Abstract
Cerebral microbleeds (MBs) have been found in patients with cognitive decline. We aimed to examine whether MBs are associated with motor or cognitive decline in patients with Parkinson’s disease (PD). We enrolled 135 PD patients and 34 healthy controls. All participants underwent brain MRI and plasma biomarker assays, including tau, Aβ42, Aβ40, and α-synuclein. PD with dementia (PDD) was operationally defined as Mini-Mental State Examination (MMSE) score < 26 and advanced motor stage was defined as Hoehn-Yahr stage ≥ 3 during “on” status. The association between MBs and disease severity was examined using multivariate logistic regression models. More lobar MBs were observed in PD patients than controls (20.7% vs. 3.3%, p = 0.031). PDD patients had more lobar MBs (33.3% vs. 15.6%, p = 0.034), more white matter hyperintensity (p = 0.021) and reduced hippocampal volume (p = 0.001) than PD with normal cognition. The presence of lobar MB (odds ratio = 2.83 [95% confidence interval 1.04–7.70], p = 0.042) and severe white matter hyperintensity (3.29 [1.21–8.96], p = 0.020) was independently associated with PDD after adjusting for vascular risk factors and other confounders. Furthermore, plasma Aβ40 levels were associated the MMSE score (p = 0.004) after adjusting for age and sex. Our findings demonstrated that lobar MBs, reduced hippocampal volume, and elevated plasma Aβ40 levels are associated with PDD.
Highlights
Cerebral microbleeds (MBs) have been found in patients with cognitive decline
We found no significant differences in vascular risk factors and baseline characteristics between Parkinson’s disease (PD) patients and controls (Table 1)
The prevalence of lobar MBs was higher in PD patients than controls (20.7% vs. 2.9%, p = 0.011) (Fig. 1A,B)
Summary
We aimed to examine whether MBs are associated with motor or cognitive decline in patients with Parkinson’s disease (PD). PDD patients had more lobar MBs (33.3% vs 15.6%, p = 0.034), more white matter hyperintensity (p = 0.021) and reduced hippocampal volume (p = 0.001) than PD with normal cognition. One cohort study even reported the presence of microvasculopathy lesions in 94% of patients with PDD compared to roughly 50% in PD7 These findings from previous literature suggest that in addition to the contribution of limbic and cortical spreading of Lewy body pathology to PDD8, several other mechanisms have been proposed for cognitive decline in PD. We examined whether MBs are associated with risk and severity, especially cognitive decline, in patients with PD. Basic characteristics Male, N (%) Age, years Hypertension Diabetes Mellitus Dyslipidemia 3 T MRI scanner, N (%) Disease duration (years) Hoehn-Yahr stage (on) Hoehn-Yahr stage (off) UPDRS part III (on) UPDRS part III (off) Mean LEDD (mg/day) Presence of cerebral microbleed Presence of lobar MB Presence of deep MB Presence of infratentorial MB White matter hyperintensity Fazekas scale ≥ 2
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