Differential Implications of Cerebral Hypoperfusion and Hyperperfusion in Parkinson's Disease

Abstract

BackgroundPatients with Parkinson's disease (PD) exhibit widespread brain perfusion changes.ObjectiveThis study investigated whether cerebral regions with hypoperfusion and hyperperfusion have differential effects on motor and cognitive symptoms in PD using early‐phase 18F‐N‐(3‐fluoropropyl)‐2β‐carboxymethoxy‐3β‐(4‐iodophenyl) nortropane (18F‐FP‐CIT) positron emission tomography (PET) scans.MethodsWe enrolled 394 patients with newly diagnosed PD who underwent dual‐phase 18F‐FP‐CIT PET scans. Indices reflecting associated changes in regional cerebral hypoperfusion and hyperperfusion on early‐phase 18F‐FP‐CIT PET scans were calculated as PD[hypo] and PD[hyper], respectively. The associations of PD[hypo] and PD[hyper] on motor and cognitive symptoms at baseline were assessed using multivariate linear regression. Also, Cox regression and linear mixed models were performed to investigate the effects of baseline PD[hypo] and PD[hyper] on longitudinal outcomes.ResultsThere was a weak correlation between PD[hypo] and PD[hyper] (γ = −0.19, P < 0.001). PD[hypo] was associated with baseline Unified Parkinson's Disease Rating Scale Part III scores (β = −1.02, P = 0.045), rapid increases in dopaminergic medications (β = −18.02, P < 0.001), and a higher risk for developing freezing of gait (hazard ratio [HR] = 0.67, P = 0.019), whereas PD[hyper] was not associated. Regarding cognitive function, PD[hypo] was more relevant to the baseline cognitive performance levels of visuospatial, memory, and frontal/executive function than PD[hyper]. However, greater PD[hyper] was associated with future dementia conversion (HR = 1.43, P = 0.004), whereas PD[hypo] was not associated.ConclusionsThese findings suggest that PD[hypo] and PD[hyper] may differentially affect motor and cognitive functions in patients with PD. © 2023 International Parkinson and Movement Disorder Society.

Nonarteritic anterior ischemic optic neuropathy and incidence of Parkinson’s disease based on a nationwide population based study

“…Further, it has been reported that compared to healthy controls, PD patients show vascular abnormalities and reduced perfusion 23 . Additionally, chronic cerebral hypoperfusion has been identified as a risk factor for the exacerbation of symptoms such as memory decline and motor dysfunction in PD patients 31 , 32 . In other words, hypoperfusion, which is implicated in the onset of NAION, can act as a major risk factor in the onset and progression of PD.…”

Hypoperfusion in Alzheimer’s Disease–Prone Regions and Dementia Conversion in Parkinson’s Disease

“…Substantial evidence suggests that early-phase 18 F-N-(3fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane ( 18 F-FP-CIT) PET images, which are acquired within the first 10 min after injection in a single PET session when diagnosing PD, can provide information on regional cerebral perfusion, which is closely coupled to cerebral metabolism in dopamine-poor brain regions and resembles 18 F-fluorodeoxyglucose ( 18 F-FDG) PET images. 12,13 In the present study, we investigated whether patterns of cerebral perfusion on early-phase 18 F-FP-CIT PET images have the potential to serve as a neuroimaging predictor for early dementia conversion (ie, within a 5-year time window) 7,14 in patients with newly diagnosed PD. A linear discriminant analysis (LDA) was additionally performed to develop a prediction model for PDD conversion based on regional cerebral perfusion.…”