Objective: This study aims to evaluate the presence of differences in cortical morphometry and subcortical volumetry in tremor dominant Parkinson’s disease (TDPD) and postural instability and gait disturbance (PIGD) subtypes of PD.

Background: TDPD and PIGD are distinct motor subtypes of PD, and the possibility of differences in pathophysiology specifically related to regions of brain involvement has been suggested.

Method: Data was analyzed for 73 patients with TDPD and 61 patients with PIGD who were prospectively recruited in the Young and late onset Parkinson’s disease (YLOPD) study, funded by the Scientific Knowledge for Ageing and Neurological ailments (SKAN) research trust at the National Institute of Mental Health and Neuro Sciences, Bengaluru, India from July 2022 to October 2023. All subjects underwent detailed clinical assessment including the MDS-UPDRS and MDS-NMS.  The “recon-all” function from Freesurfer v7.3.2 was used to estimate the cortical thickness and subcortical volumes for all subjects. Statistical analysis was carried out with age, gender, duration of illness and total intracranial volume as covariates, with p<0.05 considered to be significant..

Results: There was no difference in the age at assessment, gender, age at onset, and MDS-UPDRS III score between TDPD and PIGD. However, PIGD has a significantly longer duration of illness, and higher MDS-UPDRS Part I, II, H&Y stage and levodopa equivalence dose. Higher MDS-NMS total score and urinary and sleep subdomain scores were observed in the PIGD variant. PIGD showed significant thinning of bilateral inferior parietal, lateral occipital, lingual and supramarginal cortex, left post central, precuneus, and right parahippocampal gyrus and entorhinal cortex.  Significant volume loss of the anterior corpus callosum and right accumbens was also observed in PIGD.

Conclusion: Patients with PIGD have significant alterations in cortical morphometry and subcortical volumes in comparison to TDPD. These regions probably contribute to the higher burden NMS observed in PIGD and substantiate the concept of higher disease burden in this variant.

Regions with cortical thinning in PIGD PD

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cortical-morphometry-and-subcortical-volumetry-in-motor-subtypes-of-parkinsons-disease/