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      Cognition, Olfaction and Uric Acid in Early de novo Parkinson’s Disease

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          Abstract

          Objective

          Cognitive impairment is one of the nonmotor symptoms in Parkinson’s disease (PD), and olfactory dysfunction is used as a marker to detect premotor stages of PD. Serum uric acid (sUA) levels have been found to be a risk factor for PD. Our objective in this study was to examine whether sUA levels are associated with cognitive changes and olfactory dysfunction in early de novo PD patients.

          Methods

          The study participants included 196 de novo PD patients. We assessed cognitive function by the Korean versions of the Mini-Mental State Examination and the Montreal Cognitive Assessment and assessed olfactory function by the Korean version of the Sniffin’ Sticks test.

          Results

          The mean sUA level was 4.7 mg/dL and was significantly lower in women than in men. Cognitive scores were lower in women, suggesting that sUA levels were related to cognitive function. The olfactory functions were not related to sUA level but were clearly associated with cognitive scores. Olfactory threshold, odor discrimination, and odor identification were all significantly related to cognitive scores.

          Conclusion

          We conclude that lower sUA levels were associated with cognitive impairment, not olfactory dysfunction, in de novo PD patients. This finding suggests that UA is neuroprotective as an antioxidant in the cognitive function of PD patients.

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          Most cited references19

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          Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.

          A J Hughes, S Daniel, L Kilford … (1992)
          Few detailed clinico-pathological correlations of Parkinson's disease have been published. The pathological findings in 100 patients diagnosed prospectively by a group of consultant neurologists as having idiopathic Parkinson's disease are reported. Seventy six had nigral Lewy bodies, and in all of these Lewy bodies were also found in the cerebral cortex. In 24 cases without Lewy bodies, diagnoses included progressive supranuclear palsy, multiple system atrophy, Alzheimer's disease, Alzheimer-type pathology, and basal ganglia vascular disease. The retrospective application of recommended diagnostic criteria improved the diagnostic accuracy to 82%. These observations call into question current concepts of Parkinson's disease as a single distinct morbid entity.
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            Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam study.

            Michiel Bos, Peter J Koudstaal, Albert Hofman … (2006)
            The role of uric acid as a risk factor for myocardial infarction is controversial, and little is known about its role as a risk factor for stroke. Recent evidence suggests that uric acid may be an important causal agent in cardiovascular disease, for example, by inducing renal disease and hence hypertension. We investigated the association between serum uric acid and coronary heart disease and stroke in a large prospective population-based study. The study was based on 4385 participants of the Rotterdam Study who, at baseline (1990 to 1993), were > or =55 years of age, free from stroke and coronary heart disease, and had blood taken. Follow-up for incident stroke and myocardial infarction was complete until January 1, 2002. Data were analyzed with Cox proportional hazards models with adjustment for relevant confounders. Average follow-up was 8.4 years. High serum uric acid levels were associated with risk of myocardial infarction and stroke; age- and sex-adjusted hazard ratios (95% CIs) for highest versus lowest quintile of uric acid were 1.68 (1.24 to 2.27) for cardiovascular disease (515 cases), 1.87 (1.12 to 3.13) for myocardial infarction (194 cases), 1.57 (1.11 to 2.22) for stroke (381 cases), 1.77 (1.10 to 2.83) for ischemic stroke (205 cases), and 1.68 (0.68 to 4.15) for hemorrhagic stroke (46 cases). Adjustment for other vascular risk factors only slightly attenuated these associations. Associations were stronger in persons without hypertension than in those with hypertension. Uric acid is a strong risk factor for myocardial infarction and stroke.
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              Uric acid-iron ion complexes. A new aspect of the antioxidant functions of uric acid.

              Matthew S. Kelly, G. Davies, A Sevanian … (1986)
              In order to survive in an oxygen environment, aerobic organisms have developed numerous mechanisms to protect against oxygen radicals and singlet oxygen. One such mechanism, which appears to have attained particular significance during primate evolution, is the direct scavenging of oxygen radicals, singlet oxygen, oxo-haem oxidants and hydroperoxyl radicals by uric acid. In the present paper we demonstrate that another important 'antioxidant' property of uric acid is the ability to form stable co-ordination complexes with iron ions. Formation of urate-Fe3+ complexes dramatically inhibits Fe3+-catalysed ascorbate oxidation, as well as lipid peroxidation in liposomes and rat liver microsomal fraction. In contrast with antioxidant scavenger reactions, the inhibition of ascorbate oxidation and lipid peroxidation provided by urate's ability to bind iron ions does not involve urate oxidation. Association constants (Ka) for urate-iron ion complexes were determined by fluorescence-quenching techniques. The Ka for a 1:1 urate-Fe3+ complex was found to be 2.4 X 10(5), whereas the Ka for a 1:1 urate-Fe2+ complex was determined to be 1.9 X 10(4). Our experiments also revealed that urate can form a 2:1 complex with Fe3+ with an association constant for the second urate molecule (K'a) of approx. 4.5 X 10(5). From these data we estimate an overall stability constant (Ks approximately equal to Ka X K'a) for urate-Fe3+ complexes of approx. 1.1 X 10(11). Polarographic measurements revealed that (upon binding) urate decreases the reduction potential for the Fe2+/Fe3+ half-reaction from -0.77 V to -0.67 V. Thus urate slightly diminishes the oxidizing potential of Fe3+. The present results provide a mechanistic explanation for our previous report that urate protects ascorbate from oxidation in human blood. The almost saturating concentration of urate normally found in human plasma (up to 0.6 mM) represents 5-10 times the plasma ascorbate concentration, and is orders of magnitude higher than the 'free' iron ion concentration. These considerations point to the physiological significance of our findings.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Mov Disord
                Journal ID (iso-abbrev): J Mov Disord
                Journal ID (publisher-id): JMD
                Title: Journal of Movement Disorders
                Publisher: The Korean Movement Disorder Society
                ISSN (Print): 2005-940X
                ISSN (Electronic): 2093-4939
                Publication date (Print): September 2018
                Publication date (Electronic): 30 September 2018
                Volume: 11
                Issue: 3
                Pages: 139-144
                Affiliations
                [1 ]Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
                [2 ]Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
                Author notes
                Corresponding author: Jong Sam Baik, MD, PhD, https://orcid.org/0000-0002-5300-203X Department of Neurology, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 04763, Korea / Tel: +82-950-4833 / Fax: +82-2-950- 1955 / E-mail: jsbaik@ 123456paik.ac.kr
                Author information
                http://orcid.org/0000-0002-5300-203X
                Article
                Publisher ID: jmd-18037
                DOI: 10.14802/jmd.18037
                PMC ID: 6182300
                PubMed ID: 30304927
                SO-VID: 73fba206-99a4-426d-93d5-72571d863724
                Copyright © Copyright © 2018 The Korean Movement Disorder Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 July 2018
                Date revision received : 5 September 2018
                Date accepted : 11 September 2018
                Categories
                Subject: Original Article

                Keywords: cognition,parkinson’s disease,olfaction,uric acid
                Data availability:
                Keywords: cognition, parkinson’s disease, olfaction, uric acid

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