- •Motor dysfunction in Parkinson's Disease (PD) is apparently multifactorial.
- •Attributing the appropriate motor phenotype requires a prolonged clinical observation.
- •Comorbid white matter disease is important in the development of the motor phenotype of PD.
- •Comorbidities only give a partial contribution in defining the motor subtype, compared to white matter disease.
- •Gender is important in defining the motor course of PD.
Parkinson's Disease (PD) patients are usually divided into Tremor Dominant (TD) and Postural Instability/Gait Difficulty (PIGD) subtypes. The latter is characterized by axial motor symptoms and worse outcomes, possibly also because of comorbid white matter disease. Therefore, the current study investigated the importance of Age-Related White Matter Changes (ARWMCs) in the development of different PD motor phenotypes.
The present 4-year longitudinal study recruited 63 de novo PD patients, who underwent MRI at the time of the diagnosis to rate ARWMCs. Motor subtypes (PIGD or TD) were evaluated at baseline visit, and after 2 and 4 years. Age, gender, UPDRS part III total score, comorbidities and ARWMC total score were included in a mixed effect logistic regression model for repeated measures.
The likelihood of being PIGD subtype during the study period was associated with higher ARWMC total score (OR = 2.743; 95%CI = 1.137–7.802), but not with age (OR = 0.967; 95%CI = 0.818–1.143), female gender (OR = 0.169; 95%CI = 0.014–1.970), UPDRS part III total score (OR = 1.942; 95%CI = 0.888–13.470), and comorbidities (OR = 2.979; 95%CI = 0.560–15.849).
Motor dysfunction in PD is apparently multifactorial and, in particular, comorbid white matter disease might concur in the development of axial impairment.
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- Variable expression of Parkinson's disease: a base-line analysis of the DATATOP cohort. The Parkinson study group..Neurology. 1990; 40: 1529-1534
- The CamPaIGN study of Parkinson's disease: 10-year outlook in an incident population-based cohort.J. Neurol. Neurosurg. Psychiatry. 2013; 84: 1258-1264https://doi.org/10.1136/jnnp-2013-305277
- Heterogeneity among patients with Parkinson's disease: cluster analysis and genetic association.J. Neurol. Sci. 2015; 351: 41-45https://doi.org/10.1016/j.jns.2015.02.029
- Changes in motor subtype and risk for incident dementia in Parkinson's disease.Mov. Disord. 2006; 21: 1123-1130https://doi.org/10.1002/mds.20897
- White matter lesions in Parkinson disease.Nat. Rev. Neurol. 2011; 7: 229-236https://doi.org/10.1016/j.biotechadv.2011.08.021
- The severity of leukoaraiosis correlates with the clinical phenotype of Parkinson's disease.Arch. Gerontol. Geriatr. 2009; 49: 255-259https://doi.org/10.1016/j.archger.2008.09.005
- Greater loss of white matter integrity in postural instability and gait difficulty subtype of Parkinson's disease.Can. J. Neurol. Sci. 2014; 41: 763-769https://doi.org/10.1017/cjn.2014.34
- Leucoaraiosis, nigrostraital denervation and motor symptoms in Parkinson's disease.Brain. 2011; 134: 2358-2365https://doi.org/10.1093/brain/awr139
- Axial signs and magnetic resonance imaging correlates in Parkinson's disease.Can. J. Neurol. Sci. 2007; 34: 56-61
- The effect of vascular disease on late onset Parkinson's disease.Eur. J. Neurol. 2004; 11: 231-235https://doi.org/10.1046/j.1468-1331.2003.00748.x
- Modifiable cardiovascular risk factors and axial motor impairments in Parkinson disease.Neurology. 2014; 82: 1514-1520
- Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.J. Neurol. Neurosurg. Psychiatry. 1992; 55: 181-184https://doi.org/10.1136/jnnp.55.3.181
- Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis.Mov. Disord. 2004; 19: 630-640https://doi.org/10.1002/mds.20083
- How to weight chronic diseases in multimorbidity indices? Development of a new method on the basis of individual data from five population-based studies.J. Clin. Epidemiol. 2012; 65: 679-685https://doi.org/10.1016/j.jclinepi.2011.11.006
- A four-year longitudinal study on restless legs syndrome in Parkinson disease.Sleep. 2016; 39: 405-412https://doi.org/10.5665/sleep.5452
- Systematic review of levodopa dose equivalency reporting in Parkinson's disease.Mov. Disord. 2010; 25: 2649-2653https://doi.org/10.1002/mds.23429
- A new rating scale for age-related white matter changes applicable to MRI and CT.Stroke. 2001; 32: 1318-1322https://doi.org/10.1161/01.STR.32.6.1318
- Impact of white matter hyperintensities scoring method on correlations with clinical data: the LADIS study.Stroke. 2006; 37: 836-840https://doi.org/10.1161/01.STR.0000202585.26325.74
- National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards.Stroke. 2006; 37: 2220-2241https://doi.org/10.1161/01.STR.0000237236.88823.47
- Operational definitions improve reliability of the age-related white matter changes scale.Eur. J. Neurol. 2011; 18: 744-749https://doi.org/10.1111/j.1468-1331.2010.03272.x
- White matter hyperintensities in Parkinson's disease: do they explain the disparity between the postural instability gait difficulty and tremor dominant subtypes?.PLoS ONE. 2013; 8e55193https://doi.org/10.1371/journal.pone.0055193
- Dopamine transporter availability in motor subtypes of de novo drug-naïve Parkinson's disease.J. Neurol. 2014; 261: 2112-2118https://doi.org/10.1007/s00415-014-7459-8
- The effect of tremor onset on middle cerebellar peduncle of Parkinson's disease.J. Neurol. Sci. 2015; 358: 172-177https://doi.org/10.1016/j.jns.2015.08.1531
- Differential effect of environmental risk factors on postural instability gait difficulties and tremor dominant Parkinson's disease.Mov. Disord. 2010; 25: 1847-1852https://doi.org/10.1002/mds.23178
- Non-motor correlates of smoking habits in de Novo Parkinson's disease.J Parkinsons Dis. 2015; 5: 913-924https://doi.org/10.3233/JPD-150639
- Case-control study of risk of Parkinson's disease in relation to hypertension, hypercholesterolemia, and diabetes in Japan.J. Neurol. Sci. 2010; 293: 82-86https://doi.org/10.1016/j.jns.2010.03.002
- Cortical thickness in de novo patients with Parkinson disease and mild cognitive impairment with consideration of clinical phenotype and motor laterality.Eur. J. Neurol. 2015; 22: 1564-1572https://doi.org/10.1111/ene.12785
- Analysis among cognitive profiles and gray matter volume in newly diagnosed Parkinson's disease with mild cognitive impairment.J. Neurol. Sci. 2014; 347: 210-213https://doi.org/10.1016/j.jns.2014.09.049
- The Framingham cardiovascular risk score in multiple sclerosis.Eur. J. Neurol. 2015; 22: 1176-1183https://doi.org/10.1111/ene.12720
- Gender differences in non-motor symptoms in early Parkinson's disease: a 2-years follow-up study on previously untreated patients.Parkinsonism Relat. Disord. 2014; 20: 850-854https://doi.org/10.1016/j.parkreldis.2014.04.023
- Gender differences in motor and non-motor symptoms among Sardinian patients with Parkinson's disease.J. Neurol. Sci. 2012; 323: 33-39https://doi.org/10.1016/j.jns.2012.07.026
- Characterization of cerebral microbleeds in idiopathic Parkinson's disease.Eur. J. Neurol. 2015; 22: 377-383https://doi.org/10.1111/ene.12584
- Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration.Lancet Neurol. 2013; 12: 822-838https://doi.org/10.1016/S1474-4422(13)70124-8
- The prevalence and risk factors of cerebral microbleeds in patients with Parkinson's disease.Parkinsonism Relat. Disord. 2015; 21: 1076-1081https://doi.org/10.1016/j.parkreldis.2015.06.019
- Differential neuropsychological profiles in Parkinsonian patients with or without vascular lesions.Mov. Disord. 2010; 25: 50-56https://doi.org/10.1002/mds.22893
- The age-related white matter changes scale correlates with cognitive impairment.Eur. J. Neurol. 2010; 17: 1451-1456https://doi.org/10.1111/j.1468-1331.2010.03078.x
- Does motor subtype influence neurocognitive performance in Parkinson's disease without dementia ?.Eur. J. Neurol. 2008; 15: 262-267https://doi.org/10.1111/j.1468-1331.2007.02046.x
Published online: June 08, 2016
Accepted: June 7, 2016
Received in revised form: May 7, 2016
Received: March 16, 2016
© 2016 Elsevier B.V. All rights reserved.