Background: Mild Parkinsonian signs (MPS) are commonly seen in aging, and have been
related to cerebral Small Vessel Diseases (SVD) with no univocal results.
Objective: The aim of this study was to investigate the cross-sectional relation between MPS and White
Matter Hyperintensities (WMH), lacunes, caudate atrophy, and global cerebral atrophy in a large cohort
of Neurologically and Cognitively Healthy (NCH) aging individuals.
Method: 1,219 NCH individuals were included in the analysis, and underwent standard brain MRI. The
items of the motor section of the Unified Parkinson’s Disease Rating Scale were used to evaluate
tremor, rigidity, bradykinesia, and gait/balance/axial dysfunction. Caudate atrophy and global cerebral
atrophy were assessed through the bicaudate ratio and the lateral ventricles to brain ratio, respectively.
WMH were assessed through two visual rating scales. Lacunes were also rated. Associations of MPS
with vascular risk factors/diseases and imaging findings were determined through the logistic regression
Results: Frontal and basal ganglia lacunes, frontal WMH, caudate atrophy, and global cerebral atrophy
were associated with bradykinesia. Basal ganglia lacunes, caudate atrophy, and global cerebral atrophy
were associated with gait/balance/axial dysfunction. Rigidity was associated with frontal WMH, and
tremor with caudate atrophy and global cerebral atrophy. NCH subjects with MPS, performed less than
subjects without MPS in tests evaluating global cognition and language.
Conclusion: This study demonstrates that in NCH aging individuals, MPS are associated with cortical
and subcortical vascular and atrophic changes, and are probably, a warning sign of incipient cognitive
decline. Subjects with MPS should manage rigorously cerebral SVD to prevent future physical and cognitive