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White matter integrity and cognition in Parkinson's disease: a cross-sectional study
  1. Eirik Auning1,2,
  2. Veslemøy Krohn Kjærvik3,
  3. Per Selnes3,
  4. Dag Aarsland1,4,5,
  5. Astrid Haram2,6,
  6. Atle Bjørnerud7,8,
  7. Erik Hessen3,9,
  8. Abdolreza Esnaashari10,
  9. Tormod Fladby3
  1. 1Department of Geriatric Psychiatry, Akershus University Hospital, Lørenskog, Norway
  2. 2University of Oslo, AHUS Campus, Oslo, Norway
  3. 3Department of Neurology, Akershus University Hospital, Lørenskog, Norway
  4. 4Department of Neurobiology, Alzheimer's Disease Research Centre, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
  5. 5Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
  6. 6Department of Geriatric Psychiatry, Østfold Central Hospital, Fredrikstad, Norway
  7. 7The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  8. 8Department of Physics, University of Oslo, Oslo, Norway
  9. 9Department of Psychology, University of Oslo, Norway
  10. 10Department of Radiology, Akershus University Hospital, Lørenskog, Norway
  1. Correspondence to Dr Eirik Auning; eirikauning{at}


Objective We used diffusion tensor imaging (DTI) to test the following hypotheses: (1) there is decreased white matter (WM) integrity in non-demented Parkinson’s disease (PD), (2) WM integrity is differentially reduced in PD and early Alzheimer’s disease (AD) and (3) DTI changes in non-demented PD are specifically associated with cognitive performance.

Methods This study included 18 non-demented patients with PD, 18 patients with mild cognitive impairment due to incipient AD and 19 healthy elderly normal control (NC) participants in a cross-sectional design. The participants underwent DTI, and tract-based spatial statistics was used to analyse and extract radial diffusivity and fractional anisotropy. Correlations between scores from a battery of neuropsychological tests and DTI were performed in the PD group.

Results Patients with PD had significant differences in DTI in WM underlying the temporal, parietal and occipital cortex as compared with NC. There were no significant differences between the PD and AD groups in the primary region of interest analyses, but compared with NC there was a tendency for more anterior changes in AD in contrast to more posterior changes in PD. In a secondary whole-brain analysis there were frontoparietal areas with significant differences between AD and PD. In patients with PD, there were significant correlations between DTI parameters in WM underlying the prefrontal cortex and executive and visuospatial abilities.

Conclusions In early, non-demented PD we found reduced WM integrity underlying the temporal, parietal and occipital cortices. In addition, WM integrity changes in prefrontal areas were associated with executive and visuospatial ability. These findings support that DTI may be an important biomarker in early PD, and that WM changes are related to cognitive impairment in PD.

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