Department of Medicine, Division of Neurology, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada.
Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
J Neurol Sci. 2021 Jul 15;426:117481. doi: 10.1016/j.jns.2021.117481. Epub 2021 May 4.
Mechanisms driving neurodegeneration in Parkinson's disease (PD) are unclear and neurovascular dysfunction may be a contributing factor. White matter hyperintensities (WMH) are commonly found on brain MRI in patients with PD. It is controversial if they are more prevalent or more severe in PD compared with controls. This systematic review aims to answer this question.
A systematic search of electronic databases was conducted for studies of WMH in patients with PD. A qualitative synthesis was done for studies reporting WMH prevalence or WMH scores on a visual rating scale (VRS). In studies reporting total WMH volume, the difference between patients with PD and controls was pooled using random effects meta-analysis.
Among 3860 subjects from 24 studies, 2360 were cases and 1500 controls. Fifteen studies reported WMH scores and four studies reported the prevalence of WMH. On VRS, five studies reported no difference in WMH scores, three found higher WMH scores in PD compared to controls, three reported increased WMH scores either in periventricular or deep white matter, and four reported higher scores only in PD with dementia. In studies reporting WMH volume, there was no difference between patients with PD and controls (pooled standardized mean difference = 0.1, 95%CI: -0.1-0.4, I = 81%).
WMH are not more prevalent or severe in patients with PD than in age-matched controls. PD dementia may have more severe WMH compared to controls and PD with normal cognition. Prospective studies using standardized methods of WMH assessment are needed.
帕金森病 (PD) 中神经退行性变的机制尚不清楚，神经血管功能障碍可能是一个促成因素。在 PD 患者的脑部磁共振成像 (MRI) 上通常可以发现脑白质高信号 (WMH)。与对照组相比，PD 患者的 WMH 是否更常见或更严重存在争议。本系统评价旨在回答这个问题。
对 PD 患者 WMH 的研究进行了电子数据库的系统搜索。对报告 WMH 患病率或视觉评分量表 (VRS) 上 WMH 评分的研究进行了定性综合。在报告总 WMH 体积的研究中，使用随机效应荟萃分析汇总了 PD 患者与对照组之间的差异。
在 24 项研究的 3860 名受试者中，2360 名是病例，1500 名是对照。15 项研究报告了 WMH 评分，4 项研究报告了 WMH 的患病率。在 VRS 上，有 5 项研究报告 WMH 评分无差异，3 项研究发现 PD 患者的 WMH 评分高于对照组，3 项研究报告脑室周围或深部白质的 WMH 评分增加，4 项研究报告仅在 PD 合并痴呆患者中评分较高。报告 WMH 体积的研究中，PD 患者与对照组之间无差异（合并标准化均数差=0.1，95%CI：-0.1-0.4，I=81%）。
与年龄匹配的对照组相比，PD 患者的 WMH 并不更常见或更严重。PD 痴呆患者的 WMH 可能比对照组和认知正常的 PD 患者更严重。需要使用 WMH 评估的标准化方法进行前瞻性研究。
