Abstract: Objective To investigate the association between white matter lesions (WML) and motor impairment in patients with Parkinson's disease (PD). Methods A total of 281 patients with PD over 60 years old were enrolled in this study. Diagnosis of severity of motor impairment in patients with PD was based on Hoehn & Yahr staging scale. The patients with PD were divided into mild PD group and moderate/severe PD group according to the severity of motor impairment. The severity of WML was divided into 3 grades according to the modified visual scale of Fazekas. The association between WML and moderate/severe PD and main symptoms of motor impairment were analyzed. Results Multifactorial logistic regression analysis showed that the association between age, PD pathogenesis>3 years, hypertension, diabetes, metabolic syndrome, WML and moderate/severe PD was statistically significant (all P<0.05). Meanwhile, WML was significantly associated with tremor at rest, rigidity, and postural/gait instability (all P<0.05). In addition, moderate and severe WML were the independent risk factors for tremor at rest (all P<0.05), and different severities of WML were the independent risk factors for rigidity and postural/gait instability (all P<0.05). Conclusion WML might increase the risk of severe motor impairment in patients with PD, and WML was associated with major symptoms of motor impairment in patients with PD.