Research Paper Volume 12, Issue 15 pp 15682—15704

Vascular, inflammatory and metabolic risk factors in relation to dementia in Parkinson’s disease patients with type 2 diabetes mellitus

Ting Wang1, *, , Feilan Yuan1, *, , Zhenze Chen1, *, , Shuzhen Zhu1, *, , Zihan Chang1, , Wanlin Yang1, , Bin Deng1, , Rongfang Que1, , Peihua Cao2, , Yinxia Chao3, , Lingling Chan3, , Ying Pan4, , Yanping Wang4, , Linting Xu5, , Qiurong Lyu6, , Piu Chan7, , Midori A. Yenari8, , Eng-King Tan3, , Qing Wang1, ,

  • 1 Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, P.R. China
  • 2 Clinical Research Center, ZhuJiang Hospital of Southern Medical University, Guangzhou, Guangdong, P.R. China
  • 3 Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Duke-NUS Medical School, Singapore
  • 4 Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
  • 5 Department of Neurology, Puning People’s Hospital, Puning, Guangdong, China
  • 6 Department of Neurology, Guiping People’s Hospital, Guangxi, China
  • 7 Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
  • 8 Department of Neurology, University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
* Equal contribution

Received: February 13, 2020       Accepted: July 14, 2020       Published: August 15, 2020
How to Cite

Copyright © 2020 Wang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


There are limited data on vascular, inflammatory, metabolic risk factors of dementia in Parkinson’s disease (PD) with type 2 diabetes mellitus (DM) (PD-DM). In a study of 928 subjects comprising of 215 PD with DM (including 31 PD-DM with dementia, PD-DMD), 341 PD without DM (including 31 PD with dementia, PDD) and 372 DM without PD (including 35 DM with dementia, DMD) patients, we investigated if vascular, inflammatory, metabolic, and magnetic resonance imaging (MRI) markers were associated with dementia in PD-DM. Lower fasting blood glucose (FBG<5mmol/L, OR=4.380; 95%CI: 1.748-10.975; p=0.002), higher homocysteine (HCY>15μmol/L, OR=3.131; 95%CI: 1.243-7.888; p=0.015) and hyperlipidemia (OR=3.075; 95%CI: 1.142-8.277; p=0.026), increased age (OR=1.043; 95%CI: 1.003-1.084; p=0.034) were the most significant risk factors in PDD patients. Lower low-density lipoprotein cholesterol (LDL-C<2mmol/L, OR=4.499; 95%CI: 1.568-12.909; p=0.005) and higher fibrinogen (>4g/L, OR=4.066; 95%CI: 1.467-11.274; p=0.007) were the most significant risk factors in PD-DMD patients. The area under the curve (AUC) for fibrinogen and LDL-C was 0.717 (P=0.001), with a sensitivity of 80.0% for the prediction of PD-DMD.

In summary, we identified several factors including LDL-C and fibrinogen as significant risk factors for PD-DMD and these may have prognostic and treatment implications.


AST: Aspartate transaminase; ALT: Alanine transaminase; AUC: area under the curve; BMI: body mass index; BBB: blood brain barrier; Cystatin C: Cys C; CNS: Central Nervous System; CI: confidence interval; DM: type 2 diabetes mellitus without Parkinson disease; DMD: type 2 diabetes mellitus with dementia; DBP: diastolic blood pressure; EDTA: Ethylene Diamine Tetraacetic Acid; FBG: Fasting blood glucose; hs- CRP: hypersensitive C-reactive protein; HCY: homocysteine; HbA1c: glycated hemoglobin; H&Y: the modified Hoehn and Yahr staging scale; IQR: interquartile range; L-Dopa: Levodopa and Benserazide; LDL-C: low density lipoprotein cholesterol; MDS-UPDRS: Movement Disorder Society–Unified Parkinson’s Disease Rating Scale; MCV: mean corpuscular volume; MoCA: Montreal Cognitive Assessment; MMSE: mini mental state examination; MRI: magnetic resonance imaging; NMSS: Non-Motor Symptoms Scale for Parkinson’s Disease; NVU: neurovascular units; OR: odds ratio; PD: patients with Parkinson disease without type 2 diabetes mellitus; PD-DM: patients with Parkinson disease and type 2 diabetes mellitus; PD-DMD: patients with Parkinson disease and type 2 diabetes mellitus and dementia; PSP: progressive superanuclear palsy; ROC: receiver operating characteristic analysis; SBP: systolic blood pressure; SAE: subcortical arteriosclerotic encephalopathy; SPSS: Statistical Package for the Social Sciences; WBC: White blood cell count; WMLs: White matter lesions.