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Neurosciences: NeurologyMovement Disorders |
1 Radiology & Neurology; 2 Radiology; 3 Psychiatry, University of Michigan, Ann Arbor, Michigan; 4 Radiology, University of Washington, Seattle, Washington
20
Objectives: To investigate longitudinal cerebral metabolic changes in patients with Parkinson disease (PD) with incident dementia.
Methods: Twenty-three PD patients without dementia (HY I-III, age 61.8±9.7, MMSE 28.0±1.4) and twenty-seven normal controls (age 59.8±11.5) underwent FDG PET imaging at the entry of the study followed by yearly clinical assessment to determine conversion to incident dementia. Follow-up FDG PET imaging was available in a subset of patients at 2, 4, and 5 years. Both 3D-SSP and volume-of-interest analysis (normalized to pons) was performed.
Results: After a median duration of 3.9 years 6 patients became demented (PDD). There were significant metabolic reductions in the posterior cingulate (-12.5%), primary (-15.7%) and associative occipital (-10.9%) cortices in the prospective PDD converters at study entry compared to controls. Analysis of the 2-year follow-up scans in 5 PDD patients demonstrated significant year 2 versus baseline interval changes most prominent in the thalamus (-11.4%), posterior cingulum (-9.1%), striatum (-9.9%) and with moderate reductions in the primary (-7.6%) and associative occipital (-6.8%), parietal (-7.1%), and frontal (-6.7%) lobes. A similar pattern of further interval change was seen at years 4 for 2 and at year 5 for 1 subject(s).
Conclusions: Incident dementia in PDD initially presents as a predominant posterior neocortical disease in the preclinical stage. Unlike typical patterns in Alzheimer disease, progression of PDD is associated with mixed subcortical and cortical changes in the presence of relative sparing of the temporal lobe.
Research Support: DOE
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