Abstract
BackgroundBrain white matter hyperintensities (WMHs) commonly observed on brain imaging of older adults are associated with balance and gait impairment and have also been linked to cognitive deficits. Parkinson’s disease (PD) is traditionally sub-classified into the postural instability gait difficulty (PIGD) sub-type, and the tremor dominant (TD) sub-type. Considering the known association between WMHs and axial symptoms like gait disturbances and postural instability, one can hypothesize that WMHs might contribute to the disparate clinical sub-types of patients with PD.Methods110 patients with PD underwent a clinical evaluation and a 3T MRI exam. Based on the Unified Parkinson Disease Rating Scale, the patients were classified into motor sub-types, i.e., TD or PIGD, and scores reflecting PIGD and TD symptoms were computed. We compared white matter burden using three previously validated methods: one using a semi-quantitative visual rating scale in specific brain regions and two automated methods.ResultsOverall, MRI data were obtained in 104 patients. The mean WMHs scores and the percent of subjects with lesions in specific brain regions were similar in the two subtypes, p = 0.678. The PIGD and the TD scores did not differ even when comparing patients with a relatively high burden of WMHs to patients with a relatively low burden. Across most of the brain regions, mild to moderate correlations between WMHs and age were found (r = 0.23 to 0.41; p<0.021). Conversely, no significant correlations were found between WMHs and the PIGD score or disease duration. In addition, depressive symptoms and cerebro-vascular risk factors were similar among the two subtypes.ConclusionsIn contrast to what has been reported previously among older adults, the present study could not demonstrate any association between WMHs and the PIGD or TD motor sub-types in patients with PD.
Highlights
Parkinson’s disease (PD) is a progressive neurodegenerative disorder, manifested by a broad spectrum of motor and non-motor features [1]
Given that some of the motor changes that have been associated with white matter hyperintensities (WMHs) overlap with features of PD, one can hypothesize that comorbid white matter (WM) lesions might contribute to the clinical symptoms of PD and might explain some of the differences between PD patients with postural instability gait difficulty (PIGD) symptoms, as compared to tremor dominant (TD) patients [15]
Based on the categorization proposed by Jankovic et al [83], 42 patients (38.2%) were classified as TD, 62 patients (56.4%) were classified as PIGD, and six patients (5.5%) were classified as undetermined
Summary
Parkinson’s disease (PD) is a progressive neurodegenerative disorder, manifested by a broad spectrum of motor and non-motor features [1]. White matter hyperintensities (WMHs), referred to as leukoaraiosis, are commonly observed on brain imaging studies in older adults, often presenting as signal hyperintensities in MRI images [5] These WMHs are associated with and apparently contribute to balance and gait impairment in aging populations[6,7,8,9,10,11,12,13,14]. WMHs have been linked with general cognitive decline in older adults and in normal aging[16,17,18], and with impairment in attention, executive functions and processing speed [19,20] These cognitive changes are commonly observed among patients with PD, even in the early stages of the disease [21,22,23,24]. Considering the known association between WMHs and axial symptoms like gait disturbances and postural instability, one can hypothesize that WMHs might contribute to the disparate clinical sub-types of patients with PD
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