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Neurology. 2015 Nov 3;85(18):1569-77. doi: 10.1212/WNL.0000000000002082. Epub 2015 Oct 7.

Cerebral small vessel disease and incident parkinsonism: The RUN DMC study.

Author information

1
From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands.
2
From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands. frankerik.deleeuw@radboudumc.nl.

Abstract

OBJECTIVE:

To investigate the relation between baseline cerebral small vessel disease (SVD) and the risk of incident parkinsonism using different MRI and diffusion tensor imaging (DTI) measures.

METHODS:

In the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study, a prospective cohort study, 503 elderly participants with SVD and without parkinsonism were included in 2006. During follow-up (2011-2012), parkinsonism was diagnosed according to UK Brain Bank criteria. Cox regression analysis was used to investigate the association between baseline imaging measures and incident all-cause parkinsonism and vascular parkinsonism (VP). Tract-based spatial statistics analysis was used to identify differences in baseline DTI measures of white matter (WM) tracts between participants with VP and without parkinsonism.

RESULTS:

Follow-up was available from 501 participants (mean age 65.6 years; mean follow-up duration 5.2 years). Parkinsonism developed in 20 participants; 15 were diagnosed with VP. The 5-year risk of (any) parkinsonism was increased for those with a high white matter hyperintensity (WMH) volume (hazard ratio [HR] 1.8 per SD increase, 95% confidence interval [CI] 1.3-2.4) and a high number of lacunes (HR 1.4 per number increase, 95% CI 1.1-1.8) at baseline. For VP, this risk was also increased by the presence of microbleeds (HR 5.7, 95% CI 1.9-16.8) and a low gray matter volume (HR 0.4 per SD increase, 95% CI 0.2-0.8). Lower fractional anisotropy values in bifrontal WM tracts involved in movement control were observed in participants with VP compared to participants without parkinsonism.

CONCLUSIONS:

SVD at baseline, especially a high WMH volume and a high number of lacunes, is associated with incident parkinsonism. Our findings favor a role of SVD in the etiology of parkinsonism.

Comment in

PMID:
26446068
PMCID:
PMC4642143
DOI:
10.1212/WNL.0000000000002082
[Indexed for MEDLINE]
Free PMC Article

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