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Dr. Okun

Post of the Week: Risk of Stroke and Parkinson's

7 posts in this topic

Despite potential issues with the methods in this study from Switzerland it is interesting that when examining a large database two issues emerged: 1- Risk of PD diagnosis was increased if a previous stroke, 2- the risk of first time ischemic stroke was increased in PD. These findings will need to be confirmed, but raise the possibility of some association of PD and stroke.

 

Parkinsonism Relat Disord. 2009 Jul 27. [Epub ahead of print]Links

Risk of stroke in patients with idiopathic Parkinson disease.

 

Becker C, Jick SS, Meier CR.

Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Switzerland.

PURPOSE: Large population based studies on the association of Parkinson disease (PD) with stroke are scarce. This study aimed to quantify the risk of a first-time diagnosis of idiopathic PD in patients with a history of stroke, and to assess incidence rates for stroke in PD patients. METHODS: We used the UK-based General Practice Research Database to compare the prevalence of stroke/TIA in newly diagnosed PD patients and in a matched comparison group without PD between 1994 and 2005. We conducted a follow-up study with a nested case-control analysis to quantify the risk of incident stroke/TIA in relation to a previous PD diagnosis. RESULTS: A history of stroke/TIA was associated with a significantly increased relative risk of being diagnosed with PD compared to patients without such a history (adj. odds ratio [OR] 1.65, 95% confidence intervals [CI] 1.47-2.00). In the cohort study, the crude incidence rate ratios (IRRs) for incident hemorrhagic stroke, ischemic stroke or TIA were 0.66 (95% CI 0.26-1.72), 1.46 (95% CI 1.03-2.07) and 1.86 (95% CI 1.40-2.47), respectively. CONCLUSIONS: In this large observational study the risk of a PD diagnosis was significantly increased after a previous stroke event, as was the risk of a first-time ischemic stroke in newly diagnosed PD patients compared to persons free of PD.

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Regarding the increased risk of stoke among PWP, it may be as simple as the fact that blood pressure rises as one struggles to function during an "off" period. I have observed alarming but short-lived increases in my own in conjunction with making my way to the bathroom when off. Yet, in a resting state when off or during a normal on period, I am mildly hypertensive.

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Great comment.

 

Note the stroke data in PD is weak and we need more data.

 

When off indeed BP can skyrocket in some patients.

 

When on and sometimes when off a lot of PD patients have low BP which may decrease stroke risk.

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My blood pressure swings wildly but most interesting was the fact that Aleve cause it to go well about 200 even when I was not "off meds" or stressed. I stopped taking it and by the next day BP had dropped 30 points and continued to drop to normal.

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This happened during proton treatment for prostate cancer. When my blood pressure went up significantly from one week to the next the doctor felt it was just the PD (everything is blamed on PD it seems) but I had never had significantly elevated blood pressure so I really didn't think this was the case. Both a nurse and another patient heard our discussion and asked me if I was on Aleve as it is used quite a bit as we reach the end of treatment and the bladder becomes irritated. I said "yes I am". They both told me that it could elevate blood pressure significantly so as I mentioned, I stopped taking it and indeed the pressure went down immediately.

 

Patients who are at the proton center being treated for prostate cancer are routinely given Aleve so a group who is under constant doctor supervision and whose blood pressure is checked at least weekly is available The blood pressure and meds are on file digitally so I bet some number cruncher could find out quite easily just how often this occurs, It may be that with PWP the effect is exacerbated by a propensity for blood pressure swings???

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Thanks for the post. When under treatment for cancer many abnormal responses may happen with medications and we cannot generalize to the PD patient not undergoing cancer. Having said that, if anyone has high blood pressure for any reason please consult your doctor.

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