University of Pittsburgh School of Medicine, Department of Neurology, 3550 Terrace St, Pittsburgh, PA, 15213, USA.
University of Pittsburgh School of Medicine, Department of Neurology, 3550 Terrace St, Pittsburgh, PA, 15213, USA.
Parkinsonism Relat Disord. 2020 Jun;75:85-90. doi: 10.1016/j.parkreldis.2020.05.023. Epub 2020 May 22.
Mild parkinsonian signs (MPS) are associated with morbidity. Identification of MPS progression markers may be vital for preventive management, yet has not been pursued. This study aimed to ascertain clinical/neuroimaging features predictive of MPS progression.
205 participants in the Health ABC Study were included. MPS was defined using published guidelines. MPS progression was evaluated by determining UPDRS-III change between baseline and follow-up ≥2 years later. Standard brain MRI and DTI were obtained at baseline. Correlation coefficients between demographics, vascular risk factors, imaging markers, and UPDRS-III change were adjusted for follow-up time. Linear regression was used to adjust for possible confounders in the relationship between imaging markers and MPS progression.
30% of participants had baseline MPS. Demographics and risk factors did not differ significantly between participants with MPS (MPS+) and without MPS (MPS-). Mean follow-up time was 3.8±0.8 years. Older age, male gender, diabetes were associated with faster rate of UPDRS-III change in MPS- but not MPS+ participants. Among MPS- participants, the only imaging marker associated with faster UPDRS-III progression was higher gray matter mean diffusivity (MD), widespread in various cortico-subcortical bihemispheric regions, independent of age, gender, diabetes. No imaging features were associated with UPDRS-III change among MPS+ participants.
Lower gray matter integrity predicted MPS progression in those who did not have baseline MPS. Microstructural imaging may capture early changes related to MPS development, prior to macrostructural change. Any future management promoting gray matter preservation may inhibit MPS development.
轻度帕金森病征象（MPS）与发病率相关。识别 MPS 进展标志物对于预防管理可能至关重要，但尚未得到研究。本研究旨在确定预测 MPS 进展的临床/神经影像学特征。
纳入健康 ABC 研究中的 205 名参与者。使用已发表的指南定义 MPS。通过确定基线和随访≥2 年后 UPDRS-III 变化≥2 来评估 MPS 进展。基线时获得标准脑 MRI 和 DTI。在调整随访时间后，对人口统计学、血管危险因素、影像学标志物和 UPDRS-III 变化之间的相关系数进行了调整。使用线性回归来调整影像学标志物与 MPS 进展之间关系中的可能混杂因素。
30%的参与者有基线 MPS。MPS+参与者和无 MPS（MPS-）参与者的人口统计学和危险因素无显著差异。平均随访时间为 3.8±0.8 年。年龄较大、男性、糖尿病与 MPS-参与者的 UPDRS-III 变化较快相关，但与 MPS+参与者无关。在 MPS-参与者中，唯一与 UPDRS-III 进展较快相关的影像学标志物是较高的灰质平均弥散度（MD），广泛存在于左右半球的各种皮质下区域，与年龄、性别、糖尿病无关。在 MPS+参与者中，没有影像学特征与 UPDRS-III 变化相关。
基线无 MPS 的参与者中，灰质完整性降低预测 MPS 进展。微观结构成像可能在宏观结构变化之前捕捉与 MPS 发展相关的早期变化。任何促进灰质保存的未来管理都可能抑制 MPS 的发展。
