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Yoon SH, You DH, Na HK, Kang S, Baik K, Park M, Lyoo CH, Sohn YH, Lee PH. Parkinson's disease with hyposmia and dysautonomia: does it represent a distinct subtype? J Neurol 2024; 271:5064-5073. [PMID: 38806701 DOI: 10.1007/s00415-024-12332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/26/2024] [Accepted: 03/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND AND PURPOSE Olfactory dysfunction or dysautonomia is one of the earliest prodromal nonmotor symptoms of Parkinson's disease (PD). We aimed to investigate whether PD patients with dysautonomia and hyposmia at the de novo stage present different prognoses regarding PD dementia (PDD) conversion, motor complication development, and change in levodopa-equivalent doses (LED). METHODS In this retrograde cohort study, we included 105 patients with newly diagnosed PD patients who underwent cross-cultural smell identification test (CC-SIT), autonomic function tests (AFT), and dopamine transporter (DAT) scan at the de novo stage. PD patients were divided into Hyposmia + /Dysautonomia + (H + /D +) and Hyposmia - /Dysautonomia - (H - /D -) groups depending on the result of AFT and CC-SIT. Baseline clinical, cognitive, imaging characteristics, longitudinal risks of PDD development and motor complication occurrence, and longitudinal LED changes were compared between the two groups. RESULTS When compared with the H - /D - group, the H + /D + group showed lower standardized uptake value ratios in all subregions, lower asymmetry index, and steeper ventral - dorsal gradient in the DAT scan. The H + /D + group exhibited poorer performance in frontal/executive function and a higher risk of PDD development. The risk of motor complications including levodopa-induced dyskinesia, wearing off, and freezing of gait, was comparable between the two groups. The analysis of longitudinal changes in LED using a linear mixed model showed that the increase of LED in the H + /D + group was more rapid. CONCLUSIONS Our results suggest that PD patients with dysautonomia and hyposmia at the de novo stage show a higher risk of PD dementia conversion and rapid progression of motor symptoms.
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Affiliation(s)
- So Hoon Yoon
- Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Dae Hyuk You
- College of Letters and Science, University of Wisconsin-Madison, Madison, WI, USA
| | - Han Kyu Na
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sungwoo Kang
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Mincheol Park
- Department of Neurology, Gwangmyeong Hospital, Chung-Ang University College of Medicine and Graduate School of Medicine, Gwangmyeong, South Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Park M, Kim HJ, Baik K, Na HK, Lee YG, Yoon SH, Jeong SH, Chung SJ, Shin HW, Lyoo CH, Sohn YH, Lee PH. Association between striatal amyloid deposition and motor prognosis in Parkinson's disease. Eur J Neurol 2024:e16364. [PMID: 39034046 DOI: 10.1111/ene.16364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/18/2024] [Accepted: 05/12/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND PURPOSE The co-occurrence of amyloid-β pathology in Parkinson's disease (PD) is common; however, the role of amyloid-β deposition in motor prognosis remains elusive. This study aimed to investigate the association between striatal amyloid deposition, motor complications and motor prognosis in patients with PD. METHODS Ninety-six patients with PD who underwent 18F florbetaben (FBB) positron emission tomography were retrospectively assessed. The ratio of the striatum to global (STG) FBB uptake was obtained for each individual, and patients were allotted into low and high STG groups according to the median value. The effect of STG group on regional amyloid deposition, the occurrence of motor complications and longitudinal change in levodopa equivalent dose (LED) requirement were investigated after controlling for age, sex, LED and disease duration at FBB scan. RESULTS The high STG group was associated with lower cortical FBB uptake in the parietal, occipital and posterior cingulate cortices and higher striatal FBB uptake compared to the low STG group. Patients in the high STG group had a higher risk of developing wearing off and levodopa-induced dyskinesia than those in the low STG group, whereas the risk for freezing of gait was comparable between the two groups. The high STG group showed a more rapid increase in LED requirements over time than the low STG group. CONCLUSIONS These findings suggest that relatively high striatal amyloid deposition is associated with poor motor outcomes in patients with PD.
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Affiliation(s)
- Mincheol Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Hyun Joo Kim
- Department of Nuclear Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kyoungwon Baik
- Department of Neurology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Han Kyu Na
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Gun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - So Hoon Yoon
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Catholic Kwandong University International St. Mary's Hospital, Incheon, Republic of Korea
| | - Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Chung SJ, Kim YJ, Kim YJ, Lee HS, Jeong SH, Hong JM, Sohn YH, Yun M, Jeong Y, Lee PH. Association Between White Matter Networks and the Pattern of Striatal Dopamine Depletion in Patients With Parkinson Disease. Neurology 2022; 99:e2672-e2682. [PMID: 36195451 DOI: 10.1212/wnl.0000000000201269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Individual variability in nigrostriatal dopaminergic denervation is an important factor underlying clinical heterogeneity in Parkinson disease (PD). This study aimed to explore whether the pattern of striatal dopamine depletion was associated with white matter (WM) networks in PD. METHODS A total of 240 newly diagnosed patients with PD who underwent 18F-FP-CIT PET scans and brain diffusion tensor imaging at initial assessment were enrolled in this study. We measured 18F-FP-CIT tracer uptake as an indirect marker for striatal dopamine depletion. Factor analysis-derived striatal dopamine loss patterns were estimated in each patient to calculate the composite scores of 4 striatal subregion factors (caudate, more-affected and less-affected sensorimotor striata, and anterior putamen) based on the availability of striatal dopamine transporter. The WM structural networks that were correlated with the composite scores of each striatal subregion factor were identified using a network-based statistical analysis. RESULTS A higher composite score of caudate (i.e., relatively preserved dopaminergic innervation in the caudate) was associated with a strong structural connectivity in a single subnetwork comprising the left caudate and left frontal gyri. Selective dopamine loss in the caudate was associated with strong connectivity in the structural subnetwork whose hub nodes were bilateral thalami and left insula, which were connected to the anterior cingulum. However, no subnetworks were correlated with the composite scores of other striatal subregion factors. The connectivity strength of the network with a positive correlation with the composite score of caudate affected the frontal/executive function either directly or indirectly through the mediation of dopamine depletion in the caudate. CONCLUSIONS Our findings indicate that different patterns of striatal dopamine depletion are closely associated with WM structural alterations, which may contribute to heterogeneous cognitive profiles in individuals with PD.
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Affiliation(s)
- Seok Jong Chung
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Yae Ji Kim
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea.
| | - Seong Ho Jeong
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Man Hong
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Mijin Yun
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- From the Department of Neurology (S.J.C., Yun Joong Kim, Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.J.C., Yun Joong Kim), Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; Program of Brain and Cognitive Engineering (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KI for Health Science and Technology (Yae Ji Kim, Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.H.J.), Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine (M.Y.), Yonsei University College of Medicine, Seoul, South Korea; Department of Bio and Brain Engineering (Y.J.), Korea Advanced Institute of Science and Technology, Daejeon, South Korea; and Severance Biomedical Science Institute (P.H.L.), Yonsei University College of Medicine, Seoul, South Korea.
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Jeong SH, Lee EC, Chung SJ, Lee HS, Jung JH, Sohn YH, Seong JK, Lee PH. Local striatal volume and motor reserve in drug-naïve Parkinson's disease. NPJ Parkinsons Dis 2022; 8:168. [PMID: 36470876 PMCID: PMC9722895 DOI: 10.1038/s41531-022-00429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Motor reserve (MR) may explain why individuals with similar pathological changes show marked differences in motor deficits in Parkinson's disease (PD). In this study, we investigated whether estimated individual MR was linked to local striatal volume (LSV) in PD. We analyzed data obtained from 333 patients with drug naïve PD who underwent dopamine transporter scans and high-resolution 3-tesla T1-weighted structural magnetic resonance images. Using a residual model, we estimated individual MRs on the basis of initial UPDRS-III score and striatal dopamine depletion. We performed a correlation analysis between MR estimates and LSV. Furthermore, we assessed the effect of LSV, which is correlated with MR estimates, on the longitudinal increase in the levodopa-equivalent dose (LED) during the 4-year follow-up period using a linear mixed model. After controlling for intracranial volume, there was a significant positive correlation between LSV and MR estimates in the bilateral caudate, anterior putamen, and ventro-posterior putamen. The linear mixed model showed that the large local volume of anterior and ventro-posterior putamen was associated with the low requirement of LED initially and accelerated LED increment thereafter. The present study demonstrated that LSV is crucial to MR in early-stage PD, suggesting LSV as a neural correlate of MR in PD.
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Affiliation(s)
- Seong Ho Jeong
- grid.15444.300000 0004 0470 5454Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea ,grid.411627.70000 0004 0647 4151Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Eun-Chong Lee
- grid.222754.40000 0001 0840 2678School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Seok Jong Chung
- grid.15444.300000 0004 0470 5454Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea ,grid.413046.40000 0004 0439 4086Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Hye Sun Lee
- grid.15444.300000 0004 0470 5454Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- grid.411625.50000 0004 0647 1102Department of Neurology, Inje University Busan Paik Hospital, Seoul, South Korea
| | - Young H. Sohn
- grid.15444.300000 0004 0470 5454Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon-Kyung Seong
- grid.222754.40000 0001 0840 2678School of Biomedical Engineering, Korea University, Seoul, South Korea ,grid.222754.40000 0001 0840 2678Department of Artificial Intelligence, Korea University, Seoul, South Korea
| | - Phil Hyu Lee
- grid.15444.300000 0004 0470 5454Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea ,grid.15444.300000 0004 0470 5454Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Disbrow EA, Glassy ND, Dressler EM, Russo K, Franz EA, Turner RS, Ventura MI, Hinkley L, Zweig R, Nagarajan SS, Ledbetter CR, Sigvardt KA. Cortical oscillatory dysfunction in Parkinson disease during movement activation and inhibition. PLoS One 2022; 17:e0257711. [PMID: 35245294 PMCID: PMC8896690 DOI: 10.1371/journal.pone.0257711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/08/2021] [Indexed: 12/27/2022] Open
Abstract
Response activation and inhibition are functions fundamental to executive control that are disrupted in Parkinson disease (PD). We used magnetoencephalography to examine event related changes in oscillatory power amplitude, peak latency and frequency in cortical networks subserving these functions and identified abnormalities associated with PD. Participants (N = 18 PD, 18 control) performed a cue/target task that required initiation of an un-cued movement (activation) or inhibition of a cued movement. Reaction times were variable but similar across groups. Task related responses in gamma, alpha, and beta power were found across cortical networks including motor cortex, supplementary and pre- supplementary motor cortex, posterior parietal cortex, prefrontal cortex and anterior cingulate. PD-related changes in power and latency were noted most frequently in the beta band, however, abnormal power and delayed peak latency in the alpha band in the pre-supplementary motor area was suggestive of a compensatory mechanism. PD peak power was delayed in pre-supplementary motor area, motor cortex, and medial frontal gyrus only for activation, which is consistent with deficits in un-cued (as opposed to cued) movement initiation characteristic of PD.
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Affiliation(s)
- Elizabeth A. Disbrow
- LSU Health Shreveport Center for Brain Health, Shreveport, Louisiana, United States of America
- Department of Neurology, LSU Health Shreveport, Shreveport, Louisiana, United States of America
- * E-mail:
| | - Nathaniel D. Glassy
- LSU Health Shreveport Center for Brain Health, Shreveport, Louisiana, United States of America
| | - Elizabeth M. Dressler
- LSU Health Shreveport Center for Brain Health, Shreveport, Louisiana, United States of America
| | - Kimberley Russo
- Department of Psychology, UC Berkeley, Berkeley, California, United States of America
| | - Elizabeth A. Franz
- Action Brain and Cognition Laboratory, Department of Psychology, and fMRIotago, University of Otago, Dunedin, New Zealand
| | - Robert S. Turner
- Department of Neurobiology and Center for the Neural Basis of Cognition University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Maria I. Ventura
- Department of Psychiatry, UC Davis, Sacramento, California, United States of America
| | - Leighton Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States of America
| | - Richard Zweig
- LSU Health Shreveport Center for Brain Health, Shreveport, Louisiana, United States of America
- Department of Neurology, LSU Health Shreveport, Shreveport, Louisiana, United States of America
| | - Srikantan S. Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States of America
| | - Christina R. Ledbetter
- LSU Health Shreveport Center for Brain Health, Shreveport, Louisiana, United States of America
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, Louisiana, United States of America
| | - Karen A. Sigvardt
- Department of Neurology, UC Davis, Sacramento, California, United States of America
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Bastos P, Barbosa R. Motor reserve: How to build neuronal resilience against ageing and neurodegeneration? Rev Neurol (Paris) 2022; 178:845-854. [DOI: 10.1016/j.neurol.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/14/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
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Chung SJ, Kim YJ, Yoo HS, Jung JH, Baik K, Lee HS, Lee YH, Hong JM, Sohn YH, Lee PH. Temporalis Muscle Thickness as an Indicator of Sarcopenia Is Associated With Long-term Motor Outcomes in Parkinson's Disease. J Gerontol A Biol Sci Med Sci 2021; 76:2242-2248. [PMID: 33754634 DOI: 10.1093/gerona/glab082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To investigate the relationship between temporalis muscle thickness (TMT) at baseline as a surrogate marker for sarcopenia and long-term motor outcomes in patients with Parkinson's disease (PD). METHODS We enrolled 249 patients with drug-naïve early-stage PD (119 males and 130 females, follow-up > 3 years). Baseline TMT of each patient was measured on the axial plane of T1-weighted images. The association between baseline TMT and long-term motor outcomes in PD was assessed using Cox regression models for levodopa-induced dyskinesia, wearing-off, and freezing of gait and a linear mixed model for the longitudinal increases in levodopa-equivalent dose per body weight over time. Statistical analyses were performed separately for sex if an interaction effect between TMT and sex was assumed. RESULTS TMT differed substantially between the sexes, and male PD patients had higher TMT (6.69 ± 1.39 mm) than female PD patients (5.64 ± 1.34 mm, p < .001). Cox regression models demonstrated that baseline TMT was not associated with the risk of developing levodopa-induced dyskinesia, wearing-off, or freezing of gait during the follow-up period. The linear mixed model was applied separately for sex and demonstrated that higher TMT at baseline was associated with slower increases in levodopa-equivalent dose per body weight in male PD patients, but not in female PD patients. CONCLUSIONS This study demonstrated that baseline TMT could be an indicator of the longitudinal requirement for dopaminergic medications in male patients with PD, suggesting that sarcopenia may have a detrimental effect on disease progression in PD in a sex-specific manner.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
| | - Ji-Man Hong
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul,South Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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8
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Yoo HS, Lee YG, Jeong SH, Ye BS, Sohn YH, Yun M, Lee PH. Clinical and Dopamine Depletion Patterns in Hyposmia- and Dysautonomia-Dominant Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:1703-1713. [PMID: 34275910 DOI: 10.3233/jpd-212747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Olfactory or autonomic dysfunction is one of the earliest prodromal symptoms of Parkinson's disease (PD). It has not been investigated whether PD patients have different phenotypes depending on the presence of these prodromal symptoms. OBJECTIVE To investigate whether hyposmia-dominant and dysautonomia-dominant patients with early PD have different clinical manifestations and nigrostriatal degeneration. METHODS This cross-sectional study recruited 168 drug-naive PD patients and 34 control subjects. PD patients were classified as patients without hyposmia and dysautonomia (PD-H-D-, n = 51), hyposmia-dominant patients (PD-H+D-, n = 36), dysautonomia-dominant patients (PD-H-D+, n = 33), and patients with hyposmia and dysautonomia (PD-H+D+, n = 48). We then compared the baseline clinical characteristics, striatal specific to non-specific binding ratio (SNBR), neuropsychological performance, and neuropsychiatric symptoms among the groups. RESULTS The PD-H+D-group had a lower SNBR in the ventral striatum (p = 0.013), a greater asymmetric index of striatal SNBRs, and higher prevalence of apathy (p = 0.021) than the PD-H-D+ group. The PD-H-D+ group had older age at onset (p = 0.043) and a higher prevalence of REM sleep behavior disorder (p = 0.041) than the PD-H+D-group. The PD-H+D+ group had higher motor deficits, lower cognitive function, and lower SNBRs in all striatal subregions than the PD-H-D-group. Decreased SNBRs in the anterior caudate, posterior caudate, and ventral striatum were associated with the presence of apathy. CONCLUSION The present study suggests that hyposmia-dominant and dysautonomia-dominant PD have different clinical characteristics and patterns of striatal dopamine depletion.
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Affiliation(s)
- Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Gun Lee
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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9
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Cotogni M, Sacchi L, Sadikov A, Georgiev D. Asymmetry at Disease Onset Is Not a Predictor of Parkinson's Disease Progression. JOURNAL OF PARKINSONS DISEASE 2021; 11:1689-1694. [PMID: 34250949 DOI: 10.3233/jpd-202525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Even though a significant fraction of Parkinson's disease (PD) patients presents with only minor or no motor asymmetry, the motor symptoms in PD typically start on one side of the body and worse symptoms on the side of the disease onset usually persist long after the disease has become clinically bilateral. The asymmetric presentation of PD has been studied over the years, with some studies showing slower progression in PD subjects with asymmetric disease presentation. In other studies, however, it was not possible to relate the asymmetry to disease progression. OBJECTIVE The main objective of the present study was to assess the effect of asymmetry at disease onset on disease progression. METHODS Using the data available in the Parkinson's Progression Markers Initiative (PPMI) database, at baseline, 423 subjects with de-novo PD were included in the study. Instead of dichotomizing the subjects in asymmetric and symmetric, we kept the asymmetry index and the non-motor, disability, and motor progression at one-, three-, and five-year follow-up continuous. Linear regression was used to correlate asymmetry indices and disease progression. RESULTS There was no correlation between neither clinically, nor DatSCAN defined asymmetry and non-motor, motor, and disability progression in the de-novo PD subjects with a 5-year follow-up. CONCLUSION Asymmetry does not predict progression of PD. Further studies are needed to investigate whether early detection of asymmetry on clinical grounds could successfully distinguish between PD and symmetric types of atypical parkinsonism in the early stages of the disease.
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Affiliation(s)
- Marco Cotogni
- Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia.,Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Aleksander Sadikov
- Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Dejan Georgiev
- Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia.,Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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10
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Labrador-Espinosa MA, Grothe MJ, Macías-García D, Jesús S, Adarmes-Gómez A, Muñoz-Delgado L, Fernández-Rodríguez P, Martín-Rodríguez JF, Huertas I, García-Solís D, Mir P. Levodopa-Induced Dyskinesia in Parkinson Disease Specifically Associates With Dopaminergic Depletion in Sensorimotor-Related Functional Subregions of the Striatum. Clin Nucl Med 2021; 46:e296-e306. [PMID: 33782308 DOI: 10.1097/rlu.0000000000003609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether the development of levodopa-induced dyskinesia (LID) in Parkinson disease (PD) specifically relates to dopaminergic depletion in sensorimotor-related subregions of the striatum. METHODS Our primary study sample consisted of 185 locally recruited PD patients, of which 73 (40%) developed LID. Retrospective 123I-FP-CIT SPECT data were used to quantify the specific dopamine transporter (DAT) binding ratio within distinct functionally defined striatal subregions related to limbic, executive, and sensorimotor systems. Regional DAT levels were contrasted between patients who developed LID (PD + LID) and those who did not (PD-LID) using analysis of covariance models controlled for demographic and clinical features. For validation of the findings and assessment of the evolution of LID-associated DAT changes from an early disease stage, we also studied serial 123I-FP-CIT SPECT data from 343 de novo PD patients enrolled in the Parkinson Progression Marker's Initiative using mixed linear model analysis. RESULTS Compared with PD-LID, DAT level reductions in PD + LID patients were most pronounced in the sensorimotor striatal subregion (F = 5.99, P = 0.016) and also significant in the executive-related subregion (F = 5.30, P = 0.023). In the Parkinson Progression Marker's Initiative cohort, DAT levels in PD + LID (n = 161, 47%) were only significantly reduced compared with PD-LID in the sensorimotor striatal subregion (t = -2.05, P = 0.041), and this difference was already present at baseline and remained largely constant over time. CONCLUSION Measuring DAT depletion in functionally defined sensorimotor-related striatal regions of interest may provide a more sensitive tool to detect LID-associated dopaminergic changes at an early disease stage and could improve individual prognosis of this common clinical complication in PD.
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Affiliation(s)
| | | | | | | | | | - Laura Muñoz-Delgado
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid
| | | | | | - Ismael Huertas
- From the Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville
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11
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Chung SJ, Yoo HS, Lee HS, Lee YH, Baik K, Jung JH, Ye BS, Sohn YH, Lee PH. Baseline cognitive profile is closely associated with long-term motor prognosis in newly diagnosed Parkinson's disease. J Neurol 2021; 268:4203-4212. [PMID: 33942161 DOI: 10.1007/s00415-021-10529-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the association between cognitive function at baseline and the progression of motor disability in Parkinson's disease (PD). METHODS We consecutively enrolled 257 drug-naïve patients with early-stage PD (follow-up > 2 years) who underwent a detailed neuropsychological test at initial assessment. Factor analysis was conducted to yield four cognitive function factors and composite scores thereof: Factor 1 (visual memory/visuospatial), Factor 2 (verbal memory), Factor 3 (frontal/executive), and Factor 4 (attention/working memory/language). The global cognitive composite score of each patient was calculated based on these factors. Subsequently, we assessed the effect of baseline cognitive function on long-term motor outcomes, namely levodopa-induced dyskinesia (LID), wearing-off, freezing of gait (FOG), and rate of longitudinal increases in levodopa-equivalent dose (LED). RESULTS Cox regression analysis demonstrated that higher Factor 3 (frontal/executive) composite scores (i.e., better cognitive performance) were associated with early development of LID [hazard ratio (HR), 1.507; p = 0.003], whereas higher Factor 1 (visual memory/visuospatial) composite scores (i.e., better cognitive performance) were associated with a lower risk for FOG (HR 0.683; p = 0.017). We noted that higher global cognitive composite scores were associated with a lower risk for developing FOG (HR 0.455; p = 0.045). The linear mixed model demonstrated that higher global cognitive composite scores and better cognitive performance in visual memory/visuospatial function were associated with slower longitudinal increases in LED. CONCLUSIONS These findings suggest that baseline cognitive profiles have prognostic implications on several motor aspects in patients with PD.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - KyoungWon Baik
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, 50, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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12
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Jeong SH, Chung SJ, Yoo HS, Hong N, Jung JH, Baik K, Lee YH, Sohn YH, Lee PH. Beneficial effects of dipeptidyl peptidase-4 inhibitors in diabetic Parkinson's disease. Brain 2021; 144:1127-1137. [PMID: 33895825 DOI: 10.1093/brain/awab015] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/10/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022] Open
Abstract
Dipeptidyl peptidase 4 (DPP4) inhibitors are widely used hypoglycaemic agents and improve glucose metabolism by enhancing the bioavailability of active glucagon-like peptide-1. In this study, we hypothesized that treatment with DPP4 inhibitors may have beneficial effects on nigrostriatal dopamine and longitudinal motor performance in diabetic patients with Parkinson's disease. We classified 697 drug naive patients with de novo Parkinson's disease who had undergone dopamine transporter imaging into three groups according to a prior diagnosis of diabetes and use of DPP4 inhibitors: diabetic patients with Parkinson's disease being treated with (n = 54) or without DPP4 inhibitors (n = 85), and non-diabetic patients with Parkinson's disease (n = 558). Diabetic patients with Parkinson's disease being treated with DPP4 inhibitors had a higher baseline dopamine transporter availability in the anterior (2.56 ± 0.74 versus 2.10 ± 0.50; P = 0.016), posterior (1.83 ± 0.69 versus 1.40 ± 0.50; P < 0.001), and ventral putamina (1.72 ± 0.58 versus 1.35 ± 0.37; P = 0.001) than that in diabetic patients with Parkinson's disease without DPP4 inhibitors. Additionally, diabetic patients with Parkinson's disease being treated with DPP4 inhibitors had higher dopamine transporter availability in the posterior putamen than that in non-diabetic patients with Parkinson's disease (1.83 ± 0.69 versus 1.43 ± 0.59; P < 0.001). After adjusting for age, sex, disease duration, and vascular risk factors, linear regression models showed that a prior treatment of DPP4 inhibitors remained independently and significantly associated with dopamine transporter availability in the anterior (β = -0.186, P = 0.012; β = -0.207, P = 0.003), posterior (β = -0.336, P < 0.001; β = -0.286, P < 0.001), and ventral putamina (β = -0.204, P = 0.005; β = -0.250, P < 0.001). A linear mixed model revealed that the diabetic group with Parkinson's disease being treated with DPP4 inhibitors had a slower longitudinal increase in levodopa-equivalent dose than the other groups (P = 0.003). Survival analyses showed that the rate of levodopa-induced dyskinesia was significantly lower in the diabetic group with a prior treatment with DPP4 inhibitors than the diabetic group without DPP4 inhibitors (hazard ratio = 0.194, P = 0.037). These findings suggest that DPP4 inhibitors may confer beneficial effects on the baseline nigrostriatal dopamine degeneration and long-term motor outcomes in diabetic patients with Parkinson's disease and may extend its role into non-diabetic patients with Parkinson's disease.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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13
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Toldo JMP, Arjona M, Campos Neto GC, Vitor T, Nogueira SA, Amaro E, Saba RA, Silva SMCA, Ferraz HB, Felício AC. Virtual Rehabilitation in Parkinson Disease: A Dopamine Transporter Imaging Study. Am J Phys Med Rehabil 2021; 100:359-366. [PMID: 33727518 DOI: 10.1097/phm.0000000000001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to verify the effect of a virtual rehabilitation protocol for patients with Parkinson disease, primarily assessing striatal dopamine transporters and secondarily motor symptoms and quality of life. DESIGN Nineteen patients with Parkinson disease underwent an 8-wk virtual rehabilitation protocol using XBOX 360S. Evaluation of dopamine transporters was performed by single-photon emission computed tomography using TRODAT-1 as the radioligand. Participants were clinically assessed using the Unified Parkinson Disease Rating Scale to quantify motor symptoms. Moreover, the Parkinson Disease Questionnaire and Short-Form Health Status Survey were used to assess quality of life and the Berg Balance Scale to assess balance. RESULTS Regarding our primary outcome, dopamine transporter was significantly increased in the putamen contralateral to the clinically most affected body side (P = 0.034) considering preintervention and postintervention measurements. Furthermore, we observed significant improvement in Unified Parkinson Disease Rating Scale (10-point reduction, P = 0.001), Parkinson Disease Questionnaire (11.3-point reduction, P = 0.001), Short-Form Health Status Survey ("Functional capacity," P = 0.001; "Pain," P = 0.006; and "Mental Health" domains, P < 0.001), and Berg Balance Scale (5-point increase, P = 0.015). CONCLUSIONS In our group of Parkinson disease patients, this virtual rehabilitation protocol enabled a dopamine transporter increase in the region of the putamen contralateral to the clinically most affected body side. Moreover, motor signs and quality of life were significantly improved.
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Affiliation(s)
- Juliana M P Toldo
- From the Hospital Israelita Albert Einstein, São Paulo, Brazil (JMPT, MA, GCCN, TV, SAN, EAJ, ACF); Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (RAS, SMCAS); and Universidade Federal de São Paulo, São Paulo, Brazil (RAS, SMCAS, HBF)
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14
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Chung SJ, Yoo HS, Shin NY, Park YW, Lee HS, Hong JM, Kim YJ, Lee SK, Lee PH, Sohn YH. Perivascular Spaces in the Basal Ganglia and Long-term Motor Prognosis in Newly Diagnosed Parkinson Disease. Neurology 2021; 96:e2121-e2131. [PMID: 33653906 DOI: 10.1212/wnl.0000000000011797] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the association between enlarged perivascular spaces (PVS) in the basal ganglia (BG-PVS) and long-term motor outcomes in Parkinson disease (PD). METHODS We reviewed the medical records of 248 patients with drug-naive early-stage PD (follow-up >3 years, mean age 67.44 ± 8.46 years, 130 female) who underwent brain MRI and dopamine transporter (DAT) scans at initial assessment. The number of baseline enlarged BG-PVS was counted on axial T2-weighted images. Then, patients were divided into 2 groups: a PD group with a low number (0-10) of enlarged PVS (PD-EPVS-; n = 156) and a PD group with a high number (>10) of enlarged PVS (PD-EPVS+; n = 92). We used Cox regression models to compare the levodopa-induced dyskinesia (LID)-, wearing-off-, and freezing of gait (FOG)-free times between groups. We also compared longitudinal increases in levodopa-equivalent dose per body weight between groups using a linear mixed model. RESULTS Patients in the PD-EPVS+ group were older (72.28 ± 6.07 years) and had greater small vessel disease burden than those in the PD-EPVS- group (64.58 ± 8.38 years). The PD-EPVS+ group exhibited more severely decreased DAT availability in all striatal subregions except the ventral striatum. The risk of FOG was higher in the PD-EPVS+ group, but the risk of LID or wearing-off was comparable between groups. The PD-EPVS+ group required higher doses of dopaminergic medications for effective symptom control compared to the PD-EPVS- group. CONCLUSION This study suggests that baseline enlarged BG-PVS can be an indicator of the progression of motor disability in PD.
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Affiliation(s)
- Seok Jong Chung
- From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Han Soo Yoo
- From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Na-Young Shin
- From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yae Won Park
- From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hye Sun Lee
- From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Man Hong
- From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yun Joong Kim
- From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung-Koo Lee
- From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Phil Hyu Lee
- From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young H Sohn
- From the Departments of Neurology (S.J.C., H.S.Y., J.-M.H., Y.J.K., P.H.L., Y.H.S.) and Radiology (Y.W.P., S.-K.L.) and Biostatistics Collaboration Unit (H.S.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C., J.-M.H., Y.J.K.), Yongin Severance Hospital, Yonsei University Health System, Yongin; and Department of Radiology (N.-Y.S.), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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15
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The effect of intra-striatal administration of GPR55 agonist (LPI) and antagonist (ML193) on sensorimotor and motor functions in a Parkinson's disease rat model. Acta Neuropsychiatr 2021; 33:15-21. [PMID: 32967746 DOI: 10.1017/neu.2020.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE G protein-coupled receptor 55 (GPR55) is an orphan G protein-coupled receptor with various physiological functions. Recent evidence suggests that this receptor may be involved in the control of motor functions. Therefore, in the present study, we evaluated the effects of intra-striatal administration of GPR55 selective ligands in a rat model of Parkinson's disease. METHODS Experimental Parkinson was induced by unilateral intra-striatal administration of 6-hydroxydopamine (6-OHDA, 10 µg/rat). L-α-lysophosphatidylinositol (LPI, 1 and 5 µg/rat), an endogenous GPR55 agonist, and ML193 (1 and 5 µg/rat), a selective GPR55 antagonist, were injected into the striatum of 6-OHDA-lesioned rats. Motor performance and balance skills were evaluated using the accelerating rotating rod and the ledged beam tests. The sensorimotor function of the forelimbs and locomotor activity were assessed by the adhesive removal and open field tests, respectively. RESULTS 6-OHDA-lesioned rats had impaired behaviours in all tests. Intra-striatal administration of LPI in 6-OHDA-lesioned rats increased time on the rotarod, decreased latency to remove the label, with no significant effect on slip steps, and locomotor activity. Intra-striatal administration of ML193 also increased time on the rotarod, decreased latency to remove the label and slip steps in 6-OHDA-lesioned rats mostly at the dose of 1 µg/rat. CONCLUSIONS This study suggests that the striatal GPR55 is involved in the control of motor functions. However, considering the similar effects of GPR55 agonist and antagonist, it may be concluded that this receptor has a modulatory role in the control of motor deficits in an experimental model of Parkinson.
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Juri C, Kramer V, Riss PJ, Soza-Ried C, Haeger A, Pruzzo R, Rösch F, Amaral H, Chana-Cuevas P. [18F]PR04.MZ PET/CT Imaging for Evaluation of Nigrostriatal Neuron Integrity in Patients With Parkinson Disease. Clin Nucl Med 2021; 46:119-124. [PMID: 33323728 PMCID: PMC7774816 DOI: 10.1097/rlu.0000000000003430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/14/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Degeneration of dopaminergic, nigrostriatal neurons is the hallmark of Parkinson disease (PD), and PET quantification of dopamine transporters is a widely accepted method for differential diagnosis between idiopathic PD and essential tremor. [18F]PR04.MZ is a new PET tracer with excellent imaging properties allowing for precise quantification of striatal and extrastriatal dopamine transporter. Here we describe our initial experience with [18F]PR04.MZ PET/CT in a larger cohort of healthy controls and PD patients as a proof-of-concept study for this tracer. METHODS Eighteen healthy subjects, 19 early PD patients (Hoehn-Yahr I-II), and 13 moderate-advanced PD patients (Hoehn-Yahr III-IV) underwent static PET/CT scans 60 to 90 minutes after injection of 5.16 ± 1.03 mCi (191 ± 38 MBq) [18F]PR04.MZ. Specific binding ratios (SBRs) were calculated for caudate nucleus, anterior putamen, posterior putamen, substantia nigra (SNpc), compared between different groups and correlated with clinical ratings. RESULTS [18F]PR04.MZ showed very high and specific uptake in the putamen, caudate, and substantia nigra pars compacta and very low nonspecific binding in other brain regions, and SBR values for the control group were 22.3 ± 4.1, 19.1 ± 3.5, and 5.4 ± 1.2, respectively. A reduction of SBR values was observed in all regions and in both initial and moderate PD, ranging from 35% to 89% (P < 0.001). The observed pattern of reduction was posterior putamen > anterior putamen > substantia nigra pars compacta > caudate, with contralateral posterior putamen being the most affected region. Rostrocaudal depletion gradient was evident in all PD patients and progression correlated with motor manifestations. CONCLUSIONS [18F]PR04.MZ PET/CT is a highly sensitive imaging modality for the detection of dopaminergic deficit in nigrostriatal pathways in PD.
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Affiliation(s)
- Carlos Juri
- From the Department of Neurology, Facultad de Medicina, Pontificia Universidad Católica de Chile
- Department of Neurology, Hospital Sotero del Río
| | - Vasko Kramer
- Nuclear Medicine and PET/CT Center PositronMed
- Positronpharma SA, Santiago, Chile
| | | | | | | | | | - Frank Rösch
- Institute of Nuclear Chemistry, Johannes Gutenberg-University, Mainz, Germany
| | - Horacio Amaral
- Nuclear Medicine and PET/CT Center PositronMed
- Positronpharma SA, Santiago, Chile
| | - Pedro Chana-Cuevas
- Centro de Trastornos del Movimiento
- Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago, Chile
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Chung SJ, Lee JJ, Lee PH, Sohn YH. Emerging Concepts of Motor Reserve in Parkinson's Disease. J Mov Disord 2020; 13:171-184. [PMID: 32854486 PMCID: PMC7502292 DOI: 10.14802/jmd.20029] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/05/2020] [Indexed: 01/18/2023] Open
Abstract
The concept of cognitive reserve (CR) in Alzheimer's disease (AD) explains the differences between individuals in their susceptibility to AD-related pathologies. An enhanced CR may lead to less cognitive deficits despite severe pathological lesions. Parkinson's disease (PD) is also a common neurodegenerative disease and is mainly characterized by motor dysfunction related to striatal dopaminergic depletion. The degree of motor deficits in PD is closely correlated to the degree of dopamine depletion; however, significant individual variations still exist. Therefore, we hypothesized that the presence of motor reserve (MR) in PD explains the individual differences in motor deficits despite similar levels of striatal dopamine depletion. Since 2015, we have performed a series of studies investigating MR in de novo patients with PD using the data of initial clinical presentation and dopamine transporter PET scan. In this review, we summarized the results of these published studies. In particular, some premorbid experiences (i.e., physical activity and education) and modifiable factors (i.e., body mass index and white matter hyperintensity on brain image studies) could modulate an individual's capacity to tolerate PD pathology, which can be maintained throughout disease progression.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Jae Jung Lee
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Chung SJ, Lee HS, Yoo HS, Lee YH, Lee PH, Sohn YH. Patterns of striatal dopamine depletion in early Parkinson disease. Neurology 2020; 95:e280-e290. [DOI: 10.1212/wnl.0000000000009878] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/27/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo investigate whether the patterns of striatal dopamine depletion on dopamine transporter (DAT) scans could provide information on the long-term prognosis in Parkinson disease (PD).MethodsWe enrolled 205 drug-naive patients with early-stage PD, who underwent18F-FP-CIT PET scans at initial assessment and received PD medications for 3 or more years. After quantifying the DAT availability in each striatal subregion, factor analysis was conducted to simplify the identification of striatal dopamine depletion patterns and to yield 4 striatal subregion factors. We assessed the effect of these factors on the development of levodopa-induced dyskinesia (LID), wearing-off, freezing of gait (FOG), and dementia during the follow-up period (6.84 ± 1.80 years).ResultsThe 4 factors indicated which striatal subregions were relatively preserved: factor 1 (caudate), factor 2 (more-affected sensorimotor striatum), factor 3 (less-affected sensorimotor striatum), and factor 4 (anterior putamen). Cox regression analyses using the composite scores of these striatal subregion factors as covariates demonstrated that selective dopamine depletion in the sensorimotor striatum was associated with a higher risk for developing LID. Selective dopamine loss in the putamen, particularly in the anterior putamen, was associated with early development of wearing-off. Selective involvement of the anterior putamen was associated with a higher risk for dementia conversion. However, the patterns of striatal dopamine depletion did not affect the risk of FOG.ConclusionsThese findings suggested that the patterns of striatal dopaminergic denervation, which were estimated by the equation derived from the factor analysis, have a prognostic implication in patients with early-stage PD.
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Cao R, Chen X, Xie C, Hu P, Wang K. Serial Dopamine Transporter Imaging of Nigrostriatal Function in Parkinson's Disease With Probable REM Sleep Behavior Disorder. Front Neurosci 2020; 14:349. [PMID: 32425747 PMCID: PMC7205005 DOI: 10.3389/fnins.2020.00349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/23/2020] [Indexed: 12/30/2022] Open
Abstract
The current study aimed to confirm whether probable rapid eye movement sleep behavior disorder (pRBD) is associated with a specific pattern of striatal dopamine depletion in an international, multicenter, prospective cohort of patients with Parkinson's disease (PD). Two hundred and seventy de novo, drug-naïve patients with PD underwent dopamine transporter (DAT) single photon emission computed tomography with 123I-FP-CIT at baseline and 1, 2, and 4 years after the initial scan. The diagnosis of pRBD was based on the 10-item RBD Screening Questionnaire. Striatal DAT binding levels and their rates of decline were compared between patients with pRBD and those without. At baseline, patients in the PD-pRBD+ group showed lower striatal DAT binding in the caudate (which was more pronounced in the less-affected hemisphere) and in the putamen. During the 4-year follow-up, patients in the PD-pRBD+ group consistently exhibited greater DAT loss than patients in the PD-pRBD- group with comparable disease duration in all four striatal subregions. These patients also exhibited a more rapid decrease in DAT binding in the caudate and a less prominent interhemispheric asymmetry in the putamen. The distinct pattern of striatal DAT depletion may contribute to a more malignant phenotype of PD associated with RBD, specifically faster progression of motor symptoms.
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Affiliation(s)
- Ruihua Cao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Xingui Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Chengjuan Xie
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Collaborative Innovation Centre of Neuropsychiatric Disorder and Mental Health, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
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Baik K, Chung SJ, Yoo HS, Lee YH, Jung JH, Sohn YH, Lee PH. Sex‐dependent association of urate on the patterns of striatal dopamine depletion in Parkinson’s disease. Eur J Neurol 2020; 27:773-778. [DOI: 10.1111/ene.14152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/09/2020] [Indexed: 02/06/2023]
Affiliation(s)
- K. Baik
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
| | - S. J. Chung
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
| | - H. S. Yoo
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
| | - Y. H. Lee
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
| | - J. H. Jung
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
| | - Y. H. Sohn
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
| | - P. H. Lee
- Department of Neurology Yonsei University College of Medicine Seoul South Korea
- Severance Biomedical Science Institute Yonsei University College of Medicine Seoul South Korea
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Chung SJ, Yoo HS, Lee YH, Lee PH, Sohn YH. Heterogeneous Patterns of Striatal Dopamine Loss in Patients with Young- versus Old-Onset Parkinson's Disease: Impact on Clinical Features. J Mov Disord 2019; 12:113-119. [PMID: 31158944 PMCID: PMC6547040 DOI: 10.14802/jmd.18064] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/22/2019] [Indexed: 01/15/2023] Open
Abstract
Objective Ample evidence has suggested that age at onset of Parkinson’s disease (PD) is associated with heterogeneous clinical features in individuals. We hypothesized that this may be attributed to different patterns of nigrostriatal dopamine loss. Methods A total of 205 consecutive patients with de novo PD who underwent 18F-FP-CIT PET scans (mean follow-up duration, 6.31 years) were divided into three tertile groups according to their age at onset of parkinsonian motor symptoms. Striatal dopamine transporter (DAT) availability was compared between the old- (n = 73) and young-onset (n = 66) groups. In addition, the risk of developing freezing of gait (FOG) and longitudinal requirements for dopaminergic medications were examined. Results The old-onset PD group (mean age at onset, 72.66 years) exhibited more severe parkinsonian motor signs than the young-onset group (52.58 years), despite comparable DAT availability in the posterior putamen; moreover, the old-onset group exhibited more severely decreased DAT availability in the caudate than the young-onset group. A Cox regression model revealed that the old-onset PD group had a higher risk for developing FOG than the young-onset group [hazard ratio 2.523, 95% confidence interval (1.239–5.140)]. The old-onset group required higher doses of dopaminergic medications for symptom control than the young-onset group over time. Conclusion The present study demonstrated that the old-onset PD group exhibited more severe dopamine loss in the caudate and were more likely to develop gait freezing, suggesting that age at onset may be one of the major determinants of the pattern of striatal dopamine depletion and progression of gait disturbance in PD.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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