Clínica Universidad de Navarra, Pamplona, Spain.
Eur J Neurol. 2012 Aug;19(8):1100-7. doi: 10.1111/j.1468-1331.2012.03682.x. Epub 2012 Feb 23.
White matter hyperintensities (WMHs) detected by magnetic resonance imaging (MRI) of the brain are associated with dementia and cognitive impairment in the general population and in Alzheimer's disease. Their effect in cognitive decline and dementia associated with Parkinson's disease (PD) is still unclear.
We studied the relationship between WMHs and cognitive state in 111 patients with PD classified as cognitively normal (n = 39), with a mild cognitive impairment (MCI) (n = 46) or dementia (n = 26), in a cross-sectional and follow-up study. Cognitive state was evaluated with a comprehensive neuropsychological battery, and WMHs were identified in FLAIR and T2-weighted MRI. The burden of WMHs was rated using the Scheltens scale.
No differences in WMHs were found between the three groups in the cross-sectional study. A negative correlation was observed between semantic fluency and the subscore for WMHs in the frontal lobe. Of the 36 non-demented patients re-evaluated after a mean follow-up of 30 months, three patients converted into MCI and 5 into dementia. Progression of periventricular WMHs was associated with an increased conversion to dementia. A marginal association between the increase in total WMHs burden and worsening in the Mini Mental State Examination was encountered.
White matter hyperintensities do not influence the cognitive status of patients with PD. Frontal WMHs have a negative impact on semantic fluency. Brain vascular burden may have an effect on cognitive impairment in patients with PD as WMHs increase overtime might increase the risk of conversion to dementia. This finding needs further confirmation in larger prospective studies.
磁共振成像（MRI）检测到的脑白质高信号（WMHs）与一般人群和阿尔茨海默病患者的痴呆和认知障碍相关。但其在帕金森病（PD）相关认知下降和痴呆中的作用尚不清楚。
我们在一项横断面和随访研究中，研究了 111 例 PD 患者的 WMHs 与认知状态之间的关系，这些患者分为认知正常（n = 39）、轻度认知障碍（MCI）（n = 46）或痴呆（n = 26）。认知状态通过全面的神经心理学测试进行评估，WMHs 通过 FLAIR 和 T2 加权 MRI 确定。WMHs 负荷使用 Scheltens 量表进行评分。
在横断面研究中，三组之间的 WMHs 无差异。在额叶WMHs 亚评分与语义流畅性之间观察到负相关。在平均随访 30 个月后对 36 例非痴呆患者进行重新评估，其中 3 例转为 MCI，5 例转为痴呆。脑室周围 WMHs 的进展与向痴呆的转化率增加相关。总 WMHs 负荷增加与简易精神状态检查恶化之间存在边缘相关性。
脑白质高信号不会影响 PD 患者的认知状态。额叶 WMHs 对语义流畅性有负面影响。脑血管负担可能对 PD 患者的认知障碍有影响，因为随着时间的推移 WMHs 的增加可能会增加向痴呆转化的风险。这一发现需要在更大的前瞻性研究中进一步证实。
