Ventricular Dilatation and Brain Atrophy in Patients with Parkinson’s Disease with Incipient Dementia Richard Camicioli, MD, 1 * Jennifer Sabino, BSc, 2 Myrlene Gee, PhD, 2 Thomas Bouchard, MD, 1,3 Nancy Fisher, PhD, 4 Chris Hanstock, PhD, 2 Derek Emery, MD, 2,5 and W.R. Wayne Martin, MD 1 1 Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada 2 Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada 3 Department of Medicine, University of Calgary, Calgary, Alberta, Canada 4 Division of Neurosciences, Alberta Health Services, Edmonton, Alberta, Canada 5 Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada ABSTRACT: Age-related ventricular enlargement is accelerated in Alzheimer’s disease, but its relation- ship to cognitive decline in Parkinson’s disease is less clear, even though dementia is common in Parkinson’s disease. Our goals were to determine if greater enlargement of the ventricles and gray or white matter atrophy occurred in Parkinson’s disease patients developing cognitive decline. Older nondemented patients with Parkinson’s disease (33) and age- and sex-matched controls (39) were recruited and prospec- tively assessed for the development of significant cog- nitive decline over 36 months. Magnetic resonance imaging was obtained every 18 months, and ventricu- lar volume and total brain gray and white matter vol- umes were measured using reliable segmentation of T1-weighted volumetric scans. Subjects with incidental intracranial abnormalities, an atypical course, and stroke as well as dropouts were excluded from a cohort of 52 patients and 50 controls. Among 33 patients and 39 controls, 10 patients and 3 controls developed significant cognitive impairment or demen- tia. Ventricular change and Parkinson’s disease status were significantly associated with dementia. Ventricular change was significantly correlated with change in Mini-Mental Status Examination in the Parkinson’s dis- ease with dementia group (r 5 0.87, P 5 .001). Gray matter atrophy was greater in Parkinson’s disease with dementia, with similar change over time in both Parkin- son’s disease and Parkinson’s disease with dementia. White matter volumes were not significantly different between Parkinson’s disease and Parkinson’s disease with dementia; however, the decrease over time might be greater in Parkinson’s disease with dementia. Ven- tricular dilatation occurs early in the course of signifi- cant cognitive decline in patients with Parkinson’s disease, possibly reflecting both cortical gray and white matter loss. V C 2011 Movement Disorder Society Key Words: Parkinson’s disease; dementia; magnetic resonance imaging Parkinson’s disease (PD) is associated with a risk of dementia of 80% or greater with long-term follow-up (up to 20 years). 1 Development of dementia is associ- ated with increased care needs and nursing home placement. 2 Pathologically, dementia in PD (PDD) is linked with the presence of cortical Lewy bodies, but subgroups of patients with coexistent Alzheimer’s changes occur. 3 Although hippocampal atrophy is found in Parkin- son’s disease with dementia (PDD), 4 it is not prominent in nondemented patients. Moreover, hippocampal mea- surement is time consuming and requires skilled person- nel. Cortical atrophy has been found in PDD. 5,6 Longitudinal ventricle change occurs in mild cognitive impairment 7 and is accelerated in Alzheimer’s disease, 8 demonstrating the feasibility of performing ventricular measurements longitudinally and across multiple sites. ------------------------------------------------------------ *Correspondence to: Dr. Richard Camicioli, E223, Glenrose Rehabilitation Hospital, 10230 111th Avenue, Edmonton, Alberta, Canada T5G 0B7; rcamicio@ualberta.ca Relevant conflicts of interest/financial disclosures: Nothing to report. The study was supported through an operating grant from the Canadian Institutes for Health Research. Full financial disclosures and author roles may be found in the online version of this article. Received: 19 October 2010; Revised: 27 January 2011; Accepted: 8 February 2011 Published online 25 March 2011 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/mds.23700 RESEARCH ARTICLE Movement Disorders, Vol. 26, No. 8, 2011 1443