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Frontal white matter injuries predestine gait difficulties in Parkinson's disease
Author(s) -
Lenfeldt N.,
Holmlund H.,
Larsson A.,
Birgander R.,
Forsgren L.
Publication year - 2016
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12532
Subject(s) - fractional anisotropy , white matter , diffusion mri , basal ganglia , grey matter , parkinson's disease , medicine , internal capsule , psychology , cardiology , physical medicine and rehabilitation , magnetic resonance imaging , disease , radiology , central nervous system
Objectives This study applies diffusion tensor imaging ( DTI ) to determine differences in neuronal integrity between motor phenotypes in Parkinson's disease. Material and Methods One hundred and twenty‐two patients (47 females, mean age = 70.3 years) were included at baseline. Forty patients were tremor dominant ( TD ), 64 had postural imbalance and gait difficulty ( PIGD ), and 18 patients were indeterminate. The DTI was repeated after one, three and 5 years, including reassessment of phenotype. DTI was quantified using fractional anisotropy ( FA ), and mean, radial and axial diffusion. Targeted white matter involved six regions of interests ( ROI s) in prefrontal cortex ( PFC ), the entrance to the external capsule ( EEC ) and lateral to the horn of the anterior ventricle ( LVAH ). Grey matter involved the basal ganglia. Data were analysed using mixed linear models with P < 0.05 (Bonferroni corrected) as significance threshold. Results PIGD and Indeterminate had reduced FA and axial diffusion in PFC , EEC and LVAH compared to Tremor dominant ( P < 0.05). Basal ganglia showed no differences. Post hoc analysis showed that FA correlated negatively, and mean and radial diffusion positively, to PIGD symptoms in EEC , LVAH and four ROI s in PFC ( P < 0.05). Tremor symptoms showed no correlations. Patients converting to PIGD and Indeterminate had lower FA , and higher mean and radial diffusion, at baseline in EEC , LVAH and four areas in PFC compared to non‐converting patients ( P < 0.05). Conclusion Degeneration in frontal white matter is connected to PIGD symptoms in Parkinson's disease and if present at an early stage, the risk for conversion to the PIGD phenotype increases.