Parkinson's disease, ischemic stroke, dementia, and cranial computed tomography: Preliminary study

We sought to determine whether clinical features, stroke profiles, and cranial computed tomography (CCT) findings differed in nondemented and demented Parkinson's disease (PD) patients. Data were collected from our previously published case-control review of 119 idiopathic PD patients discharged from our Veterans Affairs Medical Center Neurology Service from 1982 through 1990. Historical, physical, age, age at onset of PD, duration of PD, motor severity, frequency of ischemic stroke and stroke risk factors, modified Hachinski Ischemic Score (MHIS), and CCT findings were recorded. We previously estimated that the number ofpatients with PD and dementia was 31 of 119 (26%) from our case-control review of idiopathic PD patients. Eighty-two male PD patients, 31 demented and 51 nondemented, had CCT data available for review. Demented PD patients were older (p < 0.01), had fewer normal CT scans (p = 0.0004), and more cerebral atrophy and leuko-araiosis (p = 0.0003) than nondemented PD patients. Clinical atherosclerosis did not significantly distinguish the groups, but 9 of 31 (29%) demented PD patients had a modified HIS ≥ 5 and thus suggestive of, at least, multi-infarct dementia. Demented PD patients were older overall at PD onset, but did not appear to have significantly longer PD duration or more motor severity. Demented PD patients were also apt to have had a much more current CCT (p < 0.01) than nondemented patients. Although clinical atherosclerosis did not clearly separate groups, more than one-quarter of demented PD patients seem to have components of vascular dementia.