according to established protocols for these conditions

  • Additional well-designed and adequately powered studies are required to improve our understanding of the relationship between PD and CVD, as well as the possible therapeutic consequences

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Figure 1: Pathophysiological mechanisms that could underlie an association between Parkinson disease and cerebrovascular disease.

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Acknowledgements

This work was supported by a ZonMw VIDI research grant (number 016.076.352) to B. R. Bloem. W. Nanhoe-Mahabier was supported by the Fred Akkerman stipend. F.-E. de Leeuw received a personal fellowship from the Dutch Brain Foundation (H04-12) and a clinical fellowship from the Netherlands Organization for Scientific Research (project no. 40-00703-97-07197).

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Authors and Affiliations

  1. Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Wandana Nanhoe-Mahabier, Karlijn F. de Laat, Jasper E. Visser, Frank-Erik de Leeuw & Bastiaan R. Bloem

  2. Amphia Hospital, Breda, The Netherlands

    Jan Zijlmans

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  1. Wandana Nanhoe-Mahabier
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  2. Karlijn F. de Laat
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Correspondence to Bastiaan R. Bloem.

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Nanhoe-Mahabier, W., de Laat, K., Visser, J. et al. Parkinson disease and comorbid cerebrovascular disease. Nat Rev Neurol 5, 533–541 (2009). https://doi.org/10.1038/nrneurol.2009.136

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