From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Neurology. 2024 Jun 25;102(12):e209483. doi: 10.1212/WNL.0000000000209483. Epub 2024 Jun 4.
Although the potential role of enlarged perivascular spaces (EPVSs) in Parkinson disease (PD) is increasingly recognized, whether EPVSs located in different anatomical regions exert differential effects on clinical manifestation remains uncertain. We investigated the regional EPVS burden and its association with cognition and neuropsychiatric symptoms (NPSs) in newly diagnosed PD population.
In this retrospective, cross-sectional study, EPVS in the temporal lobe (T-EPVS), centrum semiovale (CS-EPVS), and basal ganglia (BG-EPVS) were visually rated in drug-naive patients with PD who underwent magnetic resonance imaging, dopamine transporter (DAT) scans, neuropsychological assessments, and Neuropsychiatric Inventory Questionnaire at baseline. Cognitive performance, NPS burden, vascular risk factors, small vessel disease (SVD) imaging markers, and DAT availability were compared across groups dichotomized by their regional EPVS burden (cutoff for high-degree vs low-degree: >10 for T-EPVS/BG-EPVS and >20 for CS-EPVS).
A total of 480 patients with PD (123 without cognitive impairment, 291 with mild cognitive impairment, and 66 with dementia) were included. The proportion of high-degree T-EPVS ( for trend <0.001) and BG-EPVS ( for trend = 0.001) exhibited an increasing trend across the cognitive spectrum, corresponding to worsening cognition. Compared with the low-degree group, the high-degree BG-EPVS group showed higher SVD burden (moderate-to-severe white matter hyperintensity [14.8% vs 40.5%, < 0.001], lacune [10.3% vs 30.7%, < 0.001], and cerebral microbleeds [8.1% vs 22.2%, < 0.001]), greater atrophy in cortical gray matter (40.73% ± 1.09% vs 39.96% ± 1.20% of intracranial volume, < 0.001), and lower cognitive performance (in language [-0.22 ± 1.18 vs -0.53 ± 1.29, = 0.013], and visual memory domains [-0.24 ± 0.97 vs -0.61 ± 0.96, = 0.009]). The high-degree T-EPVS group presented with greater NPS burden in decreased motivation (0.61 ± 1.78 vs 1.35 ± 2.36, = 0.007), affective dysregulation (0.88 ± 2.13 vs 2.36 ± 3.53, < 0.001), and impulse dyscontrol (0.43 ± 1.67 vs 1.74 ± 4.29, < 0.001), compared with the low-degree T-EPVS group. Meanwhile, the burden of CS-EPVS did not reveal any differences in cognition or NPS.
BG-EPVS and T-EPVS seem to exert differential effects on cognition and NPS in patients with PD. Investigating the EPVS profile in distinct anatomical regions may be useful in disentangling the heterogeneity within PD.
尽管血管周围空间扩大（EPVS）在帕金森病（PD）中的潜在作用日益受到重视，但位于不同解剖区域的 EPVS 是否对临床表现产生不同的影响仍不确定。我们研究了新诊断 PD 患者中不同解剖区域 EPVS 负荷及其与认知和神经精神症状（NPSs）的关系。
在这项回顾性、横断面研究中，我们对接受磁共振成像、多巴胺转运蛋白（DAT）扫描、神经心理学评估和基线时神经精神病学问卷的未经药物治疗的 PD 患者进行了颞叶（T-EPVS）、脑白质（CS-EPVS）和基底节（BG-EPVS）的 EPVS 视觉评分。根据其 EPVS 负荷（T-EPVS/BG-EPVS 高程度的截断值 >10，CS-EPVS 的截断值 >20）将患者分为高程度和低程度两组，比较两组间的认知表现、NPS 负担、血管危险因素、小血管疾病（SVD）影像学标志物和 DAT 可用性。
共纳入 480 例 PD 患者（123 例无认知障碍，291 例轻度认知障碍，66 例痴呆）。随着认知水平的降低，T-EPVS（趋势<0.001）和 BG-EPVS（趋势=0.001）的高程度比例呈上升趋势，这与认知能力下降相对应。与低程度组相比，高程度 BG-EPVS 组的 SVD 负担更高（中重度脑白质高信号[14.8%比 40.5%，<0.001]、腔隙[10.3%比 30.7%，<0.001]和脑微出血[8.1%比 22.2%，<0.001]），皮质灰质萎缩更严重（40.73%±1.09%比 39.96%±1.20%的颅内体积，<0.001），认知表现更差（语言领域[-0.22±1.18比-0.53±1.29，=0.013]和视觉记忆领域[-0.24±0.97比-0.61±0.96，=0.009]）。高程度 T-EPVS 组在动机降低（0.61±1.78比 1.35±2.36，=0.007）、情感调节障碍（0.88±2.13比 2.36±3.53，<0.001）和冲动控制障碍（0.43±1.67比 1.74±4.29，<0.001）方面的 NPS 负担更大，与低程度 T-EPVS 组相比。同时，CS-EPVS 的负担在认知或 NPS 方面没有差异。
BG-EPVS 和 T-EPVS 似乎对 PD 患者的认知和 NPS 有不同的影响。研究不同解剖区域的 EPVS 特征可能有助于阐明 PD 内部的异质性。
