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Abstract
Objective To investigate the association between enlarged perivascular spaces (PVS) in the basal ganglia (BG-PVS) and long-term motor outcomes in Parkinson disease (PD).
Methods We reviewed the medical records of 248 patients with drug-naive early-stage PD (follow-up >3 years, mean age 67.44 ± 8.46 years, 130 female) who underwent brain MRI and dopamine transporter (DAT) scans at initial assessment. The number of baseline enlarged BG-PVS was counted on axial T2-weighted images. Then, patients were divided into 2 groups: a PD group with a low number (0–10) of enlarged PVS (PD-EPVS−; n = 156) and a PD group with a high number (>10) of enlarged PVS (PD-EPVS+; n = 92). We used Cox regression models to compare the levodopa-induced dyskinesia (LID)–, wearing-off–, and freezing of gait (FOG)–free times between groups. We also compared longitudinal increases in levodopa-equivalent dose per body weight between groups using a linear mixed model.
Results Patients in the PD-EPVS+ group were older (72.28 ± 6.07 years) and had greater small vessel disease burden than those in the PD-EPVS− group (64.58 ± 8.38 years). The PD-EPVS+ group exhibited more severely decreased DAT availability in all striatal subregions except the ventral striatum. The risk of FOG was higher in the PD-EPVS+ group, but the risk of LID or wearing-off was comparable between groups. The PD-EPVS+ group required higher doses of dopaminergic medications for effective symptom control compared to the PD-EPVS− group.
Conclusion This study suggests that baseline enlarged BG-PVS can be an indicator of the progression of motor disability in PD.
Glossary
- 18F-FP-CIT PET=
- [18F] N-(3-fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane PET;
- BDI=
- Beck Depression Inventory;
- BG-PVS=
- enlargement of perivascular spaces in the basal ganglia;
- CCSIT=
- Cross-Cultural Smell Identification Test;
- CI=
- confidence interval;
- DAT=
- dopamine transporter;
- FLAIR=
- fluid-attenuated inversion recovery;
- FOG=
- freezing of gait;
- HR=
- hazard ratio;
- K-MMSE=
- Korean version of the Mini-Mental State Examination;
- LED=
- levodopa-equivalent dose;
- LID=
- levodopa-induced dyskinesia;
- PD=
- Parkinson disease;
- PVS=
- perivascular spaces;
- SNBR=
- specific to nonspecific binding ratio;
- TE=
- echo time;
- TR=
- repetition time;
- UPDRS-III=
- Unified Parkinson's Disease Rating Scale Part III;
- VOI=
- volume of interest;
- WMH=
- white matter hyperintensity
Footnotes
Go to Neurology.org/Nhttps://n.neurology.org/lookup/doi/10.1212/WNL.0000000000011797 for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received August 2, 2020.
- Accepted in final form January 25, 2021.
- © 2021 American Academy of Neurology
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