Dopamine transporter imaging is associated with long‐term outcomes in Parkinson's disease |
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| Authors: | Bernard Ravina MD MSCE Kenneth Marek MD Shirley Eberly MS David Oakes PhD Roger Kurlan MD Alberto Ascherio PhD Flint Beal MD PhD James Beck PhD Emily Flagg BA Wendy R. Galpern MD PhD Jennifer Harman PhD Anthony E. Lang MD Michael Schwarzschild MD PhD Caroline Tanner MD PhD Ira Shoulson MD |
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| Affiliation: | 1. Biogen Idec, Cambridge, Massachusetts, USA;2. Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA;3. University of Rochester School of Medicine and Dentistry, Rochester, New York, USA;4. Atlantic Neuroscience Institute, Summit, New Jersey, USA;5. Massachusetts General Hospital, Boston, Massachusetts, USA;6. Cornell University School of Medicine, New York, New York, USA;7. The Parkinson's Disease Foundation, New York, New York, USA;8. The National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA;9. The University of Toronto, Toronto, Ontario, Canada;10. The Parkinson's Institute, Sunnyvale, California, USA |
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| Abstract: | Dopamine (DA) transporter (DAT) imaging has been studied as a diagnostic tool for degenerative parkinsonism. Our aim was to measure the prognostic value of imaging for motor and nonmotor outcomes in Parkinson's disease (PD). We prospectively evaluated a Parkinson's cohort after enrollment in a de novo clinical trial with a battery of motor (UPDRS), cognitive (Montreal Cognitive Assessment), and behavioral measures. DAT imaging with [123I][β]‐CIT and single‐photon emission computerized tomography (SPECT) was performed at baseline and after 22 months. In total, 491 (91%) of the 537 subjects had evidence of DA deficiency on their baseline scan, consistent with PD, and were included in the analyses. The cohort was followed for 5.5 (0.8) years, with a mean duration of diagnosis of 6.3 (1.2). Lower striatal binding at baseline was independently associated with higher risk for clinical milestones and measures of disease severity, including motor‐related disability, falling and postural instability, cognitive impairment, psychosis, and clinically important depressive symptoms. Subjects in the bottom quartile for striatal binding, compared to the top quartile, had an odds ratio (95% confidence interval) of 3.3 (1.7, 6.7) for cognitive impairment and 12.9 (2.6, 62.4) for psychosis. Change from baseline in imaging after 22 months was also independently associated with motor, cognitive, and behavioral outcomes. DAT imaging with [123I][β]‐CIT and SPECT, shortly after the diagnosis of PD, was independently associated with clinically important long‐term motor and nonmotor outcomes. These results should be treated as hypothesis generating and require confirmation. © 2012 Movement Disorder Society |
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| Keywords: | Parkinson's disease dopamine transporter imaging prognosis |
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