Typical cerebral metabolic patterns in neurodegenerative brain diseases

Abstract

The differential diagnosis of neurodegenerative brain diseases on clinical grounds is difficult, especially at an early disease stage. Several studies have found specific regional differences of brain metabolism applying [(18)F]-fluoro-deoxyglucose positron emission tomography (FDG-PET), suggesting that this method can assist in early differential diagnosis of neurodegenerative brain diseases.We have studied patients who had an FDG-PET scan on clinical grounds at an early disease stage and included those with a retrospectively confirmed diagnosis according to strictly defined clinical research criteria. Ninety-six patients could be included of which 20 patients with Parkinson's disease (PD), 21 multiple system atrophy (MSA), 17 progressive supranuclear palsy (PSP), 10 corticobasal degeneration (CBD), 6 dementia with Lewy bodies (DLB), 15 Alzheimer's disease (AD), and 7 frontotemporal dementia (FTD). FDG PET images of each patient group were analyzed and compared to18 healthy controls using Statistical Parametric Mapping (SPM5).Disease-specific patterns of relatively decreased metabolic activity were found in PD (contralateral parietooccipital and frontal regions), MSA (bilateral putamen and cerebellar hemispheres), PSP (prefrontal cortex and caudate nucleus, thalamus, and mesencephalon), CBD (contralateral cortical regions), DLB (occipital and parietotemporal regions), AD (parietotemporal regions), and FTD (frontotemporal regions).The integrated method addressing a spectrum of various neurodegenerative brain diseases provided means to discriminate patient groups also at early disease stages. Clinical follow-up enabled appropriate patient inclusion. This implies that an early diagnosis in individual patients can be made by comparing each subject's metabolic findings with a complete database of specific disease related patterns.

Amyloid-β deposition and regional grey matter atrophy rates in dementia with Lewy bodies

“…To pursue these goals, we analysed the longitudinal rates of atrophy on MRI in cortical and subcortical grey matter, with a customized atlas subdivision, which includes regions of interest involved in the pathophysiology of DLB and/or Alzheimer's disease such as basal ganglia, posterior cingulate gyrus and medial temporal lobe, temporal, occipital, parietal and frontal neocortex (Minoshima et al, 2001;Whitwell et al, 2007b;Burton et al, 2009;Teune et al, 2010;Zhong et al, 2014;McCleery et al, 2015;Nedelska et al, 2015;Mak et al, 2016). Furthermore, we investigated whether amyloid-b deposition at baseline is associated with a faster cognitive and functional decline in patients with probable DLB.…”

Metabolic Connectivity as Index of Verbal Working Memory

“…2 In contrast, positron emission tomography with [ 18 F]-fluorodeoxyglucose (FDG-PET) is an established clinical tool, assisting early and differential diagnosis of dementing and movement disorders. [3][4][5] These conditions are accompanied by a certain spatial pattern of neural degeneration that is captured by PET as regional glucose hypometabolism. So far, however, this imaging tool has got little attention in studies of healthy cognitive function and non-degenerative brain diseases.…”

Nuclear Medicine Applications in Movement Disorders

“…MSA kliniğinde parkinsonizm bulgularına ek olarak serebellar ataksi, üriner disfonksiyon ve ortostatik hipotansiyon gibi belirgin otonomik disfonksiyon bulguları vardır (55). MSA hastalarında putamende ve serebellumda metabolizma düşük düzeydedir (3,20,21,25,28,37,39). Ayrıca MSA'da en sık olarak parietal ve temporal bölgelerde olmak üzere yaygın kortikal hipometabolizma bulguları izlenir (20,26,28,39).…”

“…Hastalarda göz hareketlerinde bozukluk, psödobulbar palsi ve aksiyal distoni bulguları vardır (56). Patolojik olarak en çok etkilenen bölgeler beyin sapı ve bazal ganglia olmakla birlikte, PSP hastalarında beyin FDG PET görüntülemede medial prefrontal ve ventrolateral prefrontal kortekste, kaudat çekirdekte, talamik çekirdekte ve beyin sapında hipometabolizma gözlenir (3,26,35,36,37,39,56,57). KBD ise tipik olarak asimetrik başlangıçlı, nadir görülen nörodejeneratif bir hastalık olup, hastalarda klinik olarak akineto-rijid sendrom, distoni, miyoklonus, apraksi, kortikal duyu kaybı ve yabancı el sendromu gibi bulgular vardır (56).…”

“…KBD ise tipik olarak asimetrik başlangıçlı, nadir görülen nörodejeneratif bir hastalık olup, hastalarda klinik olarak akineto-rijid sendrom, distoni, miyoklonus, apraksi, kortikal duyu kaybı ve yabancı el sendromu gibi bulgular vardır (56). KBD hastalarında vücudun en çok etkilenen tarafının karşı tarafındaki serebral hemisferde daha belirgin olmak üzere asimetrik bilateral kaudat ve talamik çekirdek tutulumu; parietal lobda, orta frontal ve singulat girusta kortikal hipometabolizma bulguları izlenir (3,21,37,39,40). Ancak her ikisi de beyinde anormal tau (4R-taupati) birikimleri ile karakterize olan PSP ve KBD, metabolik tutulum biçimi bakımından da benzerlik gösterebilir (58).…”