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White matter hyperintensities in patients with Parkinson's disease: A systematic review and meta-analysis
Asif Butt1, Joseph Kamtchum-Tatuene2, Khurshid Khan1
1Department of Medicine, Division of Neurology, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada.
Introduction:
Mechanisms driving neurodegeneration in Parkinson's disease (PD) are unclear and neurovascular dysfunction may be a contributing factor. White matter hyperintensities (WMH) are commonly found on brain MRI in patients with PD. It is controversial if they are more prevalent or more severe in PD compared with controls. This systematic review aims to answer this question.
Methods:
A systematic search of electronic databases was conducted for studies of WMH in patients with PD. A qualitative synthesis was done for studies reporting WMH prevalence or WMH scores on a visual rating scale (VRS). In studies reporting total WMH volume, the difference between patients with PD and controls was pooled using random effects meta-analysis.
Results:
Among 3860 subjects from 24 studies, 2360 were cases and 1500 controls. Fifteen studies reported WMH scores and four studies reported the prevalence of WMH. On VRS, five studies reported no difference in WMH scores, three found higher WMH scores in PD compared to controls, three reported increased WMH scores either in periventricular or deep white matter, and four reported higher scores only in PD with dementia. In studies reporting WMH volume, there was no difference between patients with PD and controls (pooled standardized mean difference = 0.1, 95%CI: -0.1-0.4, I2 = 81%).
Conclusion:
WMH are not more prevalent or severe in patients with PD than in age-matched controls. PD dementia may have more severe WMH compared to controls and PD with normal cognition. Prospective studies using standardized methods of WMH assessment are needed.
Insights
White matter hyperintensities (WMH) are not more common in Parkinson's disease (PD) patients than controls. However, PD dementia may be associated with more severe WMH, warranting further investigation.
Area of Science:
- Neurology
- Neuroimaging
- Neurodegeneration
Background:
- Neurovascular dysfunction is a potential contributor to Parkinson's disease (PD) neurodegeneration.
- White matter hyperintensities (WMH) are frequently observed in PD patients' brain MRIs.
- The prevalence and severity of WMH in PD compared to controls remain debated.
Purpose of the Study:
- To systematically review and synthesize evidence on the prevalence and severity of WMH in Parkinson's disease.
- To compare WMH in PD patients versus age-matched controls.
Main Methods:
- Systematic literature search of electronic databases for studies on WMH in PD.
- Qualitative synthesis of studies reporting WMH prevalence or visual rating scale (VRS) scores.
- Random effects meta-analysis for studies reporting total WMH volume.
Main Results:
- Analysis included 24 studies with 3860 subjects (2360 PD cases, 1500 controls).
- No significant difference in WMH scores or volume was found between PD patients and controls (SMD = 0.1, 95% CI: -0.1-0.4).
- Some studies indicated higher WMH scores in PD, particularly in PD with dementia, or in specific white matter regions.
Conclusions:
- WMH are not more prevalent or severe in Parkinson's disease patients compared to controls.
- Parkinson's disease dementia may be associated with more severe WMH than controls or PD with normal cognition.
- Further prospective studies with standardized WMH assessment methods are recommended.
