Objective: To characterize the clinical features and the neuroanatomical bases of cognitive impairment in Parkinson’s disease (PD) with respect to attention, executive function, memory, language, and visuospatial function using a battery of neuropsychological tests and ¹⁸F-fluorodeoxyglucose (FDG) and Positron Emission Tomography (PET).

Background: Cognitive impairment is a frequent comorbidity in PD. The underlying mechanism of the clinically heterogeneous deficits in cognitive dysfunction of PD remains controversial. ¹⁸F-FDG PET imaging might be able to help identify cognition-related imaging pattern to explore the underlying pathogenesis and provide the potentially objective biomarker.

Methods: We performed a cross-sectional study in a cohort of 168 PD patients and 103 health controls with similar age, education and sex distribution. All of them underwent clinical assessment including UPDRS motor score, Hoehn-Yahr Scale and a battery of neuropsychological tests suggested by Movement Disorder Society (MDS) diagnostic criteria for PD-MCI. Demographics and the results of cognitive measures were compared among patients and health controls. Correlations between Z-score values of the different cognitive domains and cerebral FDG uptake were assessed using statistical parametric mapping (SPM8) corrected for age and motor severity in 53 PD patients who underwent ¹⁸F-FDG PET brain imaging.

Results: Our study revealed the widespread nature of cognitive dysfunction in PD. 44 PD of patients (26.2%) were classified as PD patients with mild cognitive impairment (PD-MCI) and 12 patients (7.1%) were classified as PD patients with dementia (PD-D). 91.2% of PD patients with cognitive impairment showed multiple-domain deficits, with attention and executive function predominantly impaired. All the cognitive domains, except language function, correlated with FDG metabolism mainly in posterior temporo-parieto-occipital associated cortical areas. 

Conclusions: These findings suggest that cognitive impairment in PD is beyond frontal/executive deficits. The posterior cortical areas with multiple neurotransmitters and neural circuits may have taken important part in the pathogenesis of Parkinsonian cognitive impairment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-characteristics-of-cognitive-impairment-in-patients-with-parkinsons-disease-and-its-related-pattern-in-18f-fdg-pet-imaging/