White Matter Diffusion Anisotropy and the Effects of Inpatient Multidisciplinary Rehabilitation in Parkinson's Disease: A Diffusion Tensor Imaging Analysis.
TL;DR
With good internal discrimination and good internal discrimination, DTI-derived CST FA is a promising marker for stratifying rehabilitation potential, though external validation is required before clinical use.
Abstract
Background
In Parkinson's disease (PD), compensatory increases in corticospinal tract (CST) fractional anisotropy (FA) occur early; whether pretreatment white matter integrity predicts rehabilitation responsiveness is unknown.
Objective
To determine whether pretreatment CST FA predicts inpatient rehabilitation response in PD.
Methods
Ninety-four PD patients and 13 age-matched healthy controls underwent DTI before an 8-week inpatient multidisciplinary rehabilitation program. Patients were classified as responders (UPDRS Part III improvement ≥2.5 points; n = 61) or non-responders (n = 33). FA across 20 white matter ROIs was compared (Kruskal-Wallis; Mann-Whitney U post-hoc) and voxel-wise TBSS performed. Logistic regression adjusted for age, disease duration, H-Y stage, and levodopa dose.
Results
Responders had higher bilateral CST FA than non-responders (right: P < .001, d = 0.99; left: P < .001, d = 1.14; both FDR-corrected) and maintained CST FA comparable to healthy controls, whereas non-responders showed significantly lower CST FA. TBSS confirmed bilateral CST clusters of higher FA in responders (P < .05, TFCE-corrected). CST FA correlated inversely with H-Y stage (ρ = -0.307, P = .003) and motor improvement (ρ = -0.417, P < .001). Logistic regression identified CST FA as an independent predictor (OR = 5.51 per SD; 95% CI 2.50-12.06; Nagelkerke R² = 0.408; P < .001).
Conclusions
Pretreatment CST FA independently predicts rehabilitation responsiveness in PD, with responder integrity comparable to healthy controls. With good internal discrimination (AUC 0.79), DTI-derived CST FA is a promising marker for stratifying rehabilitation potential, though external validation is required before clinical use. TRIAL REGISTRATION UMIN Clinical Trials Registry, https://www.umin.ac.jp/, UMIN000023641.