Objective: It is unknown which marker is useful to identify the premotor phase PD/DLB. We recently reported four patients who, during a negative DAT scan period, had a positive MIBG result that suggested premotor PD/DLB. Here we report 18 additional patients.

Background: Neuroimaging markers for Parkinson’s disease (PD)/dementia with Lewy bodies (DLB) include dopamine transporter (DAT) scanning and metaiodobenzylguanidine (MIBG) myocardial scintigraphy.

Method: This study was a prospective cohort study: recruiting period, 5.0 years; prospective follow-up period, 5.5±3.0 years, visit at least once a year. We recruited 745 referred subjects, and the inclusion criteria were: at least one of PD’s known nonmotor features, as follows. Autonomic: postural hypotension (pure autonomic failure [PAF]), constipation, bladder dysfunction. Sleep: REM sleep behavior disorder (RBD). Cognitive: mild cognitive impairment or psychiatric symptoms; and having undergone both DAT and MIBG tests.

Results: Only 18 patients fulfilled these criteria; their characteristics were: elderly (mean age 75.5 years), with long histories (onset 61.0 years; duration 14.5 years), male dominance (14 men, four women). The patients’ neurologic diagnoses were constipation/RBD in 10, constipation/RBD/PAF in six, and constipation/PAF in two. During the follow-up period, seven patients developed PD or DLB. An abnormal MIBG result was noted in 94%, and an abnormal DAT result was noted in 56%.

Conclusion: MIBG has the potential to be a useful marker during the DAT scan negative period to identify premotor PD/DLB but further studies are needed.

References: Tateno H, Sakakibara R, Tateno F, et al. Metaiodobenzylguanidine myocardial scintigraphy identifies premotor Parkinson’s disease during a negative dopamine transporter scan. J Am Geriatr Soc. 2015; 63: 2428-2430. Sakakibara R, Uchiyama T, Yamanishi T, Shirai K, Hattori T. Bladder and bowel dysfunction in Parkinson’s disease. J Neural Transm (Vienna). 2008; 115: 443-460. Sakakibara R 1, Doi H 2, Fukudo S 3. Lewy body constipation. J Anus Rectum and Colon, 2019: in press.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mibg-myocardial-scintigraphy-identifies-premotor-pd-dlb-during-a-negative-dat-scan-period/