Reduced lateral occipital gray matter volume is associated with physical frailty and cognitive impairment in Parkinson’s disease

  • Yueh-Sheng Chen
  • Hsiu-Ling Chen
  • Cheng-Hsien Lu
  • Meng-Hsiang Chen
  • Kun-Hsien Chou
  • Nai-Wen Tsai
  • Chiun-Chieh Yu
  • Pi-Ling Chiang
  • Wei-Che LinEmail author



To investigate the structural changes of the brain that correlate with physical frailty and cognitive impairments in Parkinson’s disease (PD) patients.


Sixty-one PD patients and 59 age- and sex-matched healthy controls were enrolled. For each participant, a frailty assessment using Fried’s criteria and comprehensive neuropsychological testing using the Wechsler Adult Intelligence Scale-III and Cognitive Ability Screening Instrument were conducted, and structural brain MR images were acquired for voxel-based morphometric analysis. The neuropsychological testing includes various tests in these five domains: attention, executive, memory, speech and language, and visuospatial functions. Exploratory group-wise comparisons of gray matter volume (GMV) in the PD patients and controls were conducted. Voxel-wise multiple linear regression analyses were conducted for physical frailty–related and cognitive impairment–related GMV changes in the PD patients. Voxel-wise multiple linear regressions were also performed with the five cognitive domains separated using the same model.


The PD patients exhibited diffuse GMV reductions in comparison to the controls. In the PD patients, physical frailty–related decreases in GMV were observed in the bilateral frontal and occipital cortices, while cognitive impairment–related decreases in GMV were observed in the bilateral frontal, occipital, and temporal cortices. These regions overlap in the lateral occipital cortex. After the five domains of cognitive functions were analyzed separately, physical frailty–related decreases in GMV still overlap in lateral occipital cortices with every domain of cognitive impairment–related decreases in GMV.


Reduced GMV in the lateral occipital cortex is associated with cognitive impairment and physical frailty in PD patients.

Key Points

• Physical frailty in PD was associated with decreased GMV in the frontal and occipital cortices, while cognitive impairment was associated with decreased GMV in the frontal, temporal, and occipital cortices.

• Physical frailty and cognitive impairment were both associated with decreased GMV in the lateral occipital cortex, which is part of the ventral object-based visual pathway.

• Decreased GMV in the lateral occipital cortex may serve as a potential imaging biomarker for physical frailty and cognitive impairment in PD.


Frailty Cognitive impairment Gray matter volume Voxel-based morphometry Parkinson’s disease 



Gray matter volume


Mini-Mental State Examination


Parkinson’s disease


Total intracranial volume


Unified Parkinson’s Disease Rating Scale



This study has received funding by National Science Council (MOST 106-2314-B-182A-031-MY2 to W-C Lin).

Compliance with ethical standards


The scientific guarantor of this publication is Wei-Che Lin.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• Prospective

• Cross-sectional study

• Performed at one institution

Supplementary material

330_2018_5855_MOESM1_ESM.docx (208 kb)
ESM 1 (DOCX 208 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwan
  2. 2.Department of Neurology, Kaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwan
  3. 3.Department of Biological ScienceNational Sun Yat-Sen UniversityKaohsiungTaiwan
  4. 4.Institute of NeuroscienceNational Yang-Ming UniversityTaipeiTaiwan

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