Lin Fangju, Yang Baoling, Chen Ying, Zhao Wei, Li Binghan, Jia Weihua
Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China.
Front Neurol. 2022 Aug 19;13:985294. doi: 10.3389/fneur.2022.985294. eCollection 2022.
Freezing of gait (FOG) is one of common and disabling gait impairments of Parkinson's disease (PD). White matter hyperintensity (WMH) and lacunes, as common manifestations of cerebral small vessel diseases (CSVD), have been reported to be associated with gait function in PD patients. However, in the cases with FOG which present with extensive WMH or lacunes, it actually is difficult to distinguish pure PD pathology from vascular origin or combined effects. So far little is known about the correlation between enlarged perivascular space (PVS) and FOG in PD patients. This study aims to explore the role of enlarged PVS in FOG in PD patients.
A total of 95 patients with PD in the absence of obvious WMH and lacunes were included in our study, which were divided into PD-FOG (+) group and PD-FOG (-) group. Demographic and clinical data were investigated. Enlarged PVS in the centrum semiovale (CSO) and basal ganglia (BG) were assessed. The association between enlarged PVS and FOG in patients with PD was analyzed using the multivariate models and the Spearman's correlation.
There were 36 PD patients grouped into PD-FOG (+) (37.9%), with an older age, a longer PD disease duration, and larger numbers of enlarged PVS in CSO and BG compared with PD-FOG (-) group. The highest-severity degree of enlarged PVS burden in CSO was independently associated with FOG in patients with PD [adjusted odds ratio (OR), 3.869; = 0.022 in multivariable model]. The percentages of FOG case increased accompanied by the aggravation of enlarged PVS located in CSO. The grade and count of enlarged PVS in CSO and BG both correlated with FOGQ score in PD patients.
Enlarged PVS, particularly in CSO, are associated with FOG in patients with PD, which provides a novel perspective for the mechanisms of FOG in PD.
冻结步态（FOG）是帕金森病（PD）常见且致残的步态障碍之一。白质高信号（WMH）和腔隙性脑梗死作为脑小血管病（CSVD）的常见表现，已被报道与PD患者的步态功能相关。然而，在出现广泛WMH或腔隙性脑梗死的FOG病例中，实际上很难区分单纯的PD病理与血管源性或联合效应。迄今为止，关于PD患者血管周围间隙（PVS）扩大与FOG之间的相关性知之甚少。本研究旨在探讨扩大的PVS在PD患者FOG中的作用。
本研究共纳入95例无明显WMH和腔隙性脑梗死的PD患者，分为PD-FOG（+）组和PD-FOG（-）组。调查人口统计学和临床数据。评估半卵圆中心（CSO）和基底节（BG）的PVS扩大情况。使用多变量模型和Spearman相关性分析PD患者PVS扩大与FOG之间的关联。
有36例PD患者被归入PD-FOG（+）组（37.9%），与PD-FOG（-）组相比，年龄更大，PD病程更长，CSO和BG中PVS扩大的数量更多。CSO中PVS负担的最高严重程度与PD患者的FOG独立相关[调整优势比（OR），3.869；多变量模型中P = 0.022]。CSO中PVS扩大加重时，FOG病例的百分比增加。CSO和BG中PVS的分级和计数均与PD患者的FOGQ评分相关。
PVS扩大，尤其是CSO中的PVS扩大，与PD患者的FOG相关，这为PD中FOG的机制提供了一个新的视角。
