Objective: This study aims to identify the differences of functional neuroimaging phenotype between Parkinson’s disease (PD) patients with REM sleep behavior disorder (RBD) (PD+RBD+) and without RBD (PD+RBD-) by using a dual-tracer design.

Background: RBD can appear in any clinical course of PD which is characterized by loss of dopamine transporter (DAT) and a unique metabolic brain network (PD-related pattern, PDRP). It is regarded as a prodromal stage of synucleinopathies and also to be related with an aggressive course of PD.

Methods: Two groups of PD patients were recruited in this study, including 38 with PD+RBD+ (age 63.8±5.6years) and 38 with PD+RBD- (age 64.3±6.2years), which were matched with age, sex and disease duration. 17 age-matched healthy volunteers were also included as controls. All subjects undertook PET imaging with both 11C-CFT and 18F-FDG at the same time. Sub-regional dopamine transporter (DAT) tracer uptake of bilateral caudate, anterior putamen and posterior putamen was calculated respectively using ScAnVp software to measure the striatal dopaminergic dysfunction. The expression of PDRP was computed in each subject using a voxel-based network quantification algorithm based on the PDRP we previously identified in a cohort of 33 PD patients and 33 healthy controls [1]. Normalized regional FDG metabolism between groups was compared voxel-to-voxel using two-sample t-test by application of statistic parametric mapping (SPM).

Results: The striatal DAT distribution significantly decreased in PD patients compared with healthy controls, and the patients with PD+RBD+ tended to lose more DAT than PD+RBD- group although it didn’t reached significance. PDRP expression was significantly elevated in PD patients compared with healthy controls, and it was also found elevated in PD+RBD+ patients relative to PD+RBD- patients (P＜0.05). Regional FDG uptake in right palladic-putamen area, right thalamus and bilateral rectal gyrus were increased in PD+RBD+ cohort compared with PD+RBD- cohort (P＜0.001).

Conclusions: These findings suggest that PD patients, paralleling with RBD, may have more damage of DAT distribution and have specific spatial metabolism pattern, which may provide a clue to understand the clinical features.

References: [1] Wu P, Wang J, Peng S, et al. Metabolic brain network in the Chinese patients with Parkinson’s disease based on 18F-FDG PET imaging. Parkinsonism Relat Disord. 2013;19:622–7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparisons-of-cerebral-glucose-metabolism-and-striatal-dat-binding-in-pd-patients-with-and-without-rbd/