Research Article
Volume 13 Issue 3 - 2021
Differential Impact of Periventricular and Deep White Matter Lesions in Parkinson’s Disease
Juliana R Zuiani1,2*, Rachel P Guimarães1, Lidiane S Campos2, Augusto C Amato-Filho3, Luiza G Piovesana2, Paula C Azevedo2, Raphael F Casseb1, Joseph H Friedman4, Fernando Cendes1,2 and Anelyssa D’Abreu1,2

1Neuroimaging Laboratory, University of Campinas Rua Vital Brasil, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil

2Department of Neurology, University of Campinas Rua Vital Brasil, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil

3Department of Radiology, University of Campinas Rua Vital Brasil, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil

4Butler Hospital/Alpert Medical School of Brown University, Providence, RI, USA

*Corresponding Author: Juliana R Zuiani, Department of Neurology, UNICAMP, Rua Tessália Vieira de Camargo, Campinas, SP, Brazil.
Received: January 22, 2021;Published: February 16, 2021


Background: The clinical significance of white matter lesions (WML) is still controversial in PD. Studies differ in the differentiation between periventricular (PWML) and deep white matter lesions (DWML), the use of automated versus semi-quantitative methods to measure those and the measurement of lesion volume. Our goal was to study the burden of WML in motor and non-motor symptoms of PD, addressing those above-mentioned shortcomings.

Methods: We evaluated 77 patients with PD using a standardized clinical and imaging protocol. We used FLAIR images sequence and ITK-SNAP software for segmentation into DWML and PWML, which calculate the volume of the lesions automatically. We used generalized linear model to analyze the relationship between WML and clinical characteristics as evaluated by clinical scales (p < 0.05).

Results: In the univariate analysis, higher volume of DWML (p = 0.007), PWML (p < 0.001) and total WML (p = 0.001), was associated with higher UPDRS-III score. Conversely, lower SCOPA-COG were associated with higher PWML (p = 0.018) and total WML (p = 0.030) volume. In the multivariate analysis, higher volume of PWML (p = 0.01) was associated to higher UPDRS-III score. There was no association between WML volume, neither DWML, nor PWML, with non-motor symptoms as assessed by the non-motor symptom scale (NMSS).

Conclusion: We observed an association between the volume of the WML, mostly periventricular, and the severity of cognitive and motors symptoms, adjusting for clinical characteristics known to influence disease progression.

Keywords: Parkinson’s Disease; Periventricular White Matter Lesion, Deep White Matter Lesion


  1. Lang AE and Obeso JA. “Challenges in Parkinson’s disease: restoration of the nigrostriatal dopamine system is not enough”. The Lancet Neurology 3 (2004): 309-316.
  2. Osborn AG. “Acquired metabolic, white matter, and degenerative diseases of the brain”. In: Osborn AG, ed. Diagnostic Neuroradiology. St Louis: Mosby-Year Book 24 (2010): 227e33.
  3. Choi AS., et al. “Are there differences in cerebral white matter lesion burdens between Parkinson’s disease patients with or without dementia?” Acta Neuropathologica 1 (2010): 147-149.
  4. Fazekas F., et al. “MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging”. AJR The American Journal of Roentgenology 2 (1987): 351-356.
  5. Kim KW., et al. “Classification of white matter lesions on magnetic resonance imaging in elderly persons”. Biological Psychiatry 4 (2008): 273-280.
  6. Spilt A., et al. “Not all age-related white matter hyperintensities are the same: a magnetization transfer imaging study”. AJNR American Journal of Neuroradiology 9 (2006): 1964-1968.
  7. Mantyla R., et al. “Variable agreement between visual rating scales for white matter hyperintensities on MRI. Comparison of 13 rating scales in a poststroke cohort”. Stroke8 (1997): 1614-1623.
  8. Bohnen NI and Albin RL. “White matter lesions in Parkinson disease”. Nature Reviews Neurology 4 (2011): 229-236.
  9. Daniel SE and Lees AJ. “Parkinson’s Disease Society Brain Bank, London: overview and research”. Journal of Neural Transmission 39 (1993): 165-172.
  10. Hoehn MM and Yahr MD. “Parkinsonism: onset, progression and mortality”. Neurology 17 (1967): 427-442.
  11. Martinez- Martin P., et al. “Psychometric Attributes of the SCOPA-COG Brazilian Version”. Movement Disorders 1 (2008): 81-87.
  12. Carod-Artal FJ and Martinez-Martin P. “Independent validation of the Non motor Symptoms Scale for Parkinson’s disease in Brazilian patients”. Parkinsonism and Related Disorders 19 (2013): 115-119.
  13. Schwab R and England A. “Projection technique for evaluating surgery in Parkinson's disease”. In: Gillingham F, Donaldson I, eds. Third Symposium on Parkinson's Disease. Edinburgh: E and S Livingstone (1969): 152-157.
  15. Yushkevich PA., et al. “User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability”. Neuroimage 3 (2006): 1116-1128.
  16. De Laat KF., et al. “Cerebral white matter lesions and lacunar infarcts contribute to the presence of mild parkinsonian signs”. Stroke 10 (20120): 2574-2579.
  17. Gallardo MJ., et al. “Patients with advanced Parkinson's disease with and without freezing of gait: a comparative analysis of vascular lesions using brain MRI”. Neurologia 4 (2014): 218-223.
  18. Sunwoo MK., et al. “The burden of white matter hyperintensities is a predictor of progressive mild cognitive impairment in patients with Parkinson's disease”. European Journal of Neurology 6 (2014): 922-e950.
  19. Erten-Lyons D., et al. “Neuropathologic basis of white matter hyperintensity accumulation with advanced age”. Neurology 11 (2013): 977-983.
  20. Schmidt R., et al. “MRI-detected white matter lesions: do they really matter?” Journal of Neural Transmission 5 (2011): 673-681.
  21. Zheng JJ., et al. “Impact of white matter lesions on physical functioning and fall risk in older people: a systematic review”. Stroke7 (2011): 2086-2090.
  22. Lee SJ., et al. “The severity of leukoaraiosis correlates with the clinical phenotype of Parkinson's disease”. Archives of Gerontology and Geriatrics 2 (2009): 255-259.
  23. Piccini P., et al. “White matter hyperintensities in Parkinson's disease. Clinical correlations”. Archives of Neurology 2 (1995): 191-194.
  24. Vercruysse S., et al. “Microstructural Changes in White Matter Associated With Freezing of Gait in Parkinson’s Disease”. Movement Disorders 4 (2015): 567-576.
  25. Gallardo MJ., et al. “Patients with advanced Parkinson’s disease with and without freezing of gait: A comparative analysis of vascular lesions using brain MRI”. Neurologia4 (2014): 218-223.
  26. Bolandzadeh N., et al. “The association between cognitive function and white matter lesion location in older adults: a systematic review”. BMC Neurology 12 (2012): 126.
  27. Ryan L., et al. “Age-related differences in white matter integrity and cognitive function are related to APOE status”. Neuroimage2 (2011): 1565-1577.
  28. Adluru N., et al. “White matter microstructure in late middle-age: Effects of apolipoprotein E4 and parental family history of Alzheimer's disease”. NeuroImage: Clinical 4 (2014): 730-742.
  29. Kandiah N., et al. “Hippocampal volume and white matter disease in the prediction of dementia in Parkinson's disease”. Parkinsonism and Related Disorders 11 (2014): 1203-1208.
  30. Power MC., et al. “Smoking and white matter hyperintensity progression: the ARIC-MRI Study”. Neurology8 (2015): 841-848.
  31. Gottesman RF., et al. “Blood pressure and white-matter disease progression in a biethnic cohort: Atherosclerosis Risk in Communities (ARIC) study”. Stroke1 (2010): 3-8.
  32. Knopman DS., et al. “Vascular risk factors and longitudinal changes on brain MRI: the ARIC study”. Neurology22 (2011): 1879-1885.
  33. Espeland MA., et al. “Action for Health in Diabetes Brain Magnetic Resonance Imaging (Look AHEAD Brain) Ancillary Study Research Group. Brain and White Matter Hyperintensity Volumes After 10 Years of Random Assignment to Lifestyle Intervention”. Diabetes Care5 (2016): 764-771.
  34. Dickie DA., et al. “Vascular risk factors and progression of white matter hyperintensities in the Lothian Birth Cohort 1936”. Neurobiology of Aging 42 (2016): 116-123.
  35. Mok V and Kim JS. “Prevention and Management of Cerebral Small Vessel Disease”. Journal of Stroke2 (2015): 111-122.
Citation: Juliana R Zuiani., et al. “Differential Impact of Periventricular and Deep White Matter Lesions in Parkinson’s Disease”.EC Neurology 13.3 (2021): 29-37.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

December Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the December issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 17, 2021.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to