Accuracy of clinical diagnosis in tremulous parkinsonian patients: a blinded video study

Bajaj, Nin; Gontu, Vamsi; Birchall, J. D.; Patterson, James C.; Grosset, Donald G.; Lees, Andrew J.

doi:10.1136/jnnp.2009.193391

Cited by 101 publications

(75 citation statements)

References 37 publications

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“…It has been suggested that SWEDD subjects may have a dystonic tremor masquerading as PD, but it is uncertain whether the tremor in any of the PRE-CEPT subjects had those characteristics. 20,21 The change in diagnosis from idiopathic PD at baseline to a PP alternative at study termination in 44% of SWEDD subjects compared with 3.7% of those with DAT deficit [ 123 I] b-CIT scans at baseline again demonstrates that the SWEDD group differs from those with baseline DAT deficit scans. Based on investigator report, the baseline SWEDD subjects with a final diagnosis of PP were less likely to manifest tremor, bradykinesia, and rigidity than those with a DDP diagnosis.…”

Section: Resultsmentioning

confidence: 99%

Longitudinal follow-up of SWEDD subjects in the PRECEPT Study

et al. 2014

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Objective: To compare the clinical and imaging characteristics of those PRECEPT (Parkinson Research Examination of CEP-1347 Trial) subjects with a scan without evidence of dopaminergic deficit (SWEDD) to those with dopamine transporter (DAT) deficit scans at study baseline and during a 22-month follow-up.Methods: Baseline (n 5 799) and 22-month follow-up (n 5 701) [123 I] b-CIT SPECT scans were acquired. The percent change in [123 I] b-CIT striatal binding ratio, the percentage of subjects requiring dopaminergic therapy, the change in Unified Parkinson's Disease Rating Scale (UPDRS) score, and the PRECEPT Study investigators' diagnosis at study termination were compared between SWEDD and DAT deficit subjects.Results: SWEDD subjects (n 5 91) compared with DAT deficit subjects (n 5 708) showed reduced .9], p , 0.0001) at follow-up assessments. At PRECEPT termination, the diagnosis by study investigators was changed from Parkinson disease (PD) to other disorders not associated with DAT deficit in 44% (95% confidence interval 34.2, 54.7) of SWEDD subjects compared with 3.6% (95% confidence interval 2.3, 5.1) of DAT deficit subjects. Conclusion:These results indicate that subjects identified as having a SWEDD, with DAT imaging within the normal range, have minimal evidence of clinical or imaging PD progression. These data strongly suggest that SWEDD subjects are unlikely to have idiopathic PD. In several recent Parkinson disease (PD) clinical trials, dopaminergic imaging has been used as a tool to assess PD progression. Both dopamine transporter (DAT) SPECT and [ 18 F] fluoro-Ldopa PET imaging identified research subjects having a scan without evidence of dopaminergic deficit (SWEDD) enrolled in PD clinical trials of newly diagnosed untreated patients. [1][2][3][4] In PD studies enrolling participants within 9 months of PD diagnosis, approximately 10% to 15% of the research subjects have a SWEDD. Longitudinal assessment has demonstrated that those subjects with a SWEDD at baseline continue to have a SWEDD in follow-up scans for at least a 4-year period. 5The Parkinson Research Examination of CEP-1347 Trial (PRECEPT) was a multicenter, randomized, double-masked, placebo-controlled study to examine the efficacy and long-term safety of CEP-1347 as a potential disease-modifying treatment in patients with early PD.

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Section: Resultsmentioning

confidence: 99%

Longitudinal follow-up of SWEDD subjects in the PRECEPT Study

et al. 2014

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“…These patients could represent an important subgroup of patients suspected clinically to have early PD, but who have scans without evidence of dopaminergic deficit (SWEDD). It can be difficult to distinguish these patients from those with PD on clinical grounds, but SWEDD cases can present with atypical or dystonic tremor (Bajaj et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Glucocerebrosidase mutations and the pathogenesis of Parkinson disease

Beavan

Schapira

2013

Annals of Medicine

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“…They feature no compromised presynaptic function over years, no progressive decline of presynaptic functions, a lack of a clear positive response to dopaminergic medication (an exception may be some patients with dopa-responsive dystonic tremor), and no patterns of glucose metabolism compatible with classic PD. The prognosis of SWEED subjects is considered to be more favorable than that for classic neurodegenerative PS (32)(33)(34)(35)(36). To the best of our knowledge, histopathologic proof of SWEDD pathology is still lacking; for further clarification, such studies are clearly needed.…”

Section: Sweddsmentioning

confidence: 99%

“…Thus, the comprehensive appraisal of presynaptic DAT imaging is focused on the question of whether symptoms in a patient might be related to neurodegeneration. This question is frequently the diagnostic challenge for the neurologist in the clinical setting, as studies have indicated that a disease-particular in its early stage-that is not associated with neurodegeneration, such as the various tremor syndromes (including ET); drug-induced, psychogenic, and vascular PS; or even Alzheimer dementia, may be misdiagnosed as a neurodegenerative PS (32,45,46).…”

Section: Proof Of Symptomatic Parkinsonismmentioning

confidence: 99%

Nigrostriatal Dopamine Terminal Imaging with Dopamine Transporter SPECT: An Update

2013

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the radiopharmaceuticals used to evaluate nigrostriatal dopamine imaging; (2) the pattern of uptake of these radiopharmaceuticals in parkinsonian syndromes; and (3) the role of these radiopharmaceuticals in the evaluation of parkinsonian syndromes.Financial Disclosure: Dr. Tatsch is a meeting participant/lecturer for GE Healthcare. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, participants can access this activity through the SNMMI Web site (http:// www.snmmi.org/ce_online) through August 2016.This article gives an update on nigrostriatal dopamine terminal imaging, with emphasis on SPECT performed with the presynaptic dopamine transporter (DAT) ligand 123 I-FP-CIT. The paper covers the rational use of this technique in the diagnostic work-up of patients with known or suspected parkinsonian syndromes. In detail, it addresses the impact of the method for the proof or exclusion of neurodegenerative parkinsonism, for its early and preclinical diagnosis, and for the evaluation of disease progression. The importance of normal DAT binding for differentiating symptomatic parkinsonism and relevant tremor syndromes from neurodegeneration is highlighted. Particularly emphasized is the role of DAT SPECT for diagnosing Lewy body dementia and its separation from Alzheimer dementia. Finally, some remarks deal with the economic aspects of the use of these imaging techniques in the clinical setting.

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Accuracy of clinical diagnosis in tremulous parkinsonian patients: a blinded video study

Cited by 101 publications

References 37 publications

Longitudinal follow-up of SWEDD subjects in the PRECEPT Study

Longitudinal follow-up of SWEDD subjects in the PRECEPT Study

Glucocerebrosidase mutations and the pathogenesis of Parkinson disease

Nigrostriatal Dopamine Terminal Imaging with Dopamine Transporter SPECT: An Update

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