Mak Elijah, Dwyer Michael G, Ramasamy Deepa P, Au Wing Lok, Tan Louis C S, Zivadinov Robert, Kandiah Nagaendran
Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY.
Department of Neurology, National Neuroscience Institute, Singapore.
J Neuroimaging. 2015 Sep-Oct;25(5):754-60. doi: 10.1111/jon.12230. Epub 2015 Mar 5.
The clinical implications of white matter hyperintensities (WMH) in non-demented Parkinson's disease (PD) have not been thoroughly examined. To address this, we investigated the spatial distribution of WMH and their regional predilection in non-demented patients with mild PD.
Cognitive assessments classified the sample into patients with mild cognitive impairment (PD-MCI, n = 25) and patients with no cognitive impairment (PD-NCI, n = 65) based on the recent formal Movement Disorder Task Force diagnostic criteria. The mean age was 65.1 ± 7.7 years, disease duration was 5.3 ± 3.9 years, and Hoehn and Yahr stage was 1.9 ± .4. WMHs were outlined on T2-weighted imaging using a semi-automated technique. The spatial distribution of WMHs were compared between PD-MCI and PD-NCI using voxel-wise lesion probability maps (LPM). General linear models examined the associations between spatially specific WMHs and cognitive domains.
LPM analyses showed significant differences in the spatial distribution of WMH in PD-MCI compared to PD-NCI in widespread regions of the brain (P < .05). PD-MCI demonstrated significantly greater total and periventricular WMHs compared to PD-NCI (P ≤ .02). Spatial distribution of WMHs was also significantly associated with global cognition, performance on the Frontal Assessment Battery and Fruit Fluency (P < .05).
Voxel-wise LPM analysis revealed differences in the spatial distribution of WMH between PD-MCI and PD-NCI patients, particularly in the periventricular regions. A more widespread extent of WMH might be indicative of cognitive deterioration. Our findings warrant further longitudinal investigation into the importance of WMH spatial distribution as a predictor for conversion from PD to PD with dementia.
尚未对非痴呆型帕金森病（PD）中白质高信号（WMH）的临床意义进行全面研究。为解决这一问题，我们调查了轻度非痴呆型PD患者中WMH的空间分布及其区域偏好。
根据最近正式的运动障碍特别工作组诊断标准，通过认知评估将样本分为轻度认知障碍患者（PD-MCI，n = 25）和无认知障碍患者（PD-NCI，n = 65）。平均年龄为65.1±7.7岁，病程为5.3±3.9年，Hoehn和Yahr分期为1.9±0.4。使用半自动技术在T2加权成像上勾勒出WMH。使用体素病变概率图（LPM）比较PD-MCI和PD-NCI之间WMH的空间分布。通用线性模型检查了特定空间WMH与认知领域之间的关联。
LPM分析显示，与PD-NCI相比，PD-MCI中WMH在大脑广泛区域的空间分布存在显著差异（P <.05）。与PD-NCI相比，PD-MCI的总WMH和脑室周围WMH明显更多（P≤.02）。WMH的空间分布也与整体认知、额叶评估量表表现和水果流畅性显著相关（P <.05）。
体素LPM分析揭示了PD-MCI和PD-NCI患者之间WMH空间分布的差异，特别是在脑室周围区域。WMH更广泛的范围可能表明认知功能恶化。我们的研究结果值得进一步纵向研究WMH空间分布作为PD转化为痴呆型PD预测指标的重要性。
