Chen H M, Zhang M M, Wang Y L
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Advanced Innovation Center for Human Brain Projection, Beijing 100070, China.
Zhonghua Yi Xue Za Zhi. 2020 Nov 24;100(43):3397-3401. doi: 10.3760/cma.j.cn112137-20200519-01588.
To investigate the association of age-related white matter hyperintensity (WMH) with brain atrophy and cognitive impairment in patients with Parkinson's disease (PD). Consecutive samples of a prospective PD cohort with complete 3-dimensional magnetic resonance imaging in the Department of Movement Disorders in Beijing Tiantan Hospital, Capital Medical University, from October 2018 to August 2019 was retrospectively analyzed. Cognition was evaluated by Mini-Mental State Scale (MMSE) and Montreal Cognitive Assessment (MoCA). The severity of WMH was semi-quantitatively measured by Fazekas scale (0-6 points), and the mean cortical thickness and thalamus volume were calculated by FreeSurfer software. The demographic and disease characteristics, the severity of WMH, the mean cortical thickness and thalamus volume were respectively compared between PD patients with and without dementia. Moreover, univariate and multivariate generalized linear models were used to analyze the correlation of the severity of WMH with brain atrophy and MoCA. A total of 225 patients with PD were included in the study, with a median age of 66 years old. Comparisons between groups suggested that patients with dementia were with severer WMH, older, and had lower levels of serum cholesterol and low-density lipoprotein and more reduced mean cortical thickness than those without dementia (all <0.05), but no significant difference in the thalamus volume was found between the two groups. The generalized linear model showed that the cognitive impairment of PD patients was significantly correlated with WMH (β=-0.021, 95%:-0.040--0.002, =0.032), but independent of age, cortical thickness, and levels of serum cholesterol and low-density lipoprotein. WMH may worsen PD cognitive impairment independent of brain atrophy. Clinical prevention and treatment of cerebral small vessel disease may have protective effects on cognitive function in patients with PD.
探讨帕金森病（PD）患者中与年龄相关的脑白质高信号（WMH）与脑萎缩及认知障碍的相关性。回顾性分析了2018年10月至2019年8月在首都医科大学附属北京天坛医院运动障碍科进行完整三维磁共振成像的前瞻性PD队列的连续样本。采用简易精神状态检查表（MMSE）和蒙特利尔认知评估量表（MoCA）评估认知功能。采用Fazekas量表（0 - 6分）对WMH严重程度进行半定量测量，并通过FreeSurfer软件计算平均皮质厚度和丘脑体积。分别比较了有痴呆和无痴呆的PD患者的人口统计学和疾病特征、WMH严重程度、平均皮质厚度和丘脑体积。此外，采用单因素和多因素广义线性模型分析WMH严重程度与脑萎缩及MoCA的相关性。本研究共纳入225例PD患者，中位年龄为66岁。组间比较显示，与无痴呆患者相比，痴呆患者的WMH更严重、年龄更大、血清胆固醇和低密度脂蛋白水平更低，平均皮质厚度减少更明显（均P<0.05），但两组间丘脑体积无显著差异。广义线性模型显示，PD患者的认知障碍与WMH显著相关（β=-0.021，95%CI：-0.040--0.002，P=0.032），但与年龄、皮质厚度以及血清胆固醇和低密度脂蛋白水平无关。WMH可能独立于脑萎缩而加重PD患者的认知障碍。临床预防和治疗脑小血管疾病可能对PD患者的认知功能具有保护作用。
