Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
Department of Neurology, University of Pennsylvania, Philadelphia, PA.
Eur J Neurol. 2019 Feb;26(2):246-e18. doi: 10.1111/ene.13797. Epub 2018 Oct 28.
Dementia in Parkinson's disease (PD) is common and disabling. Identification of modifiable risk factors for it is essential. Vascular risk factors (VRFs) may be associated with cognitive decline in early PD. Biomarkers that serve as surrogates of the long-term effect of VRFs on PD are needed. To that end, we aimed to quantitate white matter hyperintensities (WMH) in early PD, measure associations with VRFs and examine relationships between WMH and longitudinal cognition.
Participants in the Parkinson's Progression Markers Initiative study (141 patients with PD, 63 healthy controls) with adequate baseline structural brain magnetic resonance imaging data were included. Hypertension and diabetes history, and body mass index were combined to create a vascular risk score. WMH were quantitated via automated methods. Cognition was assessed annually with a comprehensive test battery.
In the PD group, vascular risk score was associated with WMH for total brain (β = 0.210; P = 0.021), total white matter (β = 0.214; P = 0.013), frontal (β = 0.220; P = 0.002) and temporal (β = 0.212; P = 0.002) regions. Annual rate of change in global cognition was greater in those with higher vascular risk score (β = -0.040; P = 0.007) and greater WMH (β = -0.029; P = 0.049). Higher temporal WMH burden was associated with great decline over time in verbal memory (β = -0.034; P = 0.031).
In early PD, modifiable VRFs are associated with WMH on brain magnetic resonance imaging. Temporal WMH burden predicts decline in verbal memory. WMH may serve as a surrogate marker for the effect of VRFs on cognitive abilities in PD.
帕金森病（PD）患者常伴有痴呆，且该疾病具有致残性。因此，明确其可改变的风险因素至关重要。血管危险因素（VRFs）可能与早期 PD 患者的认知能力下降有关。目前，我们需要寻找生物标志物来替代 VRFs 对 PD 产生的长期影响。为此，我们旨在量化早期 PD 患者的脑白质高信号（WMH），并评估其与 VRFs 的相关性，以及与纵向认知的关系。
本研究纳入了帕金森进展标志物倡议研究（PD 患者 141 例，健康对照 63 例）中的参与者，这些参与者均具有充分的基线结构脑磁共振成像数据。我们通过将高血压和糖尿病病史以及体重指数结合起来，创建了一个血管风险评分。通过自动方法对 WMH 进行量化。我们每年使用全面的测试套件评估认知能力。
在 PD 组中，血管风险评分与全脑（β=0.210；P=0.021）、总白质（β=0.214；P=0.013）、额（β=0.220；P=0.002）和颞（β=0.212；P=0.002）区的 WMH 相关。血管风险评分较高的患者其全球认知年度变化率更大（β=-0.040；P=0.007），WMH 年度变化率也更大（β=-0.029；P=0.049）。较高的颞叶 WMH 负担与语言记忆随时间的显著下降有关（β=-0.034；P=0.031）。
在早期 PD 中，可改变的 VRFs 与脑磁共振成像上的 WMH 有关。颞叶 WMH 负担预测语言记忆的衰退。WMH 可能是 VRFs 对 PD 患者认知能力影响的替代标志物。
