Subclinical vascular disease and the risk of parkinsonism: The Rotterdam Study

Parkinsonism is a common neurodegenerative syndrome in middle-aged and elderly persons. The etiology is multifactorial with a possible vascular contribution, but this has not been comprehensively studied.

To determine whether selected markers of subclinical vascular pathology are associated with the risk of all-cause parkinsonism in the general population.

We assessed a range of markers of subclinical vascular pathology (ankle-brachial index, carotid plaques and intima media thickness, retinal arteriolar and venular calibers) in 6199 persons from the population-based Rotterdam Study, who were free of parkinsonism and dementia at baseline. We followed these persons up till onset of parkinsonism, dementia, and death for 89,387 person-years until January 1, 2013. Hazard ratios (HRs) for all-cause parkinsonism and separately for Parkinson disease (PD) versus non-PD were estimated from competing risk regression models adjusting for potential confounders.

During follow-up, we identified 211 cases of parkinsonism (110 had PD). None of the five markers of subclinical pathology was associated with all-cause parkinsonism. Only low ankle-brachial index was associated with a higher risk of non-PD parkinsonism (HR = 0.79, 95%CI: 0.68-0.92), but not with the risk of PD.

We did not find a consistent pattern of associations between systemic vascular pathology markers with parkinsonism, suggesting that the potential involvement of vascular pathology is not prominent or needs further evaluation in studies with an even larger sample size.