Magnetic Resonance Imaging-Visible Perivascular Spaces in Basal Ganglia Predict Cognitive Decline in Parkinson's Disease
Magnetic Resonance Imaging-Visible Perivascular Spaces in Basal Ganglia Predict Cognitive Decline in Parkinson's Disease
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DOI：
10.1002/mds.27798
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发表时间：
2019-07-19
影响因子：
8.6
通讯作者：
Ahn, Kook Jin
中科院分区：
文献类型：
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作者：
Park, Yae Won;Shin, Na-Young;Ahn, Kook Jin
背景 越来越多的证据表明小血管疾病的成像生物标志物与帕金森病 (PD) 未来认知能力下降之间存在关联。最近，磁共振成像-可见血管周围间隙（PVS）已被认为是小血管疾病的成像生物标志物，但其对帕金森病认知能力下降的影响仍有待研究。目的 本研究的目的是评估 PVS 是否可以独立预测 PD 认知能力下降。方法 271例PD患者分为完整认知障碍（PD-IC）106例和轻度认知障碍（PD-MCI）165例。经过平均 5.0 +/- 2.3 年的随访后，18 名 PD-IC 患者表现出认知能力下降至 PD-MCI，34 名 PD-MCI 患者表现出认知能力下降至痴呆。使用 4 点视觉量表对基底神经节 (BG) 和半卵圆中心的 PVS 进行评级，然后根据严重程度分为高（分数 >= 2）或低（分数 < 2）。还评估了腔隙和白质高信号的严重程度。使用多变量逻辑回归分析研究认知能力下降的独立危险因素。结果在所有患者中，较高的 BG-PVS 和白质高信号严重程度、较高的左旋多巴当量剂量、高血压和较低的简易精神状态检查评分是未来认知能力下降的独立积极预测因素。在 PD-IC 亚组中，较高的 BG-PVS 严重程度、高血压和更严重的抑郁症状是认知转变的预测因素。在 PD-MCI 亚组中，较高的 BG-PVS 和白质高信号严重程度以及较低的简易精神状态检查评分是认知能力下降的预测因素。结论 BG-PVS 可能是预测 PD 认知能力下降的有用影像学标志物。 (c) 2019年国际帕金森与运动障碍学会
Background Growing evidence suggests an association between imaging biomarkers of small vessel disease and future cognitive decline in Parkinson's disease (PD). Recently, magnetic resonance imaging-visible perivascular space (PVS) has been considered as an imaging biomarker of small vessel disease, but its effect on cognitive decline in PD is yet to be investigated. Objective The objective of this study was to evaluate whether PVS can independently predict cognitive decline in PD. Methods A total of 271 PD patients were divided into 106 patients with intact cognition (PD-IC) and 165 patients with mild cognitive impairment (PD-MCI). After a mean follow-up of 5.0 +/- 2.3 years, 18 PD-IC patients showed cognitive decline to PD-MCI and 34 PD-MCI patients showed cognitive decline to dementia. PVS was rated in the basal ganglia (BG) and centrum semiovale using a 4-point visual scale and then classified as high (score >= 2) or low (score < 2) according to severity. Lacunes and white matter hyperintensity severity were also assessed. Independent risk factors for cognitive decline were investigated using multivariable logistic regression analysis. Results In all patients, higher BG-PVS and white matter hyperintensity severity, higher levodopa-equivalent dose, hypertension, and lower Mini-Mental State Examination score were independent positive predictors of future cognitive decline. In the PD-IC subgroup, higher BG-PVS severity, hypertension, and more severe depressive symptoms were predictors of cognitive conversion. In the PD-MCI subgroup, higher BG-PVS and white matter hyperintensity severity, and lower Mini-Mental State Examination score were predictors of cognitive decline. Conclusions BG-PVS may be a useful imaging marker for predicting cognitive decline in PD. (c) 2019 International Parkinson and Movement Disorder Society