Chen Huimin, Zhang Meimei, Liu Gengliang, Wang Xuemei, Wang Zhan, Ma Huizi, Pan Yuesong, Wang David, Wang Yilong, Feng Tao
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
Neurol Sci. 2020 Dec;41(12):3617-3624. doi: 10.1007/s10072-020-04452-z. Epub 2020 May 26.
The comorbidity of cerebral small vessel disease (CSVD) may worsen gait impairment of Parkinson's disease (PD). However, the evidence remains scarce and controversial, and the mechanism of their potential interaction remains largely unknown. The present study aimed to investigate the overall impact of quantity and location of CSVD on gait/posture function in PD.
This cross-sectional study included 315 consecutive eligible patients with PD from Beijing Tiantan Hospital from May 2016 to August 2018. Associations of gait/posture subscores with the burden score of CSVD and four CSVD imaging markers were assessed using multivariate linear regression models.
Burden of CSVD was significantly associated with more severe gait/posture impairment in PD in the unadjusted model (β = 0.521, P = 0.011, 95% CI 0.118-0.923) and in the model adjusted for age, hypertension, ischemic stroke, low-density lipoprotein level, cholesterol level, and cognitive statues (β = 0.448, P = 0.047, 95% CI 0.006-0.891). The presence of lacunes, but not other CSVD markers, was significantly associated with higher gait/posture subscores after the adjustment (β = 0.492, P = 0.041, 95% CI 0.021-0.964), and the number of lacunes in the basal ganglia significantly correlated with the gait/posture subscores in patients with PD (P = 0.012, Spearman r = 0.161).
CSVD and lacunes in the basal ganglia may independently contribute to gait/posture dysfunction in PD. Promoting neurovascular health may preserve some gait/posture function of PD.
脑小血管病（CSVD）的合并症可能会加重帕金森病（PD）的步态障碍。然而，相关证据仍然稀缺且存在争议，它们潜在相互作用的机制在很大程度上仍不清楚。本研究旨在探讨CSVD的数量和位置对PD患者步态/姿势功能的总体影响。
这项横断面研究纳入了2016年5月至2018年8月期间来自北京天坛医院的315例连续符合条件的PD患者。使用多元线性回归模型评估步态/姿势子评分与CSVD负担评分和四种CSVD影像学标志物之间的关联。
在未调整模型中（β = 0.521，P = 0.011，95%CI 0.118 - 0.923）以及在调整了年龄、高血压、缺血性中风、低密度脂蛋白水平、胆固醇水平和认知状态的模型中（β = 0.448，P = 0.047，95%CI 0.006 - 0.891），CSVD负担与PD患者更严重的步态/姿势障碍显著相关。调整后，腔隙的存在与较高的步态/姿势子评分显著相关（β = 0.492，P = 0.041，95%CI 0.021 - 0.964），而其他CSVD标志物则不然，并且基底节区腔隙的数量与PD患者的步态/姿势子评分显著相关（P = 0.012，Spearman r = 0.161）。
基底节区的CSVD和腔隙可能独立导致PD患者的步态/姿势功能障碍。促进神经血管健康可能会保留PD患者的一些步态/姿势功能。
