Objective: The aim of the work is to analyze whether combined examination of the frontal lobe using single photon emission computer tomography (SPECT) and Frontal Assessment Battery (FAB) is a useful tool in differentiation of Corticobasal Syndrome (CBS) and Progressive Supranuclear Palsy (PSP).

Background: CBS and PSP are diseases classified as 4 repeats (4R) tauopathic atypical parkinsonisms. Though both diseases have a history lasting more than half century since their discovery, contemporary literature does not reveal any outstanding methods of examination.

Methods: In the study 17 patients diagnosed with probable tauopathic 4R atypical parkinsonism were examined. Ten patients had clinical manifestations of PSP and 7 presented syndromes resembling CBS. All patients were assessed using radiotracer 99mTc-HM-PAO. Automatically generated standard deviations (SD) of accumulations of radiotracer within the frontal lobe were compared. The program analyzing the deviations compared results with data obtained from healthy volunteers. The analysis was extended using neuropsychological FAB examination as a factor possibly distinguishing the diseases. The assessment of significance of differences between CBS and PSP was done using the U-Mann-Whitney test based on SD of accumulation of the radiotracer. Analysis of correlation was done using Spearman’s rank correlation. The study has the approval of the Ethical Committee of the Medical University of Warsaw-AKBE1246/2016.

Results: Isolated examination of patients diagnosed with CBS and PSP using FAB and SPECT assessment of perfusion of frontal lobe, at this stage of the study, though does not significantly differ diseases, shows a tendency where deficiencies within frontal lobe are more likely highlighted in PSP. Additional analysis using Spearman’s rank correlation shows p=0,078 (significance p<0,05) in the context of correlation of FAB results and SPECT examination of the right frontal lobe among patients diagnosed with CBS and p=0,065 among all examined patients.

Conclusions: The presence of patients with diagnosed variant of tauopathies – CBD-PSP or PSP-CBS is a supplementary obstacle in the proper diagnosis and differentiation. The study shows that this matter requires further research based on larger groups of patients.

References: 1. Armstrong MJ, Litvan I, Lang AE et al. Criteria for the diagnosis of corticobasal degeneration, Neurology 2013;80;496. 2. Höglinger GU, Respondek G, Stamelou M et al., Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria, Mov Disord. 2017 Jun;32(6):853-864.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/usefulness-of-combined-examination-using-frontal-assessment-battery-fab-and-single-photon-emission-computer-tomography-in-the-differentiation-of-4-repeats-4r-tauopathic-atypical-parkinsonism/