Reduced Gray Matter Volume and Risk of Falls in Parkinson's Disease with Dementia Patients: A Voxel-Based Morphometry Study.

Kai-Lun Cheng,Li-Han Lin,Kun-Hsien Chou,Pi-Ling Chiang,Meng-Hsiang Chen,Shau-Hsuan Li,Hsiu-Ling Chen,Po-Cheng Chen,Cheng-Hsien Lu,Wei-Che Lin,Yueh-Sheng Chen

doi:10.3390/ijerph17155374

Abstract

Purpose: Risk of falls is a common sequela affecting patients with Parkinson’s disease (PD). Although motor impairment and dementia are correlated with falls, associations of brain structure and cognition deficits with falls remain unclear. Material and Methods: Thirty-five PD patients with dementia (PDD), and 37 age- and sex-matched healthy subjects were recruited for this study. All participants received structural magnetic resonance imaging (MRI) scans, and disease severity and cognitive evaluations. Additionally, patient fall history was recorded. Regional structural differences between PDD with and without fall groups were performed using voxel-based morphometry processing. Stepwise logistic regression analysis was used to predict the fall risk in PDD patients. Results: The results revealed that 48% of PDD patients experienced falls. Significantly lower gray matter volume (GMV) in the left calcarine and right inferior frontal gyrus in PDD patients with fall compared to PDD patients without fall were noted. The PDD patients with fall exhibited worse UPDRS-II scores compared to PDD patients without fall and were negatively correlated with lower GMV in the left calcarine (p/r = 0.004/−0.492). Furthermore, lower GMV in the left calcarine and right inferior frontal gyrus correlated with poor attention and executive functional test scores. Multiple logistic regression analysis showed that the left calcarine was the only variable (p = 0.004, 95% CI = 0.00–0.00) negatively associated with the fall event. Conclusions: PDD patients exhibiting impaired motor function, lower GMV in the left calcarine and right inferior frontal gyrus, and notable cognitive deficits may have increased risk of falls.

Highlights

Common symptoms of Parkinson’s disease with dementia (PDD), including tremors, bradykinesia, rigidity, postural instability, memory impairment, and visual hallucinations can result in an increased risk of falls [1]
Attention function was positively correlated with the gray matter volume (GMV) in the left calcarine, and right inferior frontal gyrus, while executive function was positively correlated with the GMV only in the left calcarine
Differences existed in the evaluation tools, declining functions in many domains of neuropsychological tests (NPT) were noted in PDD patients, similar to the results reported

Summary

Introduction

Common symptoms of Parkinson’s disease with dementia (PDD), including tremors, bradykinesia, rigidity, postural instability, memory impairment, and visual hallucinations can result in an increased risk of falls [1]. Especially during gait initiation, is considered one of the primary factors leading to falls in patients with PDD. Cognitive decline may affect patient balance, further increasing the risk of falls. Repeated falls can result in fractures requiring hospitalization, and in more serious cases, may be fatal, in the elderly and female [2]. Long-term complications include atrophy caused by disuse, lifestyle disruptions caused by fear of falls, or possible need for institutionalization [3]. The relationship between disease severity or cognitive function and risks of falls in PDD patients has not yet to be further investigated

Objectives

Methods

Conclusion