Early- and late-phase 18F-FP-CIT PET images in vascular parkinsonism due to midbrain infarct

FUNCTIONAL NEUROMARKERS IN PARKINSON’S DISEASE (PD)

New neurotechnologies which help to study not only the structure but also brain work, especially in milliseconds, allow for a more accurate diagnosis of a given disease entity. The aim of our study was to characterize the functional neuromarkers, including a new neuromarker, that is high rolandic beta, in Parkinson’s disease (PD). A 76-year-old male patient, a university professor, a widower, in an intimate relationship with a beloved partner, was tested in the Reintegration and Training Center of the Polish Society of Neuropsychology. Five years earlier (when he was 71 years old), following long-term stress, he had had a transient ischemic attack (TIA). In the following years he experienced two neurological episodes, and was diagnosed, on the basis of MRI findings and clinical symptoms, with vascular (multi-infarct) Parkinsonism. A sudden deterioration in his functioning, including hand tremors at rest, bradykinesia (motor slowdown), asymmetrical gait difficulties, postural instability, and falls typical for PD, as well as MRI finding (the appearance of ‘a swallow tail ’ on the left side, and the lack on the right of the substantia nigra within the midbrain) was the cause of further differential diagnosis. He was assessed using the HBI methodology (Kropotov 2016; Pąchalska, Kaczmarek, Kropotov 2014). EEG was recorded from 19 scalp sites, in resting state conditions, with eyes open and eyes closed, and during the cued GO/NOGO tasks with animal/plants as GO/NOGO stimuli. The electrodes were applied according to the International 10-20 system. The EEG was recorded referentially to linked ears, allowing for a computational re-referencing of the data (remontaging). Event related potentials (ERPs) were used to assess the functional changes manifested by the patient. To compare our patient with healthy controls we used the normative Human Brain Index (HBI), a database obtained through joint research by Swiss, Norwegian, Polish and Russian neuroscientists (Kropotov 2018). This database included behavioral parameters and ERP measures in 6 different neuropsychological tasks for 1000 healthy subjects. What is striking, no signs of cognitive dysfunction was found; however observed were an asymmetrical frontal lobe alpha (a neuromarker of depression) and excessive Rolandic beta (a neuromarker of Parkinson’s disease). We will discuss the results on the basis of recent subject literature findings, including the personal factors that might influenced the process of the diagnosis and treatment of this patient, ones which should be also taken into account in any differential diagnosis. The obtained results show the importance of using HBI methodology in clinical practice. Physicians involved in the diagnosis and treatment of those with progressive ambulatory impairment and an abnormal white matter (WM) signal on neuroimaging, should when formulating any differential diagnosis consider the use of this approach. ------------------------------------------------------------------------------------------------------------------------------------

Association of freezing of gait and clinical features in patients with Parkinson's disease

Freezing of gait (FOG) is a disabling symptom that affects the quality of life of patients with Parkinson's disease (PD) and its pathophysiology is not fully understood yet. The aim of the present study is to evaluate the relationship between FOG and other clinical characteristics in patients with PD. The clinical characteristics, modified Hoehn and Yahr (mHY) stages, Unified Parkinson's Disease Rating Scale (UPDRS) scores, and total Freezing of Gait Questionnaire (FOG-Q) scores of the patients with PD were recorded. FOG-Q item 1.3 was used to evaluate patients with or without FOG. A total of 65 patients with PD (32 with FOG and 33 without FOG) were included to the study. Disease duration was longer, mHY stages were higher, bradykinesia and dyskinesia were more common in patients with FOG compared to patients without (p = 0.001, p = 0.036, p = 0.019 and p = 0.021; respectively). Patients with FOG had lower UPDRS part III tremor subscores (p = 0.020), although gait, postural balance subscores and part IV motor fluctuations scores were higher (p = 0.003, p = 0.023 and p < 0.001; respectively). A positive correlation was found between FOG-Q scores and mHY stages (p < 0.001), UPDRS part II and III total scores (p = 0.020 and p = 0.001) and part III bradykinesia, and gait and postural balance subscores (p = 0.003, p = 0.036 and p = 0.003, respectively), and part IV motor fluctuation scores (p = 0.006). The results of the present study point to an association between FOG and bradykinesia rather than tremor, prolonged disease duration and advanced disease stage reflecting its association with more severe and extensive neurodegenerative processes.

Neuroimaging in Vascular Parkinsonism

PURPOSE OF REVIEW

Being a disease with heterogeneous presentations and unclear consensus on its diagnostic criteria, it is difficult to differentiate vascular parkinsonism (VaP) from other neurodegenerative parkinsonism variants. Ongoing research on structural and functional neuroimaging targeting dopaminergic pathway provides us more insight into the pathophysiology of VaP to improve diagnostic accuracy. The aim of this article is to review how the emerging imaging modalities help the diagnostic process and treatment decision in VaP.

RECENT FINDINGS

Dopamine transporter imaging is a promising tool in differentiating presynaptic parkinsonism and VaP. It also predicts the levodopa responders in VaP. Advanced MRI techniques including volumetry, diffusion tensor imaging and sequences visualising substantia nigra are under development, and they are complementary to each other in detecting structural and functional changes in VaP, which is crucial to ensure the quality of future therapeutic trials for VaP. Dopamine transporter imaging is recommended to patients with suspected VaP. Multimodal MRI in VaP would be an important area to be investigated in the near future.

Atypical Parkinson Syndrome Hiding a Meningioma

A 59-year-old man had developed within a few months walking disorders and rigidity of the left upper limb. I-FP-CIT SPECT/CT was performed in response to the suspicion of atypical parkinsonian syndrome. It showed an anomaly in presynaptic dopaminergic transmission on the right striatum and a voluminous expansive process on CT. MRI revealed an atypical meningioma. The patient had surgery for tumor removal. Later I-FP-CIT SPECT/CT showed normalization of presynaptic dopaminergic transmission on the right striatum.