Objective: To investigate whether the degree of reduced dopamine transporter binding in the striatum is a risk factor for late complications and time of progression to H&Y stage III in patients with idiopathic Parkinson’s disease (PD).

Background: Late complications of PD include motor fluctuations and dyskinesias, freezing gait, hallucinations and dementia. Studies on the natural history of PF show that 70 % of patients are disabled or dead after 10 years. Factors that predict faster disease progression include age of disease onset, disease severity and genetic background. The role nuclear imaging as a predictor of disease progression has not been established.

Methods: The retrospective cohort study included 42 patients with early PD who underwent I-FP-CIT SPECT scanning. The patients had been followed for a minimum of 4 years (mean 7.9±2.8). The power of the quantitatively analyzed I-FP-CIT uptake in striatal subregions and other clinical factors to predict the development of disease complications and time to H&Y stage IIII was evaluated using Kaplan-Meier survival analysis with the log-rank test.

Results: Younger age at disease onset was a significant predictor of the development of motor fluctuations and time to onset of levodopa treatment. Multivariate Cox proportional hazard models revealed that dopamine transporter (DaT) uptake in both sides of the striatum and caudate and in the ipsilateral putamen were significant predictors of the development of freezing and time to H&Y stage III. The development of response fluctuations, falls, and hallucinations could not be predicted by DaT binding.

Conclusions: Decreased DaT binding at early disease predicts faster disease progression and development of freezing. This might point to dopaminergic transmission as part of the mechanism of freezing in PD.

Annual meeting of the Israeli Neurological Association, Haifa, Israel, 2015.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/presynaptic-dopamine-depletion-predicts-late-complications-and-time-of-progression-to-advanced-disease-in-patients-with-early-parkinsons-disease/