Different Perivascular Space Burdens in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson's Disease

Xiao-Li Si; Lu-Yan Gu; Zhe Song; Cheng Zhou; Yi Fang; Chong-Yao Jin; Jing-Jing Wu; Ting Gao; Tao Guo; Xiao-Jun Guan; Xiao-Jun Xu; Xin-Zhen Yin; Ya-Ping Yan; Min-Min Zhang; Jia-Li Pu

doi:10.3389/fnagi.2020.580853

Different Perivascular Space Burdens in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson's Disease

Front Aging Neurosci. 2020 Nov 5:12:580853. doi: 10.3389/fnagi.2020.580853. eCollection 2020.

Authors

Xiao-Li Si¹, Lu-Yan Gu¹, Zhe Song¹, Cheng Zhou², Yi Fang¹, Chong-Yao Jin¹, Jing-Jing Wu², Ting Gao¹, Tao Guo², Xiao-Jun Guan², Xiao-Jun Xu², Xin-Zhen Yin¹, Ya-Ping Yan¹, Min-Min Zhang², Jia-Li Pu¹

Affiliations

¹ Department of Neurology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
² Department of Radiology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

Abstract

Background: Excessive aggregation of α-synuclein is the key pathophysiological feature of Parkinson's disease (PD). Rapid eye movement sleep behavior disorder (RBD) is also associated with synucleinopathies and considered as a powerful predictor of PD. Growing evidence suggests the diminished clearance of α-synuclein may be partly attributable to poor interstitial fluid drainage, which can be reflected by magnetic resonance imaging (MRI)-visible enlarged perivascular space (EPVS). However, the effect of MRI-visible EPVS on iRBD and PD, and their correlation with clinical characteristics remain unclear.

Objective: To evaluate the clinical and neuroimaging significance of MRI-visible EPVS in iRBD and PD patients.

Methods: We enrolled 33 iRBD patients, 82 PD (with and without RBD) patients, and 35 healthy controls (HCs), who underwent clinical evaluation and 3.0 Tesla MRI. Two neurologists assessed MRI-visible EPVS in centrum semiovale (CSO), basal ganglia (BG), substantia nigra (SN), and brainstem (BS). Independent risk factors for iRBD and PD were investigated using multivariable logistic regression analysis. Spearman analysis was used to test the correlation of MRI-visible EPVS with clinical characteristics of patients.

Results: iRBD patients had significantly higher EPVS burdens (CSO, BG, SN, and BS) than PD patients. Higher CSO-EPVS and BS-EPVS burdens were independent risk factors for iRBD. Furthermore, higher CSO-EPVS and SN-EPVS burdens were positively correlated with the severity of clinical symptom in iRBD patients, and higher BG-EPVS burden was positively correlated with the severity of cognitive impairment in PD patients.

Conclusion: iRBD and PD patients have different MRI-visible EPVS burdens, which may be related with a compensatory mechanism in glymphatic system. Lower MRI-visible EPVS burden in PD patients may be a manifestation of severe brain waste drainage dysfunction. These findings shed light on the pathophysiologic relationship between iRBD and PD with respect to neuroimaging marker of PD.

Keywords: Parkinson’s disease; REM sleep behavior disorder; glymphatic system; perivascular space; white matter hyperintensity.