The severity of leukoaraiosis correlates with the clinical phenotype of Parkinson's disease.

The impact of leukoaraiosis on Parkinson's disease (PD) has not been completely explained. We evaluated 141 patients with PD to assess the role of leukoaraiosis and determined its influence on the clinical phenotype of PD. Clinical assessments during off medication and leukoaraiosis grading were performed according to the atherosclerosis risk in communities (ARIC) study. Patients were grouped into two phenotypes, tremor or postural instability and gait difficulty (PIGD)-dominant groups. Associations between the age at onset, gender, disease duration, cardiovascular risk factors, leukoaraiosis grade and the disease phenotype were analyzed. In addition, the role of the leukoaraiosis grade in relationship to the parkinsonian motor handicaps was evaluated. The leukoaraiosis correlated with the severity of the clinical symptoms of PD as measured by the United Parkinson's disease rating scale (UPDRS) scores and the Hoehn and Yahr (H + Y) stage. There were significant correlations observed between the leukoaraiosis grade and specific motor handicaps especially those with axial symptoms. Multivariate logistic regression analysis showed that the leukoaraiosis grade was independently associated with the PIGD motor phenotype of PD. The leukoaraiosis grade was independently associated with the PIGD motor phenotype of PD; this might be explained by the affects on nondopaminergic subcortical pathways. These results have implications for clinical management of PD with regard to the control of vascular risk factors.

[1]  V. Hachinski,et al.  Leukoaraiosis: reifying rarefaction. , 2000, Archives of neurology.

[2]  W. Pirker,et al.  Correlation of dopamine transporter imaging with parkinsonian motor handicap: How close is it? , 2003, Movement disorders : official journal of the Movement Disorder Society.

[3]  P. Scheltens,et al.  White matter lesions on magnetic resonance imaging in dementia with Lewy bodies, Alzheimer’s disease, vascular dementia, and normal aging , 1999, Journal of neurology, neurosurgery, and psychiatry.

[4]  J F Toole,et al.  Presence and severity of cerebral white matter lesions and hypertension, its treatment, and its control. The ARIC Study. Atherosclerosis Risk in Communities Study. , 1996, Stroke.

[5]  Kwang-Soo Lee,et al.  Cardiac [123I]metaiodobenzylguanidine scintigraphy for vascular Parkinsonism , 2006, Movement disorders : official journal of the Movement Disorder Society.

[6]  A. Graybiel,et al.  The efficacy of levodopa treatment declines in the course of Parkinson's disease: do nondopaminergic lesions play a role? , 1990, Advances in neurology.

[7]  F Lhermitte,et al.  Does long‐term aggravation of Parkinson's disease result from nondopaminergic lesions? , 1987, Neurology.

[8]  NobuhikoMiyazawa,et al.  Xenon Contrast CT-CBF Measurements in High-Intensity Foci on T2-Weighted MR Images in Centrum Semiovale of Asymptomatic Individuals , 1997 .

[9]  R W Baloh,et al.  White matter lesions and disequilibrium in older people. II. Clinicopathologic correlation. , 1995, Archives of neurology.

[10]  J. Bogousslavsky,et al.  What is the significance of leukoaraiosis in patients with acute ischemic stroke? , 2000, Archives of neurology.

[11]  Ivan Rektor,et al.  Vascular parkinsonism — an update , 2006, Journal of the Neurological Sciences.

[12]  R. Camicioli,et al.  Axial Signs and Magnetic Resonance Imaging Correlates in Parkinson's Disease , 2007, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[13]  R. Klein,et al.  Cerebral white matter lesions, retinopathy, and incident clinical stroke. , 2002, JAMA.

[14]  M. Weinrich,et al.  Axial versus distal motor impairment in Parkinson's disease , 1988, Neurology.

[15]  Wenhua Liu.  Vascular Parkinsonism , 2004 .

[16]  O. J. Greve,et al.  Visual rating of white matter hyperintensities in Parkinson's disease , 2006, Movement disorders : official journal of the Movement Disorder Society.

[17]  I. Awad,et al.  Pathogenesis of Subcortical Hyperintense Lesions on Magnetic Resonance Imaging of the Brain: Observations in Patients Undergoing Controlled Therapeutic Internal Carotid Artery Occlusion , 1993, Stroke.

[18]  J. Jankovic,et al.  Variable expression of Parkinson's disease , 1990, Neurology.

[19]  N. Quinn,et al.  Vascular parkinsonism , 2004, Journal of Neurology.

[20]  Andrew J Lees,et al.  Clinicopathological investigation of vascular parkinsonism, including clinical criteria for diagnosis , 2004, Movement disorders : official journal of the Movement Disorder Society.

[21]  S. Papapetropoulos,et al.  The effect of vascular disease on late onset Parkinson's disease , 2004, European journal of neurology.

[22]  M. O’Sullivan,et al.  Patterns of cerebral blood flow reduction in patients with ischemic leukoaraiosis , 2002, Neurology.

[23]  H. Braak,et al.  Pathoanatomy of Parkinson’s disease , 2000, Journal of Neurology.

[24]  A. Lees,et al.  A clinicopathologic study of 100 cases of Parkinson's disease. , 1993, Archives of neurology.

[25]  Dariusz Wieczorek,et al.  The influence of vascular risk factors and white matter hyperintensities on the degree of cognitive impairment in Parkinson's disease. , 2008, Neurologia i neurochirurgia polska.

[26]  R W Baloh,et al.  White matter lesions and disequilibrium in older people. I. Case-control comparison. , 1995, Archives of neurology.

[27]  D R Rajput,et al.  Accuracy of clinical diagnosis of idiopathic Parkinson's disease. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[28]  A. Zwinderman,et al.  Influence of dopaminergic medication on automatic postural responses and balance impairment in Parkinson's disease , 1996, Movement disorders : official journal of the Movement Disorder Society.

[29]  P. Piccini,et al.  White matter hyperintensities in Parkinson's disease. Clinical correlations. , 1995, Archives of neurology.

[30]  T. Kurki,et al.  Relationship between vascular factors and white matter low attenuation of the brain , 1993, Acta neurologica Scandinavica.

[31]  T. Erkinjuntti,et al.  White matter hyperintensities on MRI in the neurologically nondiseased elderly. Analysis of cohorts of consecutive subjects aged 55 to 85 years living at home. , 1995, Stroke.

[32]  T. Olsen,et al.  Leukoaraiosis in stroke patients. The Copenhagen Stroke Study. , 1995, Stroke.

[33]  Y H Sohn,et al.  The influence of white matter hyperintensities on the clinical features of Parkinson's disease. , 1998, Yonsei medical journal.

[34]  J. Jankovic,et al.  Clinical correlates of vascular parkinsonism. , 1999, Archives of neurology.

[35]  T. Bekinschtein,et al.  White matter hyperintensities are significantly associated with cortical atrophy in Alzheimer’s disease , 2004, Journal of Neurology, Neurosurgery & Psychiatry.