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. 2023 Aug 9:14:1203311.
doi: 10.3389/fneur.2023.1203311. eCollection 2023.

Effects of white matter hyperintensity on cognitive function in PD patients: a meta-analysis

Wenhao Zhao  1 , Bo Cheng  1 , Tao Zhu  2 , Yingjuan Cui  3 , Yao Shen  1 , Xudong Fu  1 , Maogeng Li  1 , Yuliang Feng  1 , Shushan Zhang  1
Affiliations

Effects of white matter hyperintensity on cognitive function in PD patients: a meta-analysis

Wenhao Zhao et al. Front Neurol. .

Abstract

Background: Parkinson's disease (PD) is often accompanied by cognitive dysfunction, which imposes a heavy burden on patients, their families, and society. Early identification and intervention are particularly important, but reliable biomarkers for identifying PD-related cognitive impairment at an early stage are currently lacking. Although numerous clinical studies have investigated the association between brain white matter hyperintensity (WMH) and cognitive decline, the findings regarding the relationships between WMH and cognitive dysfunction in PD patients have been inconsistent. Therefore, this study aims to conduct a meta-analysis of the effect of WMH on PD cognitive function.

Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We systematically searched relevant literature from databases such as PubMed, Web of Science, EMBASE, CNKI, and CBM. The retrieval time was limited to database records created up until December 31, 2022. Additionally, we manually retrieved references for full-text reading. Statistical data analysis was performed using RevMan 5.3 and Stata 15.0 software.

Results: This study encompassed 23 individual studies and involved 2,429 patients with PD. The group of PD with mild cognitive impairment (PD-MCI) exhibited a significantly higher overall level of WMH than the group of PD with normal cognitive function (PD-NC) (SMD = 0.37, 95% CI: 0.21-0.52, p < 0.01). This finding was consistent across subgroup analyses based on different ethnicities (Asian or Caucasian), WMH assessment methods (visual rating scale or volumetry), and age matching. In addition to the overall differences in WMH load between the PD-MCI and PD-NC groups, the study found that specific brain regions, including periventricular white matter hyperintensity (PVH) and deep white matter hyperintensity (DWMH), had significantly higher WMH load in the PD-MCI group compared to the PD-NC group. The study also conducted a meta-analysis of WMH load data for PD with dementia (PDD) and PD without dementia (PDND), revealing that the overall WMH load in the PDD group was significantly higher than that in the PDND group (SMD = 0.98, 95% CI: 0.56-1.41, p < 0.01). This finding was consistent across subgroup analyses based on different ethnicities and age matching. Moreover, regarding specific brain regions (PVH or DWMH), the study found that the PDD group had significantly higher WMH load than the PDND group (p < 0.01).

Conclusion: WMH was associated with PD cognitive dysfunction. The early appearance of WMH may indicate PD with MCI.

Keywords: Parkinson’s disease; cognitive impairment; dementia; meta-analysis; white matter hyperintensity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA search strategy flow diagram of studies selection process.
Figure 2
Figure 2
Forest plot and meta-analysis of total WMH between PD-MCI and PD-NC.
Figure 3
Figure 3
Forest plot and meta-analysis of WMH between PD-MCI and PD-NC: a subgroup analysis based on different assessment modalities.
Figure 4
Figure 4
Forest plot and meta-analysis of WMH between PD-MCI and PD-NC: a subgroup analysis based on different ethnicities.
Figure 5
Figure 5
Forest plot and meta-analysis of WMH between PD-MCI and PD-NC: a subgroup analysis based on age.
Figure 6
Figure 6
Forest plot and meta-analysis of PVH between PD-MCI and PD-NC.
Figure 7
Figure 7
Forest plot and meta-analysis of DWMH between PD-MCI and PD-NC.
Figure 8
Figure 8
Forest plot and meta-analysis of total WMH between PDD and PDND.
Figure 9
Figure 9
Forest plot and meta-analysis of WMH between PDD and PDND: a subgroup analysis based on different ethnicities.
Figure 10
Figure 10
Forest plot and meta-analysis of WMH between PDD and PDND: a subgroup analysis based on age.
Figure 11
Figure 11
Forest plot and meta-analysis of PVH between PDD and PDND.
Figure 12
Figure 12
Forest plot and meta-analysis of DWMH between PDD and PDND.
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