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Abstract
Objective To evaluate the statistical parametric mapping (SPM) procedure for fluorodeoxyglucose (FDG)-PET imaging as a possible single-subject marker of progression to dementia in Parkinson disease (PD).
Methods Fifty-four consecutive patients with PD without dementia (age at onset of 59.9 ± 10.1 years, disease duration of 5.3 ± 3.4 years) entered the study. The patients underwent an extensive motor and cognitive assessment and a single-subject FDG-PET SPM evaluation at baseline. A 4-year follow-up provided disease progression and dementia diagnosis.
Results The FDG-PET SPM was evaluated by 2 expert raters allowing the identification of a “typical PD pattern” in 29 patients, whereas 25 patients presented with “atypical patterns,” namely, dementia with Lewy bodies (DLB)-like (n = 12), Alzheimer disease (AD)-like (n = 6), corticobasal syndrome (CBS)-like (n = 5), and frontotemporal dementia (FTD)-like (n = 2). At 4-year follow-up, 13 patients, all showing atypical brain metabolic patterns at baseline, progressed to dementia (PD dementia). The DLB- and AD-like SPM patterns were the best predictor for incident dementia (p < 0.005, sensitivity 85%, specificity 88%), independently from demographics or cognitive baseline classification.
Conclusions This study suggests that FDG-PET SPM at the single-subject level might help in identifying patients with PD at risk of developing dementia.
Glossary
- AD=
- Alzheimer disease;
- AUC=
- area under the curve;
- CBS=
- corticobasal syndrome;
- CI=
- confidence interval;
- DLB=
- dementia with Lewy bodies;
- FDG=
- fluorodeoxyglucose;
- FTD=
- frontotemporal dementia;
- LEDD=
- levodopa equivalent daily dose;
- LL=
- log likelihood;
- LR=
- likelihood ratio;
- MCI=
- mild cognitive impairment;
- MMSE=
- Mini-Mental State Examination;
- PD=
- Parkinson disease;
- PDD=
- Parkinson disease dementia;
- PD-NC=
- Parkinson disease with normal cognition;
- SPM=
- statistical parametric mapping
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received February 12, 2017.
- Accepted in final form December 12, 2017.
- © 2018 American Academy of Neurology
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