Brain Alterations and Mini-Mental State Examination in Patients with Progressive Supranuclear Palsy: Voxel-Based Investigations Using 18F-Fluorodeoxyglucose Positron Emission Tomography and Magnetic Resonance Imaging

Abstract

Background/Aims: The aim of this study was to compare differences in morphological and functional changes in brain regions in individual patients with progressive supranuclear palsy (PSP) and correlate their Mini-Mental State Examination (MMSE) score with anatomy and function using magnetic resonance imaging (MRI) and ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET). Methods: Sixteen PSP patients and 20 age-matched healthy volunteers underwent FDG-PET and 3-dimensional MRI. Gray matter, white matter and metabolic activity were compared between patients and normal controls. In addition, possible correlations between the MMSE score and brain function/anatomy were examined. Results: The PSP group had reduced cerebral glucose metabolism, and lower gray and white matter volumes in the frontal lobes and midbrain compared with normal controls. In PSP subjects, the metabolic changes observed in the PET scans were greater than the loss in gray and white matter observed in the MRI scans. The MMSE scores were positively correlated with volume and FDG uptake in the frontal lobe. Conclusion: FDG-PET is a more effective tool in the diagnosis of PSP than MRI. Atrophy and hypometabolism in the frontal lobe are as important as in the basal midbrain for differentiating PSP patients who primarily exhibit cognitive dysfunction from normal controls.

Voxelwise meta-analysis of gray matter anomalies in progressive supranuclear palsy and Parkinson's disease using anatomic likelihood estimation

“…We identified 32 studies in the database searches (Figure 1 ) including nine PSP-HC articles (Brenneis et al, 2004 ; Cordato et al, 2005 ; Boxer et al, 2006 ; Padovani et al, 2006 ; Agosta et al, 2010 ; Lehericy et al, 2010 ; Takahashi et al, 2011 ; Ghosh et al, 2012 ; Giordano et al, 2013 ). One hundred and fourty-five PSP patients and 217 HC were included in this study and a total of 104 foci with reduced GMV were reported.…”

Radiological biomarkers for diagnosis in PSP: Where are we and where do we need to be?

“…Studies of [ 18 F]-fluorodeoxyglucose PET (FDG-PET) have shown hypometabolism in the midbrain, basal ganglia, thalamus, and frontal lobes in PSP-RS, [132][133][134][135][136][137][138][139][140][141][142][143][144][145] with frontal involvement particularly targeting premotor, precentral, and prefrontal regions 134 and anterior cingulate 146 (Fig. 2A).…”

A systematic review of lessons learned from PET molecular imaging research in atypical parkinsonism

“…Moreover, 33 % of asymptomatic relatives showed cortical and subcortical hypometabolism suggesting the presence of subclinical PSP [ 48 ]. [ 18 F]FDG PET was used to investigate neural correlates of PSP symptoms [ 49 – 52 ]. A PET study investigated the brain network relevant to postural imbalance and falls in a cohort of 16 PSP patients [ 50 ].…”

“…Smooth pursuit eye movement was correlated with hypometabolism in the inferior parietal and temporal regions and frontal eye field [ 52 ]. Reduced glucose metabolism in the frontal cortex was associated with worse Mini Mental Status Examination (MMSE) scores in 16 PSP patients the presence of frontal lobe dysfunction in PSP [ 49 ]. Frontal brain regions and in specific cingulate gyrus hypometabolism is also a feature of Frontotemporal Dementia [ 53 – 57 ].…”