ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Parkinson’s Disease and Aging-related Movement Disorders
This article is part of the Research TopicBiomarkers for early detection and progression of Parkinson’s Disease: Integrating genomic, proteomic, imaging, and clinical advancesView all 3 articles
Correlation between cerebral small vessel disease and postural instability/gait difficulty subtype in Parkinson's disease patients
Provisionally accepted
- 1Nantong University Affiliated Qidong Hospital, Qidong, China
- 2Xinjiang Medical University Affiliated Second Hospital, Urumqi, China
- 3Yancheng No 1 People's Hospital, Yancheng, China
- 4Huaian City Second People's Hospital, Huai'an, China
- 5Chongzhou People's Hospital, Chongzhou, China
- 6First Affiliated Hospital of Soochow University, Suzhou, China
- 7Yancheng First People's Hospital, Yancheng, China
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Background: Postural instability/gait difficulty (PIGD) subtype in Parkinson's disease (PD) portends poorer prognosis and limited treatment response. While cerebral small vessel disease (CSVD) is implicated in motor impairment, its specific association with PIGD remains underexplored. This study aims to investigate the correlation between the severity of CSVD and PIGD subtype in PD patients. Methods: This cross-sectional study enrolled 161 PD patients (mean age 71.14 ± 7.04 years). Motor subtyping (postural instability and gait difficulty (PIGD) /tremor-dominant (TD) /Intermediate type (IT)) used MDS-UPDRS-derived ratios. CSVD burden was quantified via two validated MRI-based scores: the total CSVD burden score (range 0–4) and modified CSVD burden score (range 0–6). Multivariate logistic regression analysis, which adjusted for age, gender, disease duration, and vascular risk factors, was used to explore the correlation between CSVD burden and PIGD. Results: The prevalence of PIGD was 49.07% (n = 79). PIGD patients exhibited a significantly higher CSVD burden than the TD and IT groups (Total score: 1.84±0.72 vs. 1.4±0.59 vs.1.15±0.49; modified score: 2.55±1.20 vs. 1.85±0.7 vs. 1.75±0.91, both p<0.001). After full adjustment, each 1-point increase in total CSVD burden score associated with 7.16-fold higher PIGD odds (aOR=7.16, 95%CI=1.64–30.82, p=0.009), and each 1-point increase in modified CSVD burden score associated with 6.03-fold higher PIGD odds (aOR=6.03, 95%CI=3.06–11.90, p<0.001). Conclusion: Global CSVD burden was independently associated with the occurrence of PIGD in PD. CSVD assessment may help identify PD patients at the highest risk for axial motor disability, highlighting the convergence of vascular and neurodegenerative pathologies.
Keywords: Cerebral small vessel disease, postural instability/gait difficulty, Parkinson's disease, imaging biomarker, Vascular pathology
Received: 15 Aug 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Ge, Zhao, Xu, Qiu, Liu, Zhao, Cheng and Xue. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yongqing Cheng, 1146976426@qq.com
Shouru Xue, chengyq1990@163.com
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