• Jaeseung Shin, Sungeun Choi, Ji E Lee, Hye Sun Lee, Young H Sohn, and Phil Hyu Lee.
• Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
• J. Neurol. Neurosurg. Psychiatr. 2012 Mar 1; 83 (3): 315-21.

BackgroundWhite matter hyperintensities (WMH) in the cholinergic pathways show a stronger correlation with cognitive performance than general WMH in Alzheimer's disease. However, the role of WMH within the cholinergic pathways in cognitive dysfunction has not been investigated in Parkinson's disease (PD).MethodThe severity of WMH within the cholinergic pathways of PD subgroups with intact cognition (PD-IC, n=44), mild cognitive impairment (PD-MCI, n=87) and dementia (PDD, n=40) were compared using the Cholinergic Pathways Hyperintensities Scale (CHIPS), and the correlation between the CHIPS score and performance on individual tests of cognitive subdomains were analysed.ResultsThe mean CHIPS score was significantly higher in patients with PDD compared with those with PD-IC (p=0.03) or PD-MCI (p=0.015). The CHIPS score in patients with PD was negatively correlated with general cognition assessed using the Mini-Mental State Examination (r=-0.28, p<0.001) and positively with the Unified Parkinson's Disease Rating Scale motor score (r=0.24, p=0.002). The CHIPS score showed a significant correlation with cognitive performance on individual cognitive subdomains and had the highest independent correlations with contrasting programme (β=-0.33, p<0.001) and forward digit span (β=-0.17, p=0.04).ConclusionsThis study demonstrated that the burden of WMH within cholinergic pathways was significantly higher in patients with PDD relative to other groups, and that cholinergic WMH was significantly correlated with a decline in frontal executive function and attention.

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