Lacunes independent imaging markers that predict acceleration of Parkinson's disease

China: A new study found that Lacunes are independent imaging markers that accelerate the course of Parkinson's disease (PD) by worsening visual scanning, attention, and processing speed in patients with PD. The study results were published in the journal Brain and Behavior.  

Parkinson's disease is a neurodegenerative, chronic, and progressive disease characterized by bradykinesia, rest tremor, rigidity, and gait/posture instability. The cognitive and motor function in PD can be worsened by Cerebral small vessel disease. Lacunes are the imaging markers of cerebral small vessel disease that frequently occur in patients with PD. As past literature has shown the relation between Cerebral small vessel disease and PD, Keke Chen et al from China conducted a study to investigate the associations of lacunes, cognition, and motor function in patients with Parkinson's disease (PD) and whether these associations are independent of other imaging markers. 

The study was carried out by including patients from Beijing Rehabilitation Hospital between April 2019 to July 2022.  All the participants underwent brain magnetic resonance imaging scans, clinical scale evaluations, and neuropsychological tests, as well as quantitative evaluation of postural control. Multivariate linear regression models were constructed to sort out the effect of lacunes and to eliminate the possible factors contributing to cognition and motor dysfunction in patients with PD, in particular white matter hyperintensities and enlarged perivascular space in the basal ganglia. 

Key findings: 

• Nearly 94 patients enrolled in this study, where 56 were without lacunes and 38 with lacunes.
• Lacunes patients exhibited shorter disease duration, and slower gait speed and spent more time on Trail-Making Test part A (TMT-A) than those without lacunes.
• There was a positive correlation between the number of lacunes and the time to complete the TMT-A and a negative correlation related to gait speed.
• The presence of lacunes was associated with longer TMT-A time as shown by the Multivariate linear regression models after adjusting for potential confounders. 

Thus, this study is the first of its kind to show that lacunes were independently associated with worse visual scanning, attention, and processing speed in patients with PD. The motor and cognitive dysfunction in these patients can be mitigated by early management of vascular disease. 

Further reading: Chen K, Jin Z, Fang J, et al. Lacunes may worsen cognition but not motor function in Parkinson's disease [published online ahead of print, 2022 Dec 31]. Brain Behav. 2022;e2880. doi: 10.1002/brb3.2880