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Spinal Arteriolosclerosis Is Common in Older Adults and Associated With Parkinsonism
Aron S Buchman1, Sue E Leurgans2, Sukriti Nag2
1From the Rush Alzheimer's Disease Center (A.S.B., S.E.L., S.N., A.K., J.A.S., D.A.B.), Department of Neurological Sciences (A.S.B., S.E.L., J.A.S., D.A.B.), and Department of Pathology (Neuropathology) (S.N., J.A.S.), Rush University Medical Center, Chicago, IL; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (V.G.J.M.V.); and Harvard Medical School, Boston, MA (V.G.J.M.V.). Aron_S_Buchman@rush.edu.
Background And Purpose:
There are few studies of spinal microvascular pathologies in older adults. We characterized spinal cord microvascular pathologies and examined their associations with other spinal and brain postmortem indices and parkinsonism in older adults.
Methods:
We documented 3 features of microvascular pathologies in spinal cord and brain specimens from 165 deceased older participants. We also measured spinal white matter pallor. Parkinsonian signs were assessed with a modified version of the motor section of the Unified Parkinson's Disease Rating Scale. We examined the associations of spinal arteriolosclerosis with other spinal and brain postmortem indices and parkinsonism proximate to death using regression models which controlled for age and sex.
Results:
Microinfarcts and cerebral amyloid angiopathy were not observed within the spinal cord parenchyma. Spinal arteriolosclerosis was observed at all spinal levels (C7, T7, L4, S4) examined and was more severe posteriorly than anteriorly (posterior: 4.3, SD=0.72 versus anterior: 3.9, SD=0.74; t=14.58; P<0.001). Arteriolosclerosis was more severe in the spinal cord than in the brain (cord: 4.10, SD=0.70; brain: 3.5, SD=0.98; t=10.39; P<0.001). The severity of spinal arteriolosclerosis was associated with spinal white matter pallor (r=0.47; P<0.001). Spinal arteriolosclerosis accounted for ≈3% of the variation in parkinsonism in models controlling for age, sex, brain arteriolosclerosis, and cerebrovascular disease pathologies. Further models showed that the association of spinal arteriolosclerosis and parkinsonism was not mediated via spinal white matter pallor.
Conclusions:
Although the regional distribution of microvascular pathologies varies within the central nervous system, spinal arteriolosclerosis is common and may contribute to the severity of spinal white matter pallor and parkinsonism in older adults.
Insights
Spinal arteriolosclerosis is common in older adults and more severe in the spinal cord than the brain. This condition is linked to spinal white matter pallor and contributes to parkinsonism severity.
Area of Science:
- Neurology
- Pathology
- Gerontology
Background:
- Limited research exists on spinal microvascular pathologies in the elderly.
- Spinal cord microvascular diseases are understudied compared to brain counterparts.
Purpose of the Study:
- To characterize spinal cord microvascular pathologies in older adults.
- To investigate associations between spinal microvascular pathologies, brain pathologies, and parkinsonism.
Main Methods:
- Examined spinal cord and brain specimens from 165 deceased older individuals.
- Assessed spinal white matter pallor and parkinsonian signs.
- Used regression models to analyze associations, controlling for age and sex.
Main Results:
- Spinal arteriolosclerosis was prevalent across all spinal levels and more severe posteriorly.
- Spinal arteriolosclerosis was more severe than in the brain and associated with white matter pallor.
- Spinal arteriolosclerosis explained approximately 3% of parkinsonism variation, independent of white matter pallor.
Conclusions:
- Spinal arteriolosclerosis is a common finding in older adults.
- This pathology may contribute to spinal white matter pallor and parkinsonism severity.
- Regional variations in microvascular pathologies exist within the central nervous system.