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Parkinson Dementia: PET Findings

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PET and SPECT in Neurology

Abstract

Degeneration of subcortical systems such as the dopaminergic nigrostriatal projection and the basal forebrain cholinergic corticopetal system as well as cortical neurodegeneration associated with depositions of α-synuclein and β-amyloid pathology are likely contributors to cognitive impairment in Parkinson disease (PD). Glucose metabolic studies have shown mixed subcortical and cortical changes in PD dementia. For example, incident dementia in idiopathic PD is heralded by decreased metabolism of visual association (Brodmann area 18) and posterior cingulate cortices with additional involvement of the caudate nucleus. Subsequent progression to dementia is associated with mixed subcortical, especially thalamic, and widespread cortical changes that involve the mesiofrontal lobes also. Neurotransmitter-specific PET imaging shows early and prominent nigrostriatal dopaminergic losses in PD, with no major differences in PD dementia. Therefore, caudate nucleus, limbic, and mesofrontal dopaminergic denervations do not appear alone sufficient for development of full-blown PD dementia. In contrast, cholinergic imaging studies have shown relatively mild losses in PD without dementia, but more prominent decreases in PD dementia. This suggests significant cholinergic pathology underlying progressive cognitive decline in PD. Average dopaminergic and cholinergic denervation does not appear to differ between PD with dementia (PDD) and dementia with Lewy bodies (DLB), supporting the view that PDD and DLB lie on a common disease spectrum. In vivo imaging studies show variable β-amyloid binding in PD dementia with prevalence of pathologic amyloid deposition higher in DLB compared to PDD. However, despite the relatively lower binding levels compared to AD, β-amyloid deposition contributes to cognitive impairment early in the course of cognitive decline in PD, suggesting a lower symptomatic threshold for the amyloid deposition compared to normal aging and Alzheimer disease (AD).

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Abbreviations

AD:

Alzheimer disease

DLB:

Dementia with Lewy bodies

DTBZ:

Dihydrotetrabenazine

FDG:

Fluorodeoxyglucose

FDOPA:

6-Fluorodopa

MP4A:

Methyl-4-piperidyl acetate

PD:

Parkinson disease

PDD:

Parkinson disease with dementia

PET:

Positron emission tomography

PMP:

Methyl-4-piperidinyl propionate

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Acknowledgments

The authors gratefully acknowledge research support from the NIH, the Department of Veterans Affairs, and the Michael J. Fox Foundation.

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Authors and Affiliations

  1. Functional Neuroimaging, Cognitive and Mobility Laboratory, Departments of Radiology and Neurology, University of Michigan and VA Ann Arbor Healthcare, Domino’s Farms, Lobby B, Suite 1000, Level I, 24 Frank Lloyd Wright Drive, 362, Ann Arbor, MI, 48105-9755, USA

    Nicolaas I. Bohnen MD

  2. Departments of Radiology and Neurology, University of Michigan and B1G5 University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA

    Kirk A. Frey MD, PhD

Authors
  1. Nicolaas I. Bohnen MD
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  2. Kirk A. Frey MD, PhD
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Correspondence to Nicolaas I. Bohnen MD .

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Editors and Affiliations

  1. Dept. of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Rudi A.J.O. Dierckx

  2. Faculty of Electrical Engineering and Information Technology, University of Applied Sciences Offenburg, Offenburg, Germany

    Andreas Otte

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Erik F.J. de Vries

  4. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Aren van Waarde

  5. Neurology, University Medical Center Groningen, Groningen, The Netherlands

    Klaus L. Leenders

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Bohnen, N.I., Frey, K.A. (2014). Parkinson Dementia: PET Findings. In: Dierckx, R., Otte, A., de Vries, E., van Waarde, A., Leenders, K. (eds) PET and SPECT in Neurology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54307-4_16

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