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April 20, 2021; 96 (16) Article

Perivascular Spaces in the Basal Ganglia and Long-term Motor Prognosis in Newly Diagnosed Parkinson Disease

View ORCID ProfileSeok Jong Chung, Han Soo Yoo, Na-Young Shin, Yae Won Park, Hye Sun Lee, Ji-Man Hong, View ORCID ProfileYun Joong Kim, Seung-Koo Lee, Phil Hyu Lee, Young H. Sohn
First published March 2, 2021, DOI: https://doi.org/10.1212/WNL.0000000000011797
Seok Jong Chung
From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Han Soo Yoo
From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Na-Young Shin
From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Yae Won Park
From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Hye Sun Lee
From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Ji-Man Hong
From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Yun Joong Kim
From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Seung-Koo Lee
From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Phil Hyu Lee
From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Young H. Sohn
From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Citation
Perivascular Spaces in the Basal Ganglia and Long-term Motor Prognosis in Newly Diagnosed Parkinson Disease
Seok Jong Chung, Han Soo Yoo, Na-Young Shin, Yae Won Park, Hye Sun Lee, Ji-Man Hong, Yun Joong Kim, Seung-Koo Lee, Phil Hyu Lee, Young H. Sohn
Neurology Apr 2021, 96 (16) e2121-e2131; DOI: 10.1212/WNL.0000000000011797

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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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