Objective: To evaluate the total cerebral small vessel disease (CSVD) score in patients with Parkinson’s disease at different stages and its related factors.

Background: Parkinson’s disease (PD) is a common neurodegenerative disease, but the mechanism is unclear. CSVD have been proven to contribute to motor and cognitive function in PD. Total SVD score/burden was used to assess the neuroimaging markers in SVD, including ALIs, high-grade WMH, EPVS in basal ganglia, and CMBs, which might be better than measuring only 1 or 2 features separately. In the past, there were only three studies calculating the total SVD burden in PD. Moreover, the interaction effect between total SVD burden and disease stage in PD has not been reported.

Method: One hundred and seven patients with idiopathic Parkinson’s disease (PD) and sixty-two normal controls (NCs) who underwent brain magnetic resonance imaging (MRI) were enrolled. PD patients were divided into two groups, early PD (HY 1-1.5, n=36) and advanced PD (HY 2-4, n=71) groups. We calculated the total CSVD score for each participant based on asymptomatic lacunar infarctions (ALIs), high-grade white matter hyperintensities (WMH), enlarged perivascular spaces (EPVSs), and cerebral microbleeds (CMBs). The differences in the total CSVD score between PD and NCs, and between two PD subgroups were compared. In addition, multivariate ordered logistic regression analysis was conducted to investigate the association between CSVD score and clinical and neuropsychological variables in PD.

Results: ALIs were found in 9.3% of the patients with PD, periventricular WMH (PVWMH) in 89.7%, deep WMH (DWMH) in 81.3%, EPVS in 85%, and CMBs in 2.8%. Compare with NCs, PD patients showed higher score in PVWMH and DWMH. Advanced PD patients exhibited markedly greater PVWMH (P=0.041), DWMH (P=0.046), and total SVD score (P=0.044) related to early PD group. After adjusting for age, gender, and vascular risk factors, higher HY stages were independently correlated with increased total SVD score (OR=2.479, 95% CI 1.133-5.430) and PVWMH score (OR= 2.217, 95% CI 1.083-4.536).

Conclusion: CSVD may play a critical role in elderly patients with PD. The total CSVD score is a potential neuroimaging biomarker for monitoring the progression of PD.

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