title: Cerebral white matter lesions and lacunar infarcts contribute to the presence of mild parkinsonian signs.
abstract: OBJECTIVE
  Mild parkinsonian signs (MPS) are common in elderly people and may be an early stage of parkinson(ism). They might be related to cerebral small-vessel disease, although this association remains incompletely understood. To identify subjects at early stages of the disease, we investigated whether the presence of MPS was dependent on the severity and location of small-vessel disease, including white matter lesions and lacunar infarcts.
  
  
  METHODS
  Four hundred thirty individuals, with small-vessel disease, aged between 50 and 85 years, without dementia or parkinsonism, were included in this analysis and underwent MRI scanning. The number and location of lacunar infarcts were rated. White matter lesion volume was assessed by manual segmentation with automated delineating of different regions. Presence of MPS was based on the motor section of the Unified Parkinson's Disease Rating Scale. Associations were determined using logistic regression analysis adjusted for age, sex, and total brain volume.
  
  
  RESULTS
  Severe white matter lesions and the presence of lacunar infarcts were independently associated with the presence of MPS (OR, 2.6; 95% CI, 1.3-4.9 and OR, 1.8; 95% CI, 1.0-3.0). Frontal and parietal white matter lesions and, to a lesser extent, lacunar infarcts in the thalamus were associated with a higher risk of MPS. The presence of lacunar infarcts was independently related to the bradykinesia category of parkinsonian signs.
  
  
  CONCLUSIONS
  This study shows that severe small-vessel disease, especially at certain locations, is associated with MPS signs in older adults. Our findings suggest that small-vessel disease interrupts basal ganglia-thalamocortical circuits involving both the frontal and parietal lobes and hence may result in MPS.
authors.affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: Karlijn F
authors.initials: KF
authors.lastname: de Laat
authors.forename: Anouk G W
authors.initials: AG
authors.lastname: van Norden
authors.forename: Rob A R
authors.initials: RA
authors.lastname: Gons
authors.forename: Inge W M
authors.initials: IW
authors.lastname: van Uden
authors.forename: Marcel P
authors.initials: MP
authors.lastname: Zwiers
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
authors.forename: Ewoud J
authors.initials: EJ
authors.lastname: van Dijk
authors.forename: Frank-Erik
authors.initials: FE
authors.lastname: de Leeuw
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001479:Basal Ganglia / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000150:complications* / Q000473:pathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D059409:Stroke, Lacunar / Q000150:complications* / Q000473:pathology; D013788:Thalamus / Q000473:pathology / Q000503:physiopathology