The Cardiovascular and Cerebrovascular Effects on Cognition in Persons with Parkinson’s Disease: A Systematic Review of the Literature


Purpose: The purpose of this systematic review of the literature is to examine the cerebrovascular and cardiovascular effects on cognition in persons with Parkinson’s disease. Relevance: Physical therapy treatment of persons with Parkinson’s disease (PD) has traditionally focused on lessening the impact of disease severity by improving quality of life and functional capacity. Research has shown that quality of life in persons with PD is not only significantly affected by motor symptoms, but also by the presence of defined non-motor symptoms such as cerebrovascular perfusion, cardiovascular dysfunction, and cognitive impairment. This study seeks to determine a causative effect among these non-motor symptoms with the intention to better manage cognitive impairment in persons with PD. Methods: A literature search was conducted utilizing the following databases: Scopus, PubMed, and CINAHL. After evaluating and grading studies using the Downs and Black Checklist, a total of seven studies remained for the final review. Results: Five common domains of cognition emerged throughout the seven studies: executive function, attention, verbal memory and fluency, visual memory, and working memory. Considering the articles reviewed, a relationship between cerebrovascular and cardiovascular deficiency and cognitive impairment in persons with PD was established. Conclusions: Persons with PD and certain cerebrovascular and cardiovascular risk factors, including orthostatic hypotension and systemic hypertension, should be referred to appropriate professionals for comprehensive neuropsychological testing secondary to an increased risk for more severe cognitive deficit.

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Carey, A. , Julian, R. , Kristeller, K. , Leonard, P. , Palmer, S. and Krisa, L. (2015) The Cardiovascular and Cerebrovascular Effects on Cognition in Persons with Parkinson’s Disease: A Systematic Review of the Literature. Advances in Parkinson's Disease, 4, 28-42. doi: 10.4236/apd.2015.42005.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Parkinson’s Disease Foundation (2014) Statistics on Parkinson’s.
[2] Umphred, D.A., Lazaro, R.T., Roller, M.L. and Burton, G.U. (2013) Umphred’s Neurological Rehabilitation. 6th Edition, Elsevier Mosby, St. Louis.
[3] Schrag, A., Jahanshahi, M. and Quinn, N. (2000) What Contributes to Quality of Life in Patients with Parkinson’s Disease? Journal of Neurology, Neurosurgery, and Psychiatry, 69, 308-312.
[4] Antonini, A., Barone, P., Marconi, R., Morgante, L., Zappulla, S., Pontieri, F.E., et al. (2012) The Progression of Non- Motor Symptoms in Parkinson’s Disease and Their Contribution to Motor Disability and Quality of Life. Journal of Neurology, 259, 2621-2631.
[5] Hely, M.A., Morris, J.G., Reid, W.G. and Trafficante, R. (2005) Sydney Multicenter Study of Parkinson’s Disease: Non-L-Dopa-Responsive Problems Dominate at 15 Years. Movement Disorders, 20, 190-199.
[6] Global Parkinson’s Disease Survey Steering Committee (2002) Factors Impacting on Quality of Life in Parkinson’s Disease: Results from an International Survey. Movement Disorders, 17, 60-67.
[7] Chaudhuri, K.R., Yates, L. and Martinez-Martin, P. (2005) The Non-Motor Symptom Complex of Parkinson’s Disease: a Comprehensive Assessment Is Essential. Current Neurology and Neuroscience Reports, 5, 275-283.
[8] Dubois, B. and Pillon, B. (1996) Cognitive Deficits in Parkinson’s Disease. Journal of Neurology, 244, 2-8.
[9] Barone, P., Antonini, A., Colosimo, C., Marconi, R., Morgante, L., Avarello, T.P., et al. (2009) The PRIAMO Study: A Multicenter Assessment of Nonmotor Symptoms and Their Impact on Quality of Life in Parkinson’s Disease. Movement Disorders, 24, 1641-1649.
[10] Nanhoe-Mahabier, W., de Laat, K.F., Visser, J.E., Zijlmans, J., de Leeuw, F.E. and Bloem, B.R. (2009) Parkinson’s Disease and Comorbid Cerebrovascular Disease. Nature Reviews Neurology, 5, 533-541.
[11] Jellinger, K.A. (2003) Prevalence of Cerebrovascular Lesions in Parkinson’s Disease: A Postmortem Study. Acta Neuropathologica, 105, 415-419.
[12] Mastaglia, F.L., Johnsen, R.D. and Kakulas, B.A. (2002) Prevalence of Stroke in Parkinson’s Disease: A Postmortem Study. Movement Disorders, 17, 772-774.
[13] Papapetropoulos, S., Ellul, J., Argyriou, A., Talelli, P., Chroni, E. and Papapetropoulos, T. (2004) The Effect of Vascular Disease on Late Onset Parkinson’s Disease. European Journal of Neurology, 11, 231-235.
[14] Le Heron, C.J., Wright, S.L., Melzer, T.R., Myall, D.J., MacAskill, M.R., Livingston, L., et al. (2014) Comparing Cerebral Perfusion in Alzheimer’s Disease and Parkinson’s Disease Dementia: An ASL-MRI Study. Journal of Cerebral Blood Flow & Metabolism, 34, 964-970.
[15] Melzer, T.R., Watts, R., MacAskill, M.R., Pearson, J.F., Rueger, S., Pitcher, T.L., et al. (2011) Arterial Spin Labelling Reveals an Abnormal Cerebral Perfusion Pattern in Parkinson’s Disease. Brain, 134, 845-855.
[16] Borghammer, P., Chakravarty, M., Jonsdottir, K.Y., Sato, N., Matsuda, H., Ito, K., et al. (2010) Cortical Hypometabolism and Hypoperfusion in Parkinson’s Disease Is Extensive: Probably Even at Early Disease Stages. Brain Structure and Function, 214, 303-317.
[17] Bayulkem, K. and Lopez, G. (2010) Nonmotor Fluctuations in Parkinson’s Disease: Clinical Spectrum and Classification. Journal of the Neurological Sciences, 289, 89-92.
[18] Raggi, A., Leonardi, M., Carella, F., Soliveri, P., Albanese, A. and Romito, L.M. (2011) Impact of Nonmotor Symptoms on Disability in Patients with Parkinson’s Disease. International Journal of Rehabilitation Research, 34, 316-320.
[19] Knopman, D., Boland, L.L., Mosley, T., Howard, G., Liao, D., Szklo, M., et al. (2001) Cardiovascular Risk Factors and Cognitive Decline in Middle-Aged Adults. Neurology, 56, 42-48.
[20] Rose, K.M., Couper, D., Eigenbrodt, M.L., Mosley, T.H., Sharrett, A.R. and Gottesman, R.F. (2010) Orthostatic Hypotension and Cognitive Function: The Atherosclerosis Risk in Communities Study. Neuroepidemiology, 34, 1-7.
[21] Downs, S.H. and Black, N. (1998) The Feasibility of Creating a Checklist for the Assessment of the Methodological Quality both of Randomised and Non-Randomised Studies of Health Care Interventions. Journal of Epidemiology & Community Health, 52, 377-384.
[22] Allcock, L.M., Kenny, R.A., Mosimann, U.P., Tordoff, S., Wesnes, K.A., Hildreth, A.J., et al. (2006) Orthostatic Hypotension in Parkinson’s Disease: Association with Cognitive Decline? International Journal of Geriatric Psychiatry, 21, 778-783.
[23] Idiaquez, J., Benarroch, E.E., Rosales, H., Milla, P. and Ríos, L. (2007) Autonomic and Cognitive Dysfunction in Parkinson’s Disease. Clinical Autonomic Research, 17, 93-98.
[24] Jones, J.D., Jacobson, C., Murphy, M., Price, C., Okun, M.S. and Bowers, D. (2014) Influence of Hypertension on Neurocognitive Domains in Nondemented Parkinson’s Disease Patients. Parkinson’s Disease, 2014, Article ID:507529.
[25] Kim, J.S., Oh, Y.S., Lee, K.S., Kim, Y.I., Yang, D.W. and Goldstein, D.S. (2012) Association of Cognitive Dysfunction with Neurocirculatory Abnormalities in Early Parkinson Disease. Neurology, 79, 1323-1331.
[26] Nobili, F., Arnaldi, D., Campus, C., Ferrara, M., De Carli, F., Brugnolo, A., et al. (2011) Brain Perfusion Correlates of Cognitive and Nigrostriatal Functions in De Novo Parkinson’s Disease. European Journal of Nuclear Medicine and Molecular Imaging, 38, 2209-2218.
[27] Peralta, C., Stampfer-Kountchev, M., Karner, E., Köllensperger, M., Geser, F., Wolf, E., et al. (2007) Orthostatic Hypotension and Attention in Parkinson’s Disease with and without Dementia. Journal of Neural Transmission, 114, 585- 588.
[28] Pilleri, M., Facchini, S., Gasparoli, E., Biundo, R., Bernardi, L., Marchetti, M., et al. (2013) Cognitive and MRI Correlates of Orthostatic Hypotension in Parkinson’s Disease. Journal of Neurology, 260, 253-259.
[29] Nobili, F., Arnaldi, D., Campus, C., Ferrara, M., De Carli, F., Brugnolo, A., et al. (2011) Brain Perfusion Correlates of Cognitive and Nigrostriatal Functions in De Novo Parkinson’s Disease. European Journal of Nuclear Medicine and Molecular Imaging, 38, 2209-2218.
[30] Firbank, M.J., Colloby, S.J., Burn, D.J., McKeith, I.G. and O’Brien, J.T. (2003) Regional Cerebral Blood Flow in Parkinson’s Disease with and without Dementia. Neuroimage, 20, 1309-1319.
[31] Van Laere, K., Santens, P., Bosman, T., De Reuck, J., Mortelmans, L. and Dierckx, R. (2004) Statistical Parametric Mapping of (99m)Tc-ECD SPECT in Idiopathic Parkinson’s Disease and Multiple System Atrophy with Predominant Parkinsonian Features: Correlation with Clinical Parameters. Journal of Nuclear Medicine, 45, 933-942.
[32] O’Donnell, J.P., Macgregor, L.A., Dabrowski, J.J., Oestreicher, J.M. and Romero, J.J. (1994) Construct Validity of Neuropsychological Tests of Conceptual and Attentional Abilities. Journal of Clinical Psychology, 50, 596-600.<596::AID-JCLP2270500416>3.0.CO;2-S
[33] Golden, C.J. (1976) Identification of Brain Disorders by the Stroop Color and Word Test. Journal of Clinical Psychology, 32, 654-658.<654::AID-JCLP2270320336>3.0.CO;2-Z
[34] Ruff, R.M., Light, R.H., Parker, S.B. and Levin, H.S. (1996) Benton Controlled Oral Word Association Test: Reliability and Updated Norms. Archives of Clinical Neuropsychology, 11, 329-338.
[35] Dubois, B., Slachevsky, A., Litvan, I. and Pillon, B. (2000) The FAB: A Frontal Assessment Battery at Bedside. Neurology, 55, 1621-1626.
[36] Blessed, G., Tomlinson, B.E. and Roth, M. (1968) The Association between Quantitative Measures of Dementia and of Senile Change in the Cerebral Grey Matter of Elderly Subjects. The British Journal of Psychiatry, 114, 797-811.
[37] Alexopoulos, G.S., Abrams, R.C., Young, R.C. and Shamoian, C.A. (1988) Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271-284.
[38] Kelland, D.Z. and Lewis, R.F. (1996) The Digit Vigilance Test: Reliability, Validity, and Sensitivity to Diazepam. Archives of Clinical Neuropsychology, 11, 339-344.
[39] Robertson, I.H., Ward, T., Ridgeway, V. and Nimmo-Smith, I. (1996) The Structure of Normal Human Attention: The Test of Everyday Attention. Journal of the International Neuropsychological Society, 2, 525-534.
[40] Guidi, M., Paciaroni, L., Paolini, S., De Padova, S. and Scarpino, O. (2006) Differences and Similarities in the Neuropsychological Profile of Dementia with Lewy Bodies and Alzheimer’s Disease in the Early Stage. Journal of the Neurological Sciences, 248, 120-123.
[41] Nobili, F., Brugnolo, A., Calvini, P., Copello, F., De Leo, C., Girtler, N., et al. (2005) Resting SPECT-Neuropsychology Correlation in Very Mild Alzheimer’s Disease. Clinical Neurophysiology, 116, 364-375.
[42] Desgranges, B., Baron, J.C., de la Sayette, V., Petit-Taboue, M.C., Benali, K., Landeau, B., et al. (1998) The Neural Substrates of Memory Systems Impairment in Alzheimer’s Disease: A PET Study of Resting Brain Glucose Utilization. Brain, 121, 611-631.
[43] Shapiro, A.M., Benedict, R.H., Schretlen, D. and Brandt, J. (1999) Construct and Concurrent Validity of the Hopkins Verbal Learning Test-Revised. The Clinical Neuropsychologist, 13, 348-358.
[44] Abikoff, H., Alvir, J., Hong, G., Sukoff, R., Orazio, J., Solomon, S., et al. (1987) Logical Memory Subtest of the Wechsler Memory Scale: Age and Education Norms and Alternate-Form Reliability of Two Scoring Systems. Journal of Clinical and Experimental Neuropsychology, 9, 435-448.
[45] Mungas, D. (1983) Differential Clinical Sensitivity of Specific Parameters of the Rey Auditory-Verbal Learning Test. Journal of Consulting and Clinical Psychology, 51, 848-855.
[46] Aschenbrenner, S., Tucha, O. and Lange, K.W. (2000) Regensburger Wortflüssigkeits-Test: RWT. Hogrefe, Verlag für Psychologie, Göttingen.
[47] Wesnes, K.A. (2008) Assessing Change in Cognitive Function in Dementia: The Relative Utilities of the Alzheimer’s Disease Assessment Scale-Cognitive Subscale and the Cognitive Drug Research System. Neurodegenerative Diseases, 5, 261-263.
[48] Fastenau, P.S., Denburg, N.L. and Hufford, B.J. (1999) Adult Norms for the Rey-Osterrieth Complex Figure Test and for Supplemental Recognition and Matching Trials from the Extended Complex Figure Test. The Clinical Neuropsychologist, 13, 30-47.
[49] Kessels, R.P., van Zandvoort, M.J., Postma, A., Kappelle, L.J. and de Haan, E.H. (2000) The Corsi Block-Tapping Task: Standardization and Normative Data. Applied Neuropsychology, 7, 252-258.
[50] Dubois, B., Burn, D., Goetz, C., Aarsland, D., Brown, R.G., Broe, G.A., et al. (2007) Diagnostic Procedures for Parkinson’s Disease Dementia: Recommendations from the Movement Disorder Society Task Force. Movement Disorders, 22, 2314-2324.
[51] Derejko, M., Slawek, J., Wieczorek, D., Brockhuis, B., Dubaniewicz, M. and Lass, P. (2006) Regional Cerebral Blood Flow in Parkinson’s Disease as an Indicator of Cognitive Impairment. Nuclear Medicine Communications, 27, 945-951.
[52] Sambati, L., Calandra-Buonaura, G., Poda, R., Guaraldi, P. and Cortelli, P. (2014) Orthostatic Hypotension and Cognitive Impairment: A Dangerous Association? Neurological Sciences, 35, 951-957.
[53] Senard, J., Brefel-Courbon, C., Rascol, O. and Montastruc, J. (2001) Orthostatic Hypotension in Patients with Parkinson’s Disease: Pathophysiology and Management. Drugs & Aging, 18, 495-505.
[54] Nutt, J.G. (1987) On-Off Phenomenon: Relation to Levodopa Pharmacokinetics and Pharmacodynamics. Annals of Neurology, 22, 535-540.
[55] Calne, D.B., Brennan, J., Spiers, A.S. and Stern, G.M. (1970) Hypotension Caused by L-Dopa. British Medical Journal, 1, 474-475.
[56] Critchley, H.D., Mathias, C.J., Josephs, O., O’Doherty, J., Zanini, S., Dewar, B.K., et al. (2003) Human Cingulate Cortex and Autonomic Control: Converging Neuroimaging and Clinical Evidence. Brain, 126, 2139-2152.
[57] Perry, R.H., Irving, D., Blessed, G., Fairbairn, A. and Perry, E.K. (1990) Senile Dementia of Lewy Body Type: A Clinically and Neuropathologically Distinct form of Lewy Body Dementia in the Elderly. Journal of the Neurological Sciences, 95, 119-139.
[58] Quinn, N. (1995) Parkinsonism—Recognition and Differential Diagnosis. British Medical Journal, 310, 447-452.
[59] Burdick, D.J., Cholerton, B., Watson, G., Siderowf, A., Trojanowski, J.Q., Weintraub, D., et al. (2014) People with Parkinson’s Disease and Normal MMSE Score Have a Broad Range of Cognitive Performance. Movement Disorders, 29, 1258-1264.
[60] Hohler, A.D., Amariei, D.E., Katz, D.I., De Piero, T.J., Allen, V.B., Boyle, S., et al. (2012) Treating Orthostatic Hypotension in Patients with Parkinson’s Disease and Atypical Parkinsonism Improves Function. Journal of Parkinson’s Disease, 2, 235-240.
[61] Ridgel, A.L., Kim, C.H., Fickes, E.J., Muller, M.D. and Alberts, J.L. (2011) Changes in Executive Function after Acute Bouts of Passive Cycling in Parkinson’s Disease. Journal of Aging and Physical Activity, 19, 87-98.
[62] Tanaka, K., Quadros Jr., A.C., Santos, R.F., Stella, F., Gobbi, L.T. and Gobbi, S. (2009) Benefits of Physical Exercise on Executive Functions in Older People with Parkinson’s Disease. Brain and Cognition, 69, 435-441.
[63] Berg, E.A. (1948) A Simple Objective Technique for Measuring Flexibility in Thinking. The Journal of General Psychology, 39, 15-22.

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