The significance of cerebral atrophy for the symptomatology of Parkinson's disease

Abstract Hitherto published results on the impact of brain atrophy on the neurological and psychopathological symptomatology in Parkinson's disease, based on pneumen cephalography, are not consistent. The introduction of computed tomography (CT) permitted the reexamination of this problem without risk of complications. We investigated 173 parkinsonian patients (89 men, 84 women) aged 37–83 years. Besides CT in all patients a standardized neurological and psychopathological investigation was carried out, including psychological tests, intelligence, personality structure, fine motor performance and visual reaction times. The investigations revealed pronounced correlations between CT-findings and more severe clinical symptomatology and a corresponding impairment in daily activities in the levodopa-treated and particularly in the untreated group, above all when there was a combination of cortical atrophy and ventricular enlargement. The same was true for fine motor performance and simple and complex reaction times. These functions were more impaired in patients with brain atrophy, irrespective of its localisation, whether cortical atrophy or ventricular enlargement. In contrast, no statistically significant relationship between the different parameters of brain atrophy and intelligence could be found. Considering cortical atrophy as a specific sign in Parkinson's disease — our results are in favour of this assumption — and ventricular enlargement more related to increasing age, parkinsonism is influenced by extranigral lesions inherent in the disease and dependent on increasing age.