Seok Jong Chung1, Han Soo Yoo1, Na-Young Shin1, Yae Won Park1, Hye Sun Lee1, Ji-Man Hong1, Yun Joong Kim1, Seung-Koo Lee1, Phil Hyu Lee1, Young H Sohn2. 1. 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. 2. 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. yhsohn62@yuhs.ac.
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.
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.