Perivascular Spaces in the Basal Ganglia and Long-term Motor Prognosis in Newly Diagnosed Parkinson Disease.

Objectives: To investigate the association between enlarged perivascular spaces (PVSs) in the basal ganglia (BG-PVSs) and long-term motor outcomes in Parkinson’s disease (PD). Methods: We reviewed the medical records of 248 patients with drug-naive early-stage PD (follow-up >3 years, mean age 67.44 ± 8.46 years, 130 females) who underwent brain MRI and dopamine transporter (DAT) scans at initial assessment. The number of baseline enlarged BG-PVSs was counted on axial T2-weighted images. Then, patients were divided into two groups: a PD group with a low number (0−10) of enlarged PVSs (PD-EPVS−; n = 156) and that with a high number (>10) of enlarged PVSs (PD-EPVS+; n = 92). We used Cox regression models to compare the levodopa-induced dyskinesia (LID)-, wearing-off-, and freezing of gait (FOG)-free times between groups. We also compared longitudinal increases in levodopa-equivalent dose per body weight between groups using a linear mixed model. Results: Patients in the PD-EPVS+ group were older (72.28 ± 6.07 years) and had greater small vessel disease burden than those in the PD-EPVS− group (64.58 ± 8.38 years). The PD-EPVS+ group exhibited more severely decreased DAT availability in all striatal sub-regions except the ventral striatum. The risk of FOG was higher in the PD-EPVS+ group, but the risk of LID or wearing-off was comparable between groups. The PD-EPVS+ group required higher doses of dopaminergic medications for effective symptom control compared to the PD-EPVS− group. Conclusions: This study suggests that baseline enlarged BG-PVSs can be an indicator of the progression of motor disability in PD.