Patterns of regional cerebral hypoperfusion in early Parkinson's disease: Clinical implications

• DOI: 10.1016/j.parkreldis.2024.106024
• Publication Date: 2024-02-02T17:29:39Z
• Authors: Seok Jong Chung; Su Hong Kim; Chan Wook Park; Hye Sun Lee; Mijin Yun; Yun Joong Kim; Young H. Sohn; Yong Jeong; Phil Hyu Lee
• Keywords: Tomography, Emission-Computed, Single-Photon; Dopamine Plasma Membrane Transport Proteins; Positron-Emission Tomography; Humans; Parkinson Disease; Dementia; Gait Disorders, Neurologic; Tropanes

This study aimed to investigate whether regional cerebral perfusion patterns on early-phase 18F-FP-CIT PET scans, which is typically coupled to cerebral metabolism, predict the long-term prognosis of Parkinson's disease (PD).We enrolled 397 drug-naïve patients with early-stage PD who underwent dual-phase 18F-FP-CIT PET scans. After quantifying the early-phase 18F-FP-CIT PET images, cluster analysis was performed to delineate the PD subtypes according to the patterns of regional cerebral perfusion. We compared the risk of developing levodopa-induced dyskinesia (LID), wearing-off, freezing of gait (FOG), and dementia between the PD subtypes.Cluster analysis classified patients into three subtypes: cluster 1 (relatively preserved cortical uptake; n = 175), cluster 2 (decreased uptake in the frontal, parietal, and temporal regions; n = 151), and cluster 3 (decreased uptake in more extensive regions, additionally involving the lateral occipital regions; n = 71). Cluster 1 was characterized by a younger age-of-onset, less severe motor deficits, less severely decreased 18F-FP-CIT binding in the caudate, and better cognitive performance. Cluster 3 was characterized by an older age-of-onset, more severe motor deficits, and poorer cognitive performance. Cluster 2 was intermediate between clusters 1 and 3. Cox regression analyses demonstrated that clusters 2 and 3 had a higher risk for dementia conversion than cluster 1, whereas the risk for developing LID, wearing-off, and FOG did not differ among the clusters.The patterns of regional cerebral perfusion can provide information on long-term prognosis with regards to cognitive, but not motor aspects of patients with early-stage PD.