Objective: To determine whether white matter hyperintensity (WMH) volume and its spatial subtypes, periventricular WMH (PWMH) and deep WMH (DWMH), are associated with cognitive impairment and motor severity in Parkinson’s disease (PD).

Background: White matter damage quantified as WMH may exacerbate cognitive and motor deficits. Whether and how WMH burden affects these impairments in PD remains incompletely understood, as previous results were somewhat inconsistent. Reliable quantification of WMHs is essential for understanding their clinical impact.

Method: A total of 127 patients with PD were included, comprising 52 cognitively normal patients (PD-N) and 75 patients with cognitive impairment (PD-CI). An ensemble triplanar network that combines predictions from three planes of brain MR images was adopted for automatic WMH segmentation [1]. The segment method generates individual-space WMH probability maps and ventricular distance maps based on T1-weighted and T2-FlAIR MR images. All segmentation outputs were visually checked without manual correction. The WMH was further divided into PWMH and DWMH using a threshold of 10mm from the lateral ventricles. The volumes of WMH, PWMH, and DWMH were standardized by the estimated total intracranial volume (TIV). Cognitive assessment included orientation, attention, language, visuospatial ability, and delayed recall. Motor severity was evaluated using the Hoehn and Yahr (H–Y) staging and the Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III).

Results: Compared with PD-N, patients with PD-CI exhibited significantly higher WMH and PWMH volumes, whereas no significant difference was observed in DWMH. In all PD patients, WMH and PWMH were significantly associated with age (p < 0.05). After adjusting for age, sex, and educational level, the WMH and PWMH were negatively correlated with place orientation, but were not correlated with other cognitive domains or motor severity. The DWMH was not correlated with any cognitive or motor measurements.

Conclusion: This study tested a reliable method to segment WMH in PD. The WMH burden, particularly PWMH, increases with aging, but has a limited impact on cognitive impairment and motor dysfunction in PD in the current study.

References: Sundaresan, V., et al., Triplanar ensemble U-Net model for white matter hyperintensities segmentation on MR images. Med Image Anal, 2021. 73: p. 102184.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/white-matter-hyperintensity-and-the-spatial-subtypes-in-parkinsons-disease/