Abnormal Echogenicity of the Substantia Nigra, Raphe Nuclei, and Third-Ventricle Width as Markers of Cognitive Impairment in Parkinsonian Disorders: A Cross-Sectional Study

Angela E P Bouwmans, Albert F G Leentjens, Werner H Mess, Wim E J Weber, Angela E P Bouwmans, Albert F G Leentjens, Werner H Mess, Wim E J Weber

Abstract

Background. Patients with Parkinson's disease (PD) have a high risk of cognitive problems. Objective. This study assesses whether abnormal echogenicity of the substantia nigra (SN) and raphe nuclei (RN) and the diameter of third ventricle are markers of cognitive impairment in patients with PD and other forms of parkinsonism. Methods. 126 outpatients with early signs of parkinsonism underwent transcranial sonography (TCS). The scales for the outcome of Parkinson's disease cognition (SCOPA-COG) were used as cognitive measure. Definite neurological diagnosis was established after two-year follow-up. Results. One-third of the patients with PD and half of those with APS had signs of cognitive impairment. The echogenicity of the SN was not related to cognitive impairment. The diameter of the third ventricle was significantly larger in PD patients with cognitive impairment compared to those without. In patients with APS we found a significantly higher frequency of hypoechogenic RN in patients with cognitive problems. Conclusions. Cognitive impairment is already present in a substantial proportion of patients with PD and APS at first referral. In patients with APS the frequency of hypoechogenic RN points to the direction of other pathophysiology with more emphasis on deficits in the serotonergic neurotransmitter system. The larger diameter of the third ventricle in PD patients with cognitive impairment may reflect Alzheimer like brain atrophy, as has been reported in earlier studies.

Figures

Figure 1
Figure 1
Figure 2
Figure 2
Boxplot of the range of scores on the SCOPA-COG scores compared to the echogenicity of the substantia nigra.
Figure 3
Figure 3
Boxplot of the range of scores on the SCOPA-COG scores compared to the echogenicity of the raphe nuclei.
Figure 4
Figure 4
Boxplot of the range of scores on the SCOPA-COG scores compared to the diameter of the third ventricle divided in subgroups with and without cognitive impairment.

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