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Aging and disease
Orginal Article |
Six Visual Rating Scales as A Biomarker for Monitoring Atrophied Brain Volume in Parkinson's Disease
Yu Lin1, Ying Fu1,2, Yi-Fang Zeng1, Jian-Ping Hu3, Xiao-Zhen Lin4, Nai-Qing Cai1, Qiang Weng3, Yi-Jing Zhao3, Yi Lin1, Dai-Rong Cao3,*, Ning Wang1,*
1Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
2Central Laboratory, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
3Department of Radiology, First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
4Department of Geriatrics, First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
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The focus of our investigation was to determine the feasibility of using six visual rating scales as whole-brain imaging markers for monitoring atrophied brain volume in Parkinson's disease (PD). This was a prospective cross-sectional single-center observational study. A total of 98 PD patients were enrolled and underwent an MRI scan and a battery of neuropsychological evaluations. The brain volume was calculated using the online resource MRICloud. Brain atrophy was rated based on six visual rating scales. Correlation analysis was performed between visual rating scores and brain volume and clinical features. We found a significant negative correlation between the total scores of visual rating scores and quantitative brain volume, indicating that six visual rating scales reliably reflect whole brain atrophy in PD. Multiple linear regression-based analyses indicated severer non-motor symptoms were significantly associated with higher scores on the visual rating scales. Furthermore, we performed sample size calculations to evaluate the superiority of visual rating scales; the result show that using total scores of visual rating scales as an outcome measure, sample sizes for differentiating cognition injury require significantly fewer subjects (n = 177) compared with using total brain volume (n = 2524). Our data support the use of the total visual rating scores rather than quantitative brain volume as a biomarker for monitoring cerebral atrophy.

Keywords whole brain atrophy      visual rating scale      structural image      Parkinson’s disease      clinical trials     
Corresponding Authors: Ning Wang, Dai-Rong Cao   
Just Accepted Date: 12 November 2019  
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Yu Lin
Ying Fu
Yi-Fang Zeng
Jian-Ping Hu
Xiao-Zhen Lin
Nai-Qing Cai
Qiang Weng
Yi-Jing Zhao
Yi Lin
Dai-Rong Cao
Ning Wang
Cite this article:   
Yu Lin,Ying Fu,Yi-Fang Zeng, et al. Six Visual Rating Scales as A Biomarker for Monitoring Atrophied Brain Volume in Parkinson's Disease[J]. Aging and disease, 10.14336/AD.2019.1103
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Figure 1.  Trial profile. (A) Diagrammatic sketch of the screening process; (B) Brain volume as quantified by MRICloud and examples of scoring of six visual rating scales. Red coloring indicates the segmentation region at level 1. The yellow frame indicates each region for image assessment. PDD and PD patients with dementia; nPDD and PD patients without dementia. OF = orbitofrontal cortex; AC = anterior cingulate; FI = frontoinsula; AT = anterior temporal; MT= medial temporal lobe; PA = posterior cortex.
Patient number98
Mean age (SD), year60.1 ± 8.7
Sex, male, n (%)52 (53)
Median education (range), year8 (0-15)
Mean duration (SD), year4.4 ± 4.6
Median MDS-UPDRS-III (range)35.5 (10-107)
Median H-Y stage (range)2.5 (1-4)
Median LEDD (range), mg/day300.0 (0-1048.8)
Median HAMD (range)5 (0-43)
Median HAMA (range)4 (0-30)
Median NMSS (range)27 (0-140)
Median MMSE (range)27 (13-30)
Median MoCA (range)23 (5-30)
Mean brain volume (SD), 103 mm31,180.5 (98.8)
Median total visual rating scores (range)11 (2-20)
Table 1  Demographic and clinical features of PD patients.
Figure 2.  Scatter-plots showing the associations between total visual rating scores and brain volume in the total PD sample and subset group. (A) Total PD samples, (B) Patients with dementia, (C) Patients without dementia. Data were analyzed using the spearman rank correlation test.
Unadjusted valueAdjusted value
Beta (95% CI)P-valueBeta (95% CI)P-value
UPDRS-III0.6 (-0.1-1.3)0.1050.4 (-0.4-1.3)0.302
NMSS2.2 (0.7-3.8)0.0052.4 (0.7-4.2)0.008
MoCA-0.1 (-0.4-0.2)0.399-0.1 (-0.2-0.3)0.638
HAMD0.3 (-0.1-0.7)0.1600.5 (0.1-1.0)0.026
Table 2  Association between total score of six visual rating scales and functional, cognitive, and psychological injury.
Figure 3.  Sample size per treatment arm using brain volume and visual rating scales. The calculation was based on the assumption that cognitive state of PD patients changed from non-cognition injury to cognition injury; an 80% power level was used, and a one-side 0.05 level was considered significant.
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