Objective: Evaluate the association between drooling and striatal dopamine terminals. Test the assumption that drooling correlates with disease progression in de novo Parkinson’s disease (PD) patients.

Background: Drooling is a common symptom in PD population, with a pathophysiology unclear. This study used [123I]-Ioflupane-SPECT to evaluate the association between drooling and striatal dopamine uptake and to test the correlation between drooling in PD patients and disease progression (faster motor progression and cognitive decline).

Method: We included 389 de novo PD patients from the Parkinson’s Progression Markers Initiative (PPMI) database. Using the MDS-UPDRS, PD patients were classified according to the presence (n=82) of any degree of drooling or absence (n=307) of drooling at baseline. PD patients had DaTSCAN and structural MRI at baseline, and clinical assessments (motor, cognition and non-motor) at baseline and follow-up visits for 60 months. We investigated the association between drooling with the clinical and neuroimaging data.

Results: At baseline 21.1% of the PD patients reported some degree of drooling. Drooling in PD patients was associated with higher motor scores (P<0.001) and lower dopamine transporter binding in the putamen (P<0.01). There was a positive correlation with bradykinesia and rigidity (P<0.01) and a negative correlation with the specific binding ratio (SBR) of putamen (P<0.01). At the Cox survival analysis, the presence of drooling was associated with cognitive decline (HR=1.823; P=0.007; 95% CI=1.176-2.827).

Conclusion: PD patients with drooling had lower dopamine transporter binding in putamen at baseline and could be associated with worse cognitive decline than PD patients without drooling. This abstract was also submitted for presentation at the 2019 European Academy of Neurology conference.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/drooling-in-parkinsons-disease-a-123ifp-cit-spect-study/