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Enlarged Substantia Nigra Hyperechogenicity and Risk for Parkinson Disease:  A 37-Month 3-Center Study of 1847 Older Persons

Daniela Berg, MD; Klaus Seppi, MD; Stefanie Behnke, MD; Inga Liepelt, PhD; Katherine Schweitzer, MD; Heike Stockner, MD; Frank Wollenweber, MD; Alexandra Gaenslen, MD; Philipp Mahlknecht, MD; Jörg Spiegel, MD; Jana Godau, MD; Heiko Huber, MD; Karin Srulijes, MD; Stefan Kiechl, MD; Marianna Bentele; Arno Gasperi, MD; Teresa Schubert; Teresa Hiry; Mareike Probst; Vera Schneider; Jochen Klenk, PhD; Martin Sawires, MD; Johann Willeit, MD; Walter Maetzler, MD; Klaus Fassbender, MD; Thomas Gasser, MD; Werner Poewe, MD
Arch Neurol. 2011;68(7):932-937. doi:10.1001/archneurol.2011.141.
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Objective To evaluate whether enlarged substantia nigra hyperechogenicity (SN+) is associated with an increased risk for Parkinson disease (PD) in a healthy elderly population.

Design Longitudinal 3-center observational study with 37 months of prospective follow-up.

Setting Individuals 50 years or older without evidence of PD or any other neurodegenerative disease.

Participants Of 1847 participants who underwent a full medical history, neurological assessment, and transcranial sonography at baseline, 1535 could undergo reassessment.

Main Outcome Measure Incidence of new-onset PD in relation to baseline transcranial sonography status.

Results There were 11 cases of incident PD during the follow-up period. In participants with SN+ at baseline, the relative risk for incident PD was 17.37 (95% confidence interval, 3.71-81.34) times higher compared with normoechogenic participants.

Conclusions In this prospective study, we demonstrate for the first time a highly increased risk for PD in elderly individuals with SN+. Transcranial sonography of the midbrain may therefore be a promising primary screening procedure to define a risk population for imminent PD.

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Figure. Transcranial sonographic images of 2 study participants. A, Participant with normal echogenicity of the substantia nigra (SN) as shown in a zoomed image of the butterfly-shaped hypoechogenic brainstem (marked with the dashed line) in the mesencephalic scanning plane. Only a small area of hyperechogenicity is visible at the anatomic area of the SN (marked with the dotted line) ipsilateral to the insonating ultrasonographic probe. B, Participant with enlarged hyperechogenicity of the SN. Here a large area of hyperechogenicity is visible at the anatomic area of the SN (marked with the dotted line) ipsilateral to the insonating ultrasonographic probe.

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