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March 02, 2021Article

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
aDepartment of Neurology, Yonsei University College of Medicine, Seoul, South Korea
bDepartment of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
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  • ORCID record for Seok Jong Chung
Han Soo Yoo
aDepartment of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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Na-Young Shin
cDepartment of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Yae Won Park
dDepartment of Radiology, Yonsei University College of Medicine, Seoul, South Korea
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Hye Sun Lee
eBiostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
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Ji-Man Hong
aDepartment of Neurology, Yonsei University College of Medicine, Seoul, South Korea
bDepartment of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
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Yun Joong Kim
aDepartment of Neurology, Yonsei University College of Medicine, Seoul, South Korea
bDepartment of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
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Seung-Koo Lee
dDepartment of Radiology, Yonsei University College of Medicine, Seoul, South Korea
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Phil Hyu Lee
aDepartment of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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Young H. Sohn
aDepartment of Neurology, Yonsei University College of Medicine, 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 Mar 2021, 10.1212/WNL.0000000000011797; DOI: 10.1212/WNL.0000000000011797

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Abstract

Objectives: To investigate the association between enlarged perivascular spaces (PVSs) in the basal ganglia (BG-PVSs) and long-term motor outcomes in Parkinson’s disease (PD).

Methods: We reviewed the medical records of 248 patients with drug-naïve early-stage PD (follow-up >3 years, mean age 67.44 ± 8.46 years, 130 females) who underwent brain MRI and dopamine transporter (DAT) scans at initial assessment. The number of baseline enlarged BG-PVSs was counted on axial T2-weighted images. Then, patients were divided into two groups: a PD group with a low number (0−10) of enlarged PVSs (PD-EPVS−; n = 156) and that with a high number (>10) of enlarged PVSs (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 sub-regions 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.

Conclusions: This study suggests that baseline enlarged BG-PVSs can be an indicator of the progression of motor disability in PD.

  • Received August 2, 2020.
  • Accepted in final form January 25, 2021.
  • © 2021 American Academy of Neurology

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