Advertisement

PET and the investigation of dementia in the parkinsonian patient

  • N. Turjanski
  • D. J. Brooks
Part of the Journal of Neural Transmission. Supplementa book series (NEURAL SUPPL, volume 51)

Summary

Parkinsonism and dementia are present in a number of neurodegenerative conditions. They may be a manifestation of isolated brain stem (Parkinson’s disease) or diffuse Lewy body disease (DLBD), or be secondary to combined Lewy body and Alzheimer’s disease (AD) pathologies. Positron emission tomography (PET) studies show a resting pattern of fronto-temporo-parietal hypometabolism in both, AD and in parkinsonism-dementia (PD-dementia) patients, even when only isolated brain stem Lewy body disease is found at pathology. We have studied three patients fulfilling clinical criteria for diagnosis of DLBD. Their 18F-fluorodeoxyglucose (FDG) PET results showed an AD pattern of fronto-temporo-parietal hypometabolism, though these patients had only mild cognitive dysfunction. Parkinsonism associated with apraxia is observed in corticobasal degeneration (CBD) while impairment of frontal functions, such as planning and sorting, is seen in patients with progressive supranuclear palsy (PSP). PET studies in CBD patients have shown an asymmetric hypometabolism of cortex and thalamus contralateral to the affected limbs, while in PSP patients there is a global metabolic reduction most pronounced in frontal areas and the basal ganglia. These results suggest that metabolic PET studies can help to distinguish PD-dementia, PSP and CBD, but are unable to distinguish PD-dementia from AD. Further studies with post-mortem confirmation are required to establish if DLBD is associated with a distinctive pattern of resting hypometabolism.

Keywords

Positron Emission Tomography Lewy Body Dementia With Lewy Body Progressive Supranuclear Palsy Positron Emission Tomography Study 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alavi A, Dann R, Chawluk J, Alavi J, Kushner M, Reivich M (1986) Positron emission tomography imaging of regional cerebral glucose metabolism. Semin Nucl Med 16: 2–34.PubMedCrossRefGoogle Scholar
  2. Blin J, Baron JC, Dubois B, Pillon B, Cambon H, Cambier J, Agid Y (1990a) Positron emission tomography study in progressive supranuclear palsy. Brain hypometabolic pattern and clinicometabolic correlations. Arch Neurol 47: 747–752.Google Scholar
  3. Blin J, Vidailhet M, Bonnet AM, Dubois B, Pillon B, Syrota A, Agid Y (1990b) PET study in cortico-basal degeneration. Mov Disord 5 [Suppl 1]: 19.Google Scholar
  4. Blin J, Vidailhet M-J, Pillon B, Dubois B, Feve J-R, Agid Y (1992) Corticobasal degeneration: decreased and asymmetrical glucose consumption as studied with PET. Mov Disord 7: 348–354.PubMedCrossRefGoogle Scholar
  5. Brooks DJ (1994) PET studies in progressive supranuclear palsy. J Neural Transm[Suppl 42]: 119–134.Google Scholar
  6. Brown RG, Marsden CD (1984) How common is dementia in Parkinson’s disease? Lancet ii: 1262–1265.Google Scholar
  7. Burn DJ, Sawle GV, Brooks DJ (1994) Differential diagnosis of Parkinson’s disease, multiple system atrophy, and Steele-Richardson-Olszewski syndrome: discriminant analysis of striatal 18F-dopa PET data. J Neurol Neurosurg Psychiatry 57: 278–284.PubMedCrossRefGoogle Scholar
  8. Byrne J, Lennox G, Lowe J, Godwin-Austen RB (1989) Diffuse Lewy body disease: clinical features in 15 cases. J Neurol Neurosurg Psychiatry 52: 709–717.PubMedCrossRefGoogle Scholar
  9. Chase TN, Foster NL, Fedio P, Brooks R, Mansi L, Di Chiro G (1984) Regional cortical dysfunction in Alzheimer’s disease as determined by positron emission tomography. Ann Neurol 15 [Suppl]: S170–S174.PubMedCrossRefGoogle Scholar
  10. Colosimo C, Albanese A, Hughes AJ, De Bruin VMS, Lees AJ (1995) Some specific clinical features differentiate multiple system atrophy (striatonigral variety) from Parkinson’s disease. Arch Neurol 52: 294–298.PubMedCrossRefGoogle Scholar
  11. Costa DC, Ell PJ, Philpot M, Levy R (1988) CBF tomograms with [99m]Tc-HM-PAO in patients with dementia (Alzheimer’s type and HIV) and Parkinson’s disease-initial results. J Cereb Blood Flow Metab 8 [Suppl 1]: S109–S115.PubMedCrossRefGoogle Scholar
  12. Crystal HA, Dickson DW, Lizardi JE, Davies P, Wolfson LI (1990) Antemortem diagnosis of diffuse Lewy body disease. Neurology 40: 1523–1528.PubMedCrossRefGoogle Scholar
  13. De Bruin VMS, Lees AJ (1994) Subcortical neurofibrillary degeneration presenting as Steele-Richardson-Olszewski and other related syndromes: a review of 90 pathologically verified cases. Mov Disord 9: 381–389.PubMedCrossRefGoogle Scholar
  14. Ditter SM, Mirra SS (1987) Neuropathology and clinical features of Parkinson’s disease in Alzheimer’s disease patients. Neurology 37: 754–760.PubMedCrossRefGoogle Scholar
  15. Duvoisin RC (1994) Differential diagnosis of PSP.J Neural Transm [Suppl 42]: 51–67. Google Scholar
  16. Eidelberg D, Moelier JR, Dhawan V, Sidtis JJ, Ginos JZ, Strother, SC, Cedarbaum J, Greene P, Fahn S, Rottenberg DA (1990) The metabolic anatomy of Parkinson’s disease: complementary [18F]Fluorodeoxyglucose and [18F]Fluorodopa positron emission tomographic studies. Mov Disord 5: 203–213.PubMedCrossRefGoogle Scholar
  17. Eidelberg D, Dhawan V, Moeller JR, Sidtis JJ, Ginos JZ, Strother SC, Cederbaum J, Greene P, Fahn S, Powers JM, Rottenberg DA (1991) The metabolic landscape of cortico-basal ganglionic degeneration: regional asymmetries studied with positron emission tomography. J Neurol Neurosurg Psychiatry 54: 856–862.PubMedCrossRefGoogle Scholar
  18. Eidelberg D, Moeller JR, Dhawan V, Spetsieris P, Takikawa S, Ishikawa T, Chaly T, Robeson W, Margouleff D, Przedborski S, Fahn S (1994) The metabolic topography of parkinsonism. J Cereb Blood Flow Metab 14: 783–801.PubMedCrossRefGoogle Scholar
  19. Fearnley JM, Revesz T, Brooks DJ, Frackowiack RSJ, Lees AJ (1991) Diffuse Lewy body disease presenting with a supranuclear gaze palsy. J Neurol Neurosurg Psychiatry 54: 159–161.PubMedCrossRefGoogle Scholar
  20. Foster NL, Chase TN, Fedio P, Patronas NJ, Brooks RA, Di Chiro G (1983) Alzheimer’s disease: focal cortical changes shown by positron emission tomography. Neurology 33: 961–965.PubMedCrossRefGoogle Scholar
  21. Foster NL, Gilman S, Berent S, Sima AAF, D’Amato C, Koeppe RA, Hicks SP (1992) Progressive subcortical gliosis and progressive supranuclear palsy can have similar clinical and PET abnormalities. J Neurol Neurosurg Psychiatry 55: 707–713.PubMedCrossRefGoogle Scholar
  22. Frackowiak RSJ, Friston KJ (1994) Functional neuroanatomy of the human brain: positron emission tomography — a new neuroanatomical technique. J Anat 184: 211–225.PubMedGoogle Scholar
  23. Frackowiak RSJ, Pozilli C, Legg, NJ, Du Boulay GH, Marshall J, Lenzi GL, Jones T (1981) Regional cerebral oxygen supply and utilization in dementia. Brain 104: 753–778.PubMedCrossRefGoogle Scholar
  24. Friedland RP, Budinger TF, Ganz E, Yano Y, Mathis CA, Koss B, Ober BA, HuesmanRH, Derenzo SE (1983) Regional cerebral metabolic alterations in dementia of the Alzheimer type: positron emission tomography with [18F]Fluorodeoxyglucose. J Comput Assist Tomogr 7: 590–598.PubMedCrossRefGoogle Scholar
  25. Friston KJ (1995) Statistical parametric mapping: ontology and current issues. J Cereb Blood Flow Metab 15: 361–370.PubMedCrossRefGoogle Scholar
  26. Gibb WRG, Luthert PJ (1994) Dementia in Parkinson’s disease and Lewy body disease. In: Burns A, Levy R (eds) Dementia. Chapman & Hall, London, pp 719–738.Google Scholar
  27. Gibb WRG, Esiri MM, Lees AJ (1985) Clinical and pathological features of diffuse cortical Lewy body disease (Lewy body dementia). Brain 110: 1131–1153.CrossRefGoogle Scholar
  28. Goffinet AM, De Volder AG, Gillain C, Rectem D, Boi A, Michel C, Cogneau M, Labar D, Laterre C (1989) Positron tomography demonstrates frontal lobe hypometabolism in progressive supranuclear palsy. Ann Neurol 25: 131–139.PubMedCrossRefGoogle Scholar
  29. Golbe LI, Miller DC, Duvoisin RC (1989) Paraneoplastic degeneration of the substantia nigra with dystonia and parkinsonism. Mov Disord 4: 147–152.PubMedCrossRefGoogle Scholar
  30. Goto I, Taniwaki T, Hosokawa S, Otsuka M, Ichiya Y, Ichimiya A (1993) Positron emission tomographic (PET) studies in dementia. J Neurol Sci 114: 1–6.PubMedCrossRefGoogle Scholar
  31. Hansen L, Salmon D, Galasko D, Mesliah E, Katzman R, DeTeresa R, Thal L, Pay MM, Hofstetter R, Klauber M, Rice V, Butters N, Alford M (1990) The Lewy body variant of Alzheimer’s disease: a clinical and pathologic entity. Neurology 40:1–8.PubMedCrossRefGoogle Scholar
  32. Hansen LA, Galasko D (1995) Lewy body disease. Curr Opin Neurol Neurosurg 5: 889–894.Google Scholar
  33. Hughes AJ, Daniel SE, Blankson S, Lees AJ (1993) A clinicopathologic study of 100 cases of Parkinson’s disease. Arch Neurol 50: 140–148.PubMedCrossRefGoogle Scholar
  34. Jellinger K, Grisold W (1982) Cerebral atrophy in Parkinson syndrome. Exp Brain Res [Suppl] 5: 26–35.CrossRefGoogle Scholar
  35. Johnson KA, Sperling RA, Holman BL, Nagel JS, Growdon JH (1992) Cerebral perfusion in progressive supranuclear palsy. J Nucl Med 33: 704–709.PubMedGoogle Scholar
  36. Karbe H, Holthoff V, Huber M, Herholz Z, Wienhard K, Wagner R, Heiss WD (1992) Positron emission tomography in degenerative disorders of the dopaminergic system. J Neural Transm [PD Sect] 4: 121–130.CrossRefGoogle Scholar
  37. Kennedy AM, Frackowiak RSJ, Newman SK, Bloomfield PM, Seaward J, Roques P, Lewington G, Cunningham VJ, Rossor MN (1995) Deficits in cerebral glucose metabolism demonstrated by positron emission tomography in individuals at risk of familial Alzheimer’s disease. Neurosci Lett 186: 17–20.PubMedCrossRefGoogle Scholar
  38. Kosaka K (1978) Lewy bodies in cerebral cortex. Report of three cases. Acta Neuropathol 42: 127–134.Google Scholar
  39. Kosaka K (1990) Diffuse Lewy body disease in Japan. J Neurol 237: 197–204.PubMedCrossRefGoogle Scholar
  40. Kosaka K, Yoshimura M, Ikeda K, Budka H (1984) Diffuse type of Lewy body disease: progressive dementia with abundant cortical Lewy bodies and senile changes of various degree — a new disease? Clin Neuropathol 3: 185–192.PubMedGoogle Scholar
  41. Kuhl DE, Metter EJ, Riege WH (1984a) Patterns of local cerebral glucose utilization determined in Parkinson’s disease by the [18F]Fluorodeoxyglucose method. Ann Neurol 15: 419–424.PubMedCrossRefGoogle Scholar
  42. Kuhl DE, Metter EJ, Riege WH, Markham CH (1984b) Patterns of cerebral glucose utilization in Parkinson’s disease and Huntington’s disease. Ann Neurol 15 [Suppl]: S119–S125.PubMedCrossRefGoogle Scholar
  43. Lees AJ (1985) Parkinson’s disease and dementia. Lancet i: 43–44.Google Scholar
  44. Litvan I (1994) Cognitive disturbances in progressive supranuclear palsy. J Neural Transm [Suppl 42]: 69–78.Google Scholar
  45. Mayeux R, Stern Y, Spanton S (1985) Heterogeneity in dementia of the Alzheimer’s type: evidence of subgroups. Neurology 35: 453–461.PubMedCrossRefGoogle Scholar
  46. McKeith I, Fairbairn A, Perry R, Thompson P, Perry E (1992) Neuroleptic sensitivity in patients with senile dementia of Lewy body type. BMJ 305: 673–678.PubMedCrossRefGoogle Scholar
  47. Mc Keith IG, Galesko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, Salmon DP, Lowe J, Mirra SS, Byrne EJ, Lennox G, Quinn NP, Edwardson JA, Ince PG, Bergeron C, Burns A, Miller BL, Lovestone S, Collerton D, Jansen ENH, Ballard C, de Vos RAI, Wilcock GK, Jellinger KA, Perry RH for the Consortium on Dementia with Lewy Bodies (1996) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology 47: 1113–1124.CrossRefGoogle Scholar
  48. Miletich RS, Chase T, Gillespie M, Di Chiro G, Stein S (1988) Contralateral basal ganglia glucose metabolism is abnormal in hemi-parkinsonian patients: an FDG-PET study. Neurology 38 [Suppl 1]: 260.Google Scholar
  49. Molsa PK, Marttila RJ, Rinne UK (1984) Extrapyramidal signs in Parkinson’s disease. Neurology 34: 1114–1116.PubMedCrossRefGoogle Scholar
  50. Murray AM, Weihmueller FB, Marshall JF, Hurtig HI, Gottleib GL, Joyce JN (1995) Damage to dopamine systems differs between Parkinson’s disease and Alzheimer’s disease with parkinsonism. Ann Neurol 37: 300–312.PubMedCrossRefGoogle Scholar
  51. Okada J, Peppard R, Calne DB (1989) Comparison study of positron emission tomography, X-ray CT and MRI in parkinsonism with dementia. Nippon Igaku Hoshasen Gakkai Zasshi 49: 643–656.PubMedGoogle Scholar
  52. Otsuka M, Ichiya Y, Hosokawa S, Kuwabara Y, Tahara T, Fukumura T, Kato M, Masuda K, Goto I (1991) Striatal blood flow, glucose metabolism and 18F-dopa uptake: difference in Parkinson’s disease and atypical parkinsonism. J Neurol Neurosurg Psychiatry 54: 898–904.PubMedCrossRefGoogle Scholar
  53. Peppard RF, MartinWRW, Guttman M, McGeer PL, Walsh EM, Carr GD, Phillips AG, Grochowski E, Okada J, Tsui JKC, Mak E, Ruth E, Adam MJ, Calne DB (1988) The relationship of cerebral glucose metabolism to cognitive deficits in Parkinson’s disease. Neurology 38 [Suppl 1]: 364.Google Scholar
  54. Peppard RF, Martin WR, Clark CM, Carr GD, McGeer PL, Calne DB (1990) Cortical glucose metabolism in Parkinson’s and Alzheimer’s disease. J Neurosci Res 27: 561–568.PubMedCrossRefGoogle Scholar
  55. Perlmutter JS, Raichle ME (1985) Regional blood flow in hemiparkinsonism. Neurology 35: 1127–1134.PubMedCrossRefGoogle Scholar
  56. Perry EK, McKeith I, Thompson P, Marshall E, Kerwin J, Jabeen S, Edwardson JA, Ince P, Blessed G, Irving D, Perry RH (1991) Topography, extent, and clinical relevance of neurochemical deficits in dementia of Lewy body type, Parkinson’s disease, and Alzheimer’s disease. Ann NY Acad Sci 640: 197–202.PubMedGoogle Scholar
  57. Perry RH, Irving D, Blessed G, Perry EK, Fairbairn AF (1989) Senile dementia of Lewy body type and spectrum of Lewy body disease. Lancet i: 1088.Google Scholar
  58. Rebeiz JJ, Kolodny EH, Richardson EP (1968) Corticodentatonigral degeneration with neuronal achromasia. Arch Neurol 18: 20–33.PubMedCrossRefGoogle Scholar
  59. Rinne JO, Lee MS, Thompson PD, Marsden CD (1994) Corticobasal degeneration. A clinical study of 36 cases. Brain 117: 1183–1196.PubMedCrossRefGoogle Scholar
  60. Sawada H, Udaka F, Kameyama M, Seriu N, Nishinaka K, Shindou K, Kodama M, Nishitani N, Okumiya K (1992) SPECT findings in Parkinson’s disease associated with dementia. J Neurol Neurosurg Psychiatry 55: 960–963.PubMedCrossRefGoogle Scholar
  61. Sawle GV, Brooks DJ, Marsden CD, Frackowiak RSJ (1991) Corticobasal degeneration. A unique pattern of regional cortical oxygen hypometabolism and striatal fluorodopa uptake demonstrated by positron emission tomography. Brain 114: 541–556.Google Scholar
  62. Schapiro MB, Grady C, Ball MJ, DeCarli C, Rapoport SI (1990) Reductions in parietal/ temporal cerebral glucose metabolism are not specific for Alzheimer’s disease. Neurology 40 [Suppl 1]: 152.Google Scholar
  63. Schmidt ML, Murray J, Lee VM-Y, Hill WD, Wertkin A, Trojanowski JQ (1991) Epitope map of neurofilament protein domains in cortical and peripheral nervous system Lewy bodies. Am J Pathol 139: 53–65.PubMedGoogle Scholar
  64. Smith FW, Besson JAO, Gemmell HG, Sharp PF (1988) The use of Technetium-99m-HM-PAO in the assessment of patients with dementia and other neuropsychiatric conditions. J Cereb Blood Flow Metab 8 [Suppl 1]: S116–S122.PubMedCrossRefGoogle Scholar
  65. Tison F, Dartigues JF, Auriacombe S, Letenneur L, Boller F, Alperovitch A (1995) Dementia in Parkinson’s disease: a population-based study in ambulatory and institutionalized individuals. Neurology 45: 705–708.PubMedCrossRefGoogle Scholar
  66. Tolosa E, Valldeoriola F, Marti MJ (1994) Clinical diagnosis and diagnostic criteria of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome). J Neural Transm 42 [Suppl]: 15–31.Google Scholar
  67. Tyrrell PJ, Sawle GV, Ibanez V, Bloomfield PM, Leenders KL, Frackowiak RS, Rossor MN (1990) Clinical and positron emission tomographic studies in the “extrapyramidal syndrome” of dementia of the Alzheimer type. Arch Neurol 47: 1318–1323.PubMedCrossRefGoogle Scholar
  68. Watts RL, Mirra SS, Richardson EP (1994) Corticobasal ganglionic degeneration. In: Marsden CD, Fahn S (eds) Movement disorders 3. Butterworth-Heinemann, London, pp 282–299.Google Scholar

Copyright information

© Springer-Verlag/Wien 1997

Authors and Affiliations

  • N. Turjanski
    • 1
    • 2
  • D. J. Brooks
    • 1
  1. 1.MRC Cyclotron UnitHammersmith HospitalLondonUK
  2. 2.MRC Cyclotron UnitHammersmith HospitalLondonUK

Personalised recommendations