Objective: The purpose of the present study was to compare alterations of brain white-matter microstructure and tissue integrity in PSP-RS and VaP patients using Diffusion Tensor Imaging (DTI).

Background: Interestingly, patients of PSP with Richardson’s syndrome (PSP-RS) and vascular parkinsonism (VaP) often present with similar motor symptom resulting in a significant diagnostic overlap.

Method: Six PSP-RS and 5 VaP patients as diagnosed by a movement disorder neurologist (HK) were enrolled in the study. Changes in DTI fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were studied using whole brain tract based spatial statistics (TBSS). Statistical inference was obtained using a non-parametric method called Threshold-Free Cluster Enhancement (TFCE) with 500 permutations. Changes were considered significant at the level of P <0.05, which was fully corrected for multiple comparisons.

Results: The two groups were matched for age (p= 0.577), and disease duration (p=0.262). Quantitative gait analysis showed similar gait velocity (p= 0.386) in both these group. TBSS revealed widespread differences in WM integrity in VaP and PSP-RS (Figure 1). Patients with VaP showed significant decreases in FA and increases in MD, RD, and AD in the bilateral anterior thalamic radiation, corticospinal tract, Inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, superior longitudinal fasciculus when compared to PSP-RS.

Conclusion: This study provides a comprehensive characterization of white matter alterations in VaP and PSP-RS patients with similar age group, disease duration and gait velocity. Our findings might be used to identify clinico-radiological markers of these diseases in future and may aid in differentiating early cases of these two diseases with overlapping clinical symptoms.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/white-matter-integrity-in-patients-with-psp-rs-and-vap-a-tbss-study/