Dilated perivascular space (dPVS) has recently been reported as a biomarker for cognitive impairment in Parkinson’s disease (PD). However, comprehensive interrelationships between various clinical risk factors, dPVS, white-matter hyperintensities (WMH), cognition, and motor function in PD have not been studied yet. The purpose of this study was to test whether dPVS might mediate the effect of clinical risk factors on WMH, cognition, and motor symptoms in PD patients. A total of 154 PD patients were assessed for vascular risk factors (hypertension, diabetes mellitus, and dyslipidemia), autonomic dysfunction (orthostatic hypotension and supine hypertension [SH]), APOE ε4 genotype, rapid eye movement sleep-behavior disorder, motor symptoms, and cognition status. The degree of dPVS was evaluated in the basal ganglia (BG) and white matter using a 5-point visual scale. Periventricular, deep, and total WMH severity was also assessed. Path analysis was performed to evaluate the associations of these clinical factors and imaging markers with cognitive status and motor symptoms. Hypertension and SH were significantly associated with more severe BGdPVS, which was further associated with higher total WMH, consequently leading to lower cognitive status. More severe BGdPVS was also associated with worse motor symptoms, but without mediation of total WMH. Similar associations were seen when using periventricular WMH as a variable, but not when using deep WMH as a variable. In conclusion, BGdPVS mediates the effect of hypertension and SH on cognitive impairment via total and periventricular WMH, while being directly associated with more severe motor symptoms.

扩张的血管周围间隙 (dPVS) 最近被报道为帕金森病 (PD) 认知障碍的生物标志物。然而，尚未研究 PD 中各种临床危险因素、dPVS、白质高信号 (WMH)、认知和运动功能之间的综合相互关系。本研究的目的是测试 dPVS 是否可能介导临床危险因素对 PD 患者 WMH、认知和运动症状的影响。共评估了 154 名 PD 患者的血管危险因素（高血压、糖尿病和血脂异常）、自主神经功能障碍（直立性低血压和仰卧位高血压 [SH]）、APOE ε4 基因型、快速眼动睡眠行为障碍、运动症状和认知状态。使用 5 点视觉量表评估基底神经节 (BG) 和白质中的 dPVS 程度。还评估了脑室周围、深部和总 WMH 严重程度。进行路径分析以评估这些临床因素和影像学标志物与认知状态和运动症状的关联。高血压和 SH 与更严重的 BGdPVS 显着相关，后者进一步与较高的总 WMH 相关，从而导致较低的认知状态。更严重的 BGdPVS 也与更严重的运动症状相关，但没有调节总 WMH。使用脑室周围 WMH 作为变量时观察到类似的关联，但使用深部 WMH 作为变量时则不然。综上所述，