Cerebral Microbleeds are Associated with Postural Instability and Gait Disturbance Subtype in People with Parkinson’s Disease

Abstract

Objectives: The motor symptoms of Parkinson’s disease (PD) vary among patients and have been categorized into 3 subtypes: tremor dominant, akinetic rigidity, and postural instability and gait disturbance (PIGD). Cerebral microbleed (CMB) is prevalent in people with PD and is associated with some nonmotor symptoms. The present study investigated the association between CMB and the motor subtypes of PD. Materials and Methods: From 2009 to 2017, medical records and brain magnetic resonance imaging (MRI) reports of 134 Taiwanese people with early- and mid-stage PD were reviewed. CMBs were quantified according to the Microbleed Anatomical Rating Scale through susceptibility-weighted MRI. Motor subtypes were determined by medical chart review. Student’s t test and multivariable logistic regression were used to analyze the association between the motor subtypes and CMB. Statistical analyses were performed using SPSS 19.0. Results: Overall, 72 (53.7%) participants were women with a mean age of 69.5 ± 9.8 years. The prevalence of CMB was 33.6%, and lobar, deep, and infratentorial CMBs comprised 21.6, 19.4, and 11.9% of cases, respectively. PIGD subtype PD was associated with a significantly higher prevalence of any CMB as well as deep or lobar CMB. After adjustment for age and sex, the PIGD subtype was significantly positively associated with the presence of any, deep, and white matter (WM) and thalamic CMB. Conclusions: CMB was prevalent in Taiwanese people with early- and mid-stage PD, especially the PIGD subtype. Deep, especially thalamic and WM, CMBs exhibited the highest association with the PIGD subtype.

Neuroimaging Detectable Differences between Parkinson's Disease Motor Subtypes: A Systematic Review

“…A recent study using ASL showed TD to have more hypoperfusion in the temporo–parieto–frontal network while PIGD showed hypoperfusion in a predominantly posterior pattern as well as hyperperfusion in the BG, although these differences were removed when levodopa medication, and disease severity and duration were controlled for 27 . Comparatively, in a recent structural study PIGD were associated with an increased prevalence of thalamic and WM cerebral microbleeds (ie, small chronic brain hemorrhages caused by abnormalities of small brain vessels) when compared to TD and AR 92 . These results suggest that CBF and other cerebral blood parameters could be valuable imaging techniques to differentiate between PD subtypes.…”

Plasma Exosomal Brain-Derived Neurotrophic Factor Correlated with the Postural Instability and Gait Disturbance–Related Motor Symptoms in Patients with Parkinson’s Disease

“…Distinct from other subtypes, PIGD is characterized by rapid progression, comorbidity with cognitive dysfunction, and motor symptoms that are unresponsive to levodopa treatment [20]. Several brain conditions are associated with PIGD, including gray matter atrophy [34], basal ganglia dysfunction [35], white matter lesions [36], and cerebral microbleeds [37], indicating a multifaceted brain pathology. Motor learning is crucial for the control of postural stability and gait.…”

Impact of Cerebral Microbleeds on Lower and Upper Extremities Function in Cerebral Small Vessel Disease

“…However, the exploration between movement disorder and CMB still rare and the conclusion was controversial. Only two studies have found the number of CMBs is related to gait disturbances [10,11] and most other studies did not nd positive results between CMBs and motor performance [3,12,13], which implied the relationship between gait and CMB was still unclear and need further exploration.…”