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Motor Function Is Associated with Cerebral Small Vessel Disease and Can Predict Mortality and Poor Functional Outcome
Megumi Hosoya1, Sono Toi1,2, Misa Seki1
1Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Introduction:
The primary objective of this study was to elucidate the predictive role of subtle motor impairment evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) Part III on mortality and functional outcome. The secondary objective was to evaluate the association of motor impairment with small vessel disease (SVD) severity.
Methods:
We derived data from a Japanese cohort of patients with evidence of SVD who were enrolled from 2015 to 2019, and followed until 2023. The present study included 586 participants who agreed for UPDRS Part III evaluation. The severity of white matter hyperintensities (WMHs) and the presence of lacunes were evaluated. Cox proportional hazard models and multiple logistic regression analysis were used to examine the association between UPDRS Part III score and all-cause death and functional outcome defined by the modified Rankin Scale (mRS) score at the last visit, respectively.
Results:
The median age was 71 years, and the median UPDRS Part III score was 2. The UPDRS Part III score was associated with the severity of WMH (r = 0.225, p < 0.001) and the number (0, 1, ≥2) of lacunes (p < 0.001). During a mean follow-up period of 4.8 years, 29 patients died. The Cox proportional hazard analysis revealed that high UPDRS Part III scores (≥5) were associated with a higher risk of all-cause death compared to low (score 0) and middle (score 1-4) scores (adjusted hazard ratio 3.04; 95% confidence interval, 1.50-7.34, p = 0.005). In multivariate logistic analysis, high UPDRS Part III scores were associated with poor functional outcome (mRS of ≥3) compared with low and middle scores after adjusting for confounding factors (adjusted odds ratio 1.86; 95% confidence interval 1.02-3.41, p = 0.043).
Conclusions:
Subtle motor impairment was associated with the severity of WMH and number of lacunes and could predict mortality and poor functional outcome independently of vascular risk factors and severity of WMH and lacunes.
Insights
Subtle motor impairment, measured by the Unified Parkinson's Disease Rating Scale (UPDRS) Part III, predicts mortality and poor functional outcomes in patients with small vessel disease (SVD). This finding holds true independently of vascular factors.
Area of Science:
- Neurology
- Geriatrics
- Vascular Neurology
Background:
- Small vessel disease (SVD) is a common cerebrovascular condition.
- Subtle motor impairments can be early indicators of neurological dysfunction.
- The Unified Parkinson's Disease Rating Scale (UPDRS) Part III assesses motor function.
Purpose of the Study:
- To determine if subtle motor impairment (UPDRS Part III) predicts mortality and functional outcomes.
- To investigate the association between motor impairment and SVD severity.
Main Methods:
- A Japanese cohort of 586 SVD patients (2015-2023) was analyzed.
- Unified Parkinson's Disease Rating Scale (UPDRS) Part III scores were correlated with white matter hyperintensities (WMHs) and lacunes.
- Cox proportional hazard and logistic regression models assessed mortality and functional outcomes (modified Rankin Scale - mRS).
Main Results:
- UPDRS Part III scores correlated with WMH severity and lacune count.
- High UPDRS Part III scores (≥5) were linked to a 3-fold increased risk of all-cause death.
- High UPDRS Part III scores were also associated with poor functional outcomes (mRS ≥3).
Conclusions:
- Subtle motor impairment is associated with SVD markers like WMH and lacunes.
- UPDRS Part III scores independently predict mortality and poor functional outcomes in SVD patients.
- Early detection of motor impairment may aid in risk stratification for SVD patients.
