Exploring the association between walking, sleep patterns, brain perivascular spaces, and cognitive function in Parkinson’s disease
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Objective
Perivascular spaces (PVSs) surround cerebral blood vessels and support metabolic waste clearance, that is modulated by sleep. In Parkinson’s disease (PD), motor impairments can affect sleep quality. This study explored the interrelationships between sleep disruption, gait difficulties, and cognition in PD, with a specific focus on the potential mediating role of PVS.
Methods
348 participants from the Parkinson’s Progression Markers Initiative (PPMI) were divided into healthy controls (HC), prodromal individuals, and patients with PD. Insomnia levels indicated sleep disruption, and walking difficulties severity were considered. Cognition was measured with the Symbol Digit Modalities (SDM) test. PVS volume fractions in white matter (WM-PVS) and basal ganglia (BG-PVS) were quantified using an automated segmentation pipeline developed by our team. Mediation analyses were conducted to assess whether PVS mediated the relationship between gait impairment and cognition, as well as the relationship between sleep and gait problems. Finally, we examined whether baseline PVS volume fraction predicted disease progression, as indexed by cerebro-spinal fluid (CSF) biomarkers collected after five years.
Results
PVS did not mediate the relationship between gait difficulties and cognition, or between sleep disruption and motor symptoms. Greater walking impairment was directly associated with poorer cognition. Insomnia severity was directly associated with greater walking problems. BG-PVS was negatively associated to cognition. Longitudinally, PVS burden was not predictive of disease progression.
Conclusions
Our findings suggest that sleep and motor impairments independently contribute to cognitive function in PD, but these effects are not mediated by PVS burden.
