Diagnostic Value of Carotid Intima-Media Thickness Combined with Periventricular White Matter Hyperintensities for Mild Cognitive Impairment in Parkinson’s Disease

Shishuang Li, Fuyou Che, Zuowen Zhang Department of Neurology, Chongqing University Jiangjin Hospital, Chongqing, People’s Republic of ChinaCorrespondence: Zuowen Zhang, Department of Neurology, Chongqing University Jiangjin Hospital, No. 725, Jiangzhou Road, Dingshan Street, Jiangjin District, Chongqing, 402260, People’s Republic of China, Tel +86-15823472901, Email [email protected]: To determine the independent association of carotid intima-media thickness (CIMT) and periventricular white matter hyperintensities (PWMHs) with mild cognitive impairment in Parkinson’s disease (PD-MCI) and evaluate the diagnostic value of CIMT combined with PWMHs for PD-MCI.Patients and Methods: A prospective cohort of 541 PD patients was enrolled, and all patients underwent carotid artery ultrasound for mean CIMT measurement and 3T brain MRI for PWMH volume quantification. PD-MCI was diagnosed via comprehensive neuropsychological assessment (10 tests across 5 domains) based on established criteria, ie, at least two tests demonstrated abnormal results, either one impaired test in two different cognitive domains or two impaired tests in a single cognitive domain. Multivariate analysis was conducted to determine the independent association, and the receiver operating characteristic (ROC) curve was employed to assess the diagnostic values, and the Z test was employed to compare the area under curve (AUC).Results: PD-MCI prevalence was 45.5% (246/541). Multivariate analysis, adjusting for education duration, Cys C levels, disease duration, total brain WMHs, hypertension, hyperlipidemia, and age, identified PWMHs [odds ratio (OR): 2.114, 95% confidence interval (CI): 1.391– 4.586], CIMT (OR: 2.027, 95% CI: 1.485– 4.281), homocysteine (OR: 1.551, 95% CI: 1.172– 2.680), Hoehn and Yahr stage (OR: 2.243, 95% CI: 1.534– 4.736), and MDS-UPDRS part III score (OR: 1.416, 95% CI: 1.158– 2.465) as independent PD-MCI predictors. ROC analysis demonstrated significantly higher diagnostic value for the combination of CIMT and PWMHs (AUC: 0.908, 95% CI: 0.882– 0.934) compared to either marker alone (AUC: 0.705, 95% CI: 0.661– 0.750 for PWMHs; AUC: 0.722, 95% CI: 0.678– 0.765 for CIMT; both P < 0.001).Conclusion: The combination of CIMT and PWMHs provides significantly superior diagnostic value for PD-MCI compared to either marker individually, and this integrated model suggests a potential tool for identifying PD patients at high risk for cognitive decline.Keywords: Parkinson’s disease, mild cognitive impairment, carotid intima-media thickness, periventricular white matter hyperintensities, prediction