A Cross-sectional Study On Visual Rating Scales With Digital Radiography For Monitoring Brain Atrophy In Parkinson’s Disease

Objective: Parkinson’s disease(PD)is a common degenerative disease.Brain atrophy is an important pathological change of Parkinson’s disease,and it aggravates with the progress of the disease.The assessment of brain atrophy is of great significance in monitoring of PD.Visual rating scales offer a semi-quantitative assessment for brain atrophy,and compared with quantitative assessment method,it is more adaptable to the clinical needs for the advantages of convenience and good comparability between different image centers.Six visual rating scales(SVRS)are combination of a set of visual rating scales for regional brain atrophy,they may comprehensively access whole brain atrophy.However,it has rarely been reported in PD.The purpose of this study was to explore the clinical value of the SVRS in assessing brain atrophy in PD.Methods: This was a cross-sectional single-center observational study.98 Patients with PD were recruited from the neurology department of First Affiliated Hospital of Fujian Medical University between March 2017 and November 2018.All patients underwent MRI scans and a battery of assessment of motor and non-motor symptoms.The PD patients were divided into patients with dementia(PDD)and patients without dementia(n PDD).The brain volume was acquired with Mri Cloud platform,and SVRS were performed by two trained neurologists.Correlation analysis was performed to estimate the relationship between the visual rating scores and the brain volume,and Multiple linear regression-based analysis was used for evaluate the relationships between the total scores of six visual scales and clinical features.The sample size required for differentiating cognition injury per arm was calculated for a hypothetical clinical trial.Results: A total of 98 PD patients were finally enrolled in this study,including 38 PDD and 60 n PDD patients.We found a significant negative correlation between the total scores of SVRS and the brain volume(r=-0.381,P=0.001).Similar negative correlations were found in subgroups with and without dementia(r=-0.461,P=0.004 and r=-0.340,P=0.008,respectively).Multiple linear regression-based analyses exhibited statistically significant positive correlations between the total scores of SVRS and scores of the NMSS and HAMD.Using total scores of SVRS as an outcome measure,sample sizes for differentiating cognition injury require rather fewer subjects(n=177)compared with using brain volumes(n=2524).Conclusions: Six visual rating scales reliably reflect whole brain atrophy in PD.Our data support the use of the total visual rating scores rather than quantitative brain volume as a biomarker for monitoring cerebral atrophy in PD.