Differences Between Patients With Vascular Parkinsonism and Parkinson's Disease

Summary

Vascular parkinsonism (VP) is defined as the presence of parkinsonian syndrome, evidence of cerebrovascular disease by brain imaging and an established relationship between the two disorders.

However, the diagnosis of VP is problematic. This study aims to distinguish VP from Parkinson's disease (PD) in multiple aspects including clinical features as motor ,non motor symptoms

,response to treatment ,cognitive assessments by using multiple scales, neuro-radiological features of magnetic resonance imaging (MRI) and transcranial color-coded duplex (TCCD) findings. This differentiation will have therapeutic and prognostic implications .

Conditions

• Vascular Parkinsonism
• Parkinson's Disease

Interventions

DIAGNOSTIC_TEST

Neuro-radiological tools:

MRI brain: to measure white matter c) Ultrasonographic examination of extracranial vessels: The intimal medial thickness of the common carotid artery (CCA-IMT) will be measured in B-mode. The carotid arteries will be evaluated for the presence of atherosclerotic lesions (plaques) either soft or hard .The residual lumen and degree of stenosis will be measured. The peak systolic velocity will be detected.

DIAGNOSTIC_TEST

cognitive tests

All patients will be evaluated for global cognitive assessment by: Montreal Cognitive Assessment (MoCA) (Arabic version) Visuospatial skills will be assessed by Clock Drawing Tests from MoCA test and copy the intersecting pentagons from Addenbrooke's test (Arabic version) Language will be examined by semantic fluency from Addenbrooke's test (Arabic version) and similarities from Wechsler Adult Intelligence Scale (WAIS) Attention will be evaluated by digit span from Wechsler test),and by the number of seconds needed to sequence numbers using a pencil (Trail making test A) from MoCA test . For the evaluation of memory, participants will complete Wechsler memory subset , and the investigators also will use their three-item recall from the Mini-Mental State Examination( MMSE). Executive functions will be measured by Wisconsin card sorting test and also verbal fluency test from Addenbrooke's test. Frontal Assessment Battery (FAB) scale

DIAGNOSTIC_TEST

lab investigations

Each patient will undergo full lab investigations:\[lipid profile ,complete blood count, uric acid ,Hemoglobin A1c (HbA1c), liver functions, renal functions, and electrolytes\]

DIAGNOSTIC_TEST

Beck depression inventory (BDI)(Arabic version)

Clinical Tool for depression

DIAGNOSTIC_TEST

Clinical Tools for Urinary symptoms:

the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) Scale (Arabic version)

DIAGNOSTIC_TEST

Freezing of gait questionnaire

Clinical Tools for Gait (in on and off state ), Gait will be assessed by: * .Freezing of gait questionnaire * Berg balance scale. * 10 meter walk test . * Timed up and go test.

DIAGNOSTIC_TEST

non-motor symptoms scales (NMSS).

Clinical Tool for assessment of non-motor symptoms of PD

DIAGNOSTIC_TEST

Movement Disorders Society- Unified Parkinson's Disease Rating Scale (MDS-UPDRS):

Clinical Tools for assessment of the neurological severity and stage of disease Clinical Tool for assessment of the neurological severity and stage of disease during "OFF" and "ON" states, Hoehn and Yahr scale. The presence of lower limb parkinsonism will be determined by a two-point difference between upper limb and lower limb scores of bradykinesia, rigidity or postural instability from part III of the MDS-UPDRS. Patients will be examined in the early morning, in 'OFF' state, with MDS-UPDRS, Hoehn and Yahr and freezing of gait questionnaire(FOG-Q) scales. Immediately afterwards, they will take their regular first dose of levodopa. After 1 hour, patients will be examined again with the same tests and scales. Response to levodopa will be determined as patients who reached a percentage reduction exceeding 25% in part III of the MDS-UPDRS

DIAGNOSTIC_TEST

ELIZA for alpha-synuclein

measuring serum of alpha-synuclein, tau and their autoantibodoies

OTHER

transcranial color-coded duplex(TCCD)

TCCD using phase array 2.4 Hz probe for evaluation of cerebral vasomotor reactivity (CVR) by measuring the Breath holding index(BHI),flow velocities and pulsatility index of middle cerebral artery and posterior cerebral artery on both sides.

OTHER

extracranial carotid duplex

to assess atherosclerosis, stenosis of carotids

OTHER

The Arabic version of Parkinson's Disease Questionnaire( PDQ-39)

Clinical tool for quality of life of PD patients

Sponsors & Collaborators

• Ain Shams University

  lead OTHER

Eligibility

Min Age

40 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2019-09-01

Primary Completion

2021-12-01

Completion

2022-04-01

Countries

• Egypt

Study Locations