Abstract

INTRODUCTION

Parkinson’s disease (PD), the second most common neurodegenerative disease in the world, has no satisfactory treatment to impede the disease progression  Evidence suggesting derangement in lipid metabolism preceding Lewy body formation is an evolving topic of research in the field of neurology Therefore, an attempt to recognise the serum lipid trends in patients with PD can pave the way to better understand and reinforce the role of lipids in PD and formulate newer treatment options for the same.

MATERIAL AND METHODS

This case-control study assessed serum lipid levels and correlated them with disease severity in 45 cases and 45 matched controls enrolled at a tertiary hospital in Dakshina Kannada. Patients with secondary rkinsonism, drugs, and diseases significantly modifying the serum lipid levels were excluded from the study. Individual matching was undertaken. Every case was matched with a control considering age ±5 years, gender, BMI ±3kg/m², Hypertension- systolic blood pressure ±10mmHg, and HbA1c ±1%. Fasting serum lipid profiles, comprising total cholesterol, triglycerides, LDL-C, HDL-C, VLDL, and serum TC-HDL ratio, were estimated for both groups. Disease severity was ass sed using modified H and Y stage. The ROC curve was drawn to assess the predictive potential.

• Most patients were 61-70 years (42.22%), and the male gender (64%). 51.11% of the patients had hypertension; 60% had type 2 diabetes. The duration of illness was 4.11 years.
• There was no statistical difference between cases and controls with respect to age, gender, BMI, HbA1c levels, and Systolic blood pressure values, reinforcing adequacy of matching.
• Females with PD had significantly higher levels of total cholesterol and LDL; the TC-HDL ratio was significantly higher in overweight and obese individuals with PD.
• Patients with PD had significantly lower total cholesterol (187±47.29), HDL-C (43.76±16.38), and LDL-C (112.34±37.85) levels than the total cholesterol, HDL-C, and LDL-C levels in the controls (214.09±38.11; 53.04±14.36; 131.13±35.01, respectively). There was no statistically significant difference between the cases and the controls in the triglyceride levels, VLDL, and TC-HDL ratios.
• Modified H and Y scores were used to assess the severity of the disease. Patients were distributed along all stages.
• Patients with Type 2 diabetes had a higher median disease stage (3) compared to the non-diabetics (2.5).
• A statistically significant negative association was found between total cholesterol and LDL levels and the severity of PD.
• The ROC for various lipid parameters demonstrated a negative predictive potential for triglycerides, VLDL, and serum TC-HDL ratio, however these findings were not statistically significant.
• The ROC demonstrated nil predictive potential of total cholesterol, LDL, and HDL in predicting the disease, with a p-value <0.05.

CONCLUSION

Our study found lower lipid levels (TC, HDL-C, and LDL-C) in patients with PD. Lower TC and levels were observed around with increasing disease severity. These findings are consistent with studies in other parts of the world, which can have a causative or curative potential. Further research establishing a stronger association between serum lipids and Parkinson’s disease can pave the way to a better understanding of the function of lipid metabolism in the brain. It opens the path for direct modifications and treatment options in either slowing disease progression or finding a cure for PD by targeting the pathology rather than treating the symptoms. Our study is one of the earliest studies establishing an association between serum lipids and Parkinson’s disease in India.