White matter hyperintensities as a predictor of freezing of gait in Parkinson's disease
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Seok Jong Chung1, Yang Hyun Lee2, Han Soo Yoo2
1Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea.
Introduction:
To investigate the effect of white matter hyperintensities (WMH) on long-term motor outcomes in Parkinson's disease (PD).
Methods:
We retrospectively reviewed medical records of 268 patients with de novo PD (follow-up > 3 years). According to the Clinical Research Center for Dementia of South Korea (CREDOS) WMH visual rating scale scores, the patients were divided into two groups: a PD group with minimal WMH (PD-WMH-; n = 198) and a PD group with moderate to severe WMH (PD-WMH+; n = 70). We compared longitudinal increases in doses of dopaminergic medications between the two groups using a mixed model. We also assessed the effects of WMH on the development of freezing of gait (FOG).
Results:
Patients in the PD-WMH + group were older than those in the PD-WMH- group, and had more severe motor deficits and more severely decreased striatal dopamine transporter availability. The PD-WMH + group required higher doses of dopaminergic medications for symptom control, compared to the PD-WMH- group, over the follow-up period. After adjusting for age, sex, striatal dopamine transporter availability, and levodopa-equivalent dose, the PD-WMH + group showed a higher risk of developing FOG (HR, 3.29; 95% CI, 1.79-6.05; p < 0.001) than the PD-WMH- group.
Conclusion:
This study demonstrates that WMH burden negatively affects the longitudinal requirement of dopaminergic medication and the development of FOG. These findings suggest that baseline WMH severity or volume may be a useful prognostic marker of motor outcomes in PD.
Insights
White matter hyperintensities (WMH) in Parkinson's disease (PD) patients are linked to increased medication needs and higher risk of developing freezing of gait (FOG). Baseline WMH severity may predict motor outcome in PD.
Area of Science:
- Neurology
- Neuroimaging
- Movement Disorders
Background:
- Parkinson's disease (PD) is a neurodegenerative disorder primarily affecting motor function.
- White matter hyperintensities (WMH) are common in aging and can be associated with various neurological conditions.
- The impact of WMH on the long-term progression of motor symptoms in PD remains an area of active investigation.
Purpose of the Study:
- To investigate the association between white matter hyperintensities (WMH) and long-term motor outcomes in patients with de novo Parkinson's disease (PD).
- To determine if WMH burden influences the need for dopaminergic medication and the development of freezing of gait (FOG).
Main Methods:
- Retrospective review of medical records for 268 de novo PD patients with over 3 years of follow-up.
- Patients classified into two groups based on WMH severity using the Clinical Research Center for Dementia of South Korea (CREDOS) WMH visual rating scale: minimal WMH (PD-WMH-) and moderate to severe WMH (PD-WMH+).
- Comparison of longitudinal increases in dopaminergic medication doses and assessment of FOG development using mixed models and survival analysis, adjusting for relevant covariates.
Main Results:
- Patients with moderate to severe WMH (PD-WMH+) were older, had more severe motor deficits, and reduced striatal dopamine transporter availability compared to the PD-WMH- group.
- The PD-WMH+ group required significantly higher doses of dopaminergic medications over the follow-up period.
- After adjustment, the PD-WMH+ group exhibited a 3.29-fold higher risk of developing freezing of gait (FOG) (p < 0.001).
Conclusions:
- WMH burden significantly impacts the longitudinal requirement for dopaminergic medication in PD patients.
- Increased WMH severity is associated with a higher risk of developing freezing of gait (FOG) in Parkinson's disease.
- Baseline WMH severity may serve as a valuable prognostic marker for predicting motor outcomes in PD.