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HMPAO SPECT in Parkinson’s disease (PD) with major depression (MD) before and after antidepressant treatment

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Abstract

Previously we suggested that major depression (MD) in Parkinson’s disease (PD) could be an indication of a more advanced and widespread neurodegenerative process, as PD symptoms were more severe in those with depression. We also found a different antidepressant response with SSRI medication in PD patients with depression compared to depressed patients without PD. This indicates diverse underlying pathophysiological mechanisms. Investigations using single-photon emission computed tomography (SPECT), measuring regional cerebral blood flow (rCBF), may contribute to enlighten the neurobiological substrates linked to depressive symptoms. SPECT was performed in order to compare rCBF in MD patients with and without PD. The study included 11 MD patients with PD, 14 non-depressed PD patients and 12 MD patients without PD. All patients were followed for 12 weeks with repeated evaluation of depressive as well as PD symptoms. Anti-Parkinsonian treatment remained unchanged during the study. Antidepressant treatment with SSRI (citalopram) was given to all patients with MD. SPECT was performed before and after 12 weeks of antidepressant treatment. rCBF was found to differ between PD patients with and without MD, as well as between MD patients with and without PD, both at baseline and concerning the response to treatment with SSRI (citalopram). In patients with PD the rCBF was found to be decreased in preoccipital and occipital regions, a finding more common when PD was combined with MD. In summary, larger cortical areas were found to be involved in depressed PD patients, both with hyperactivity (reciprocal to basal degeneration in PD and maybe dopaminergic treatment) and with hypoactivity (probably due to organic lesions leading to hypoperfusion). These observations support our hypothesis that PD combined with MD is an expression of a more advanced and widespread neurodegenerative disorder.

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Acknowledgments

Thanks to Dr. Ebba Curman and research nurse Miriam Carlsson for valuable support in recruiting and managing the patients. We are grateful to Mats Fredrikson, PhD, Faculty of Health Science, Linköping University, Sweden, and Olle Eriksson, PhD, Department of Mathematics Linköping University, Sweden, for statistical guidance and analysis. The study was supported by an unrestricted grant from H. Lundbeck AB Sweden.

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Authors and Affiliations

  1. Department of Clinical Neuroscience, Division of Neurology Huddinge, Karolinska Institute, Stockholm, Sweden

    Sven E. Pålhagen

  2. Department of Neurology, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden

    Sven E. Pålhagen

  3. Centre for Medical Imaging, University Hospital, Linköping, Sweden

    Stefan Ekberg

  4. Department of Psychiatry, Göteborg University, Mölndal, Sweden

    Jan Wålinder

  5. Department of Clinical and Experimental Medicine, Division of Geriatrics, Faculty of Health Sciences, Linköping University, Linköping, Sweden

    Ann-Kathrine Granérus

  6. Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden

    Göran Granerus

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  1. Sven E. Pålhagen
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  2. Stefan Ekberg
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  3. Jan Wålinder
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  4. Ann-Kathrine Granérus
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Correspondence to Sven E. Pålhagen.

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Pålhagen, S.E., Ekberg, S., Wålinder, J. et al. HMPAO SPECT in Parkinson’s disease (PD) with major depression (MD) before and after antidepressant treatment. J Neurol 256, 1510–1518 (2009). https://doi.org/10.1007/s00415-009-5155-x

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  • DOI: https://doi.org/10.1007/s00415-009-5155-x

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