White Matter Hyperintensities Associated With Faster Progressive Parkinsonism in Older Adults

Cerebral white matter hyperintensities (WMH) and cerebrovascular disease pathologies may contribute to progressive parkinsonism in older adults, according to recent research published in JAMA Neurology.

“Progressive parkinsonism is common in older adults without a diagnosis of Parkinson disease and is associated with adverse health outcomes, but its pathologic basis is controversial,” wrote Shahram Oveisgharan, MD, Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois.

Researchers aimed to examine if the rate of progressive parkinsonism can be linked to cerebral WMH in older adults without a clinical diagnosis of Parkinson disease in this community-based cohort study.

A total of 4427 participants from 3 ongoing cohorts were recruited in this study; enrollments began in 1994, 1997, and 2004, and patients were observed for a mean of 7.5 years prior to death. Since enrollment, a total of 2134 participants died. An autopsy was performed in 1725 decedents while magnetic resonance imaging was performed on 598 decedents. Exclusion criteria included repeated parkinsonism assessment, lack of all 9 postmortem pathology indices, or clinical diagnosis of Parkinson disease.

The primary outcome was annual assessment of Parkinsonism using a 26-item modified motor portion of the Unified Parkinson’s Disease Rating Scale. Researchers assessed the WMH burden using a modified version of the Fazekas rating scale.

What they found was that within 516 included decedents, higher WMH was associated with faster progressive parkinsonism. The association was greater when controlling for indices of cerebrovascular disease pathologies, but it remained significant when controlling for neurodegenerative pathologies.  

“In this cohort study, higher levels of both WMH and indices of cerebrovascular disease pathologies in aging brains were associated with more rapid progressive parkinsonism,” concluded Dr Oveisgharan et al. “Further studies are needed to determine if in vivo brain imaging of older adults for evidence of WMH and aggressive medical treatment of vascular risk factors and diseases can reduce the occurrence or severity of late-life parkinsonism.”

—Erin McGuinness

Oveisgharan S, Yu L, Poole VN, et al. Association of White Matter Hyperintensities With Pathology and Progression of Parkinsonism in Aging [published online ahead of print, 2021 Nov 1]. JAMA Neurol. 2021;10.1001/jamaneurol.2021.3996. doi:10.1001/jamaneurol.2021.3996