Sakakibara Ryuji, Tateno Fuyuki, Aiba Yosuke, Ogata Tsuyoshi, Kishi Masahiko, Terada Hitoshi, Inaoka Tsutomu, Nakatsuka Tomoya, Matsuoka Katsuyoshi
Neurology, Internal Medicine, Sakura Medical Center Toho University Sakura Japan.
Radiology, Sakura Medical Center Toho University Sakura Japan.
Mov Disord Clin Pract. 2018 Nov 9;6(1):46-50. doi: 10.1002/mdc3.12697. eCollection 2019 Jan.
Neuroimaging markers for Parkinson's disease (PD)/dementia with Lewy bodies (DLB) include dopamine transporter (DAT) scanning and metaiodobenzylguanidine (MIBG) myocardial scintigraphy. It is unknown which marker is useful to identify the premotor phase PD/DLB. We 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.
This study was a prospective cohort study. The recruiting period was five years; prospective follow-up period, 5.5 ± 3.0 years; and a once a year (minimum) follow-up visit. We recruited 745 referred subjects. The inclusion criteria were having at least one of the following known PD nonmotor features: (1) autonomic: postural hypotension (pure autonomic failure [PAF]), constipation, bladder dysfunction; (2) sleep: REM sleep behavior disorder (RBD); and (3) cognitive: mild cognitive impairment or psychiatric symptoms. Also, the patient had to have undergone both DAT and MIBG tests.
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), and predominately male (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%.
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.
帕金森病（PD）/路易体痴呆（DLB）的神经影像学标志物包括多巴胺转运体（DAT）扫描和间碘苄胍（MIBG）心肌闪烁显像。尚不清楚哪种标志物有助于识别运动前期的PD/DLB。我们报告了4例患者，在DAT扫描结果为阴性期间，MIBG结果呈阳性，提示为运动前期PD/DLB。在此，我们报告另外18例患者。
本研究为前瞻性队列研究。招募期为5年；前瞻性随访期为5.5±3.0年，且每年至少随访一次。我们招募了745名转诊受试者。纳入标准为至少具备以下已知的PD非运动特征之一：（1）自主神经功能：体位性低血压（纯自主神经功能衰竭[PAF]）、便秘、膀胱功能障碍；（2）睡眠：快速眼动睡眠行为障碍（RBD）；（3）认知：轻度认知障碍或精神症状。此外，患者必须接受过DAT和MIBG检查。
仅18例患者符合这些标准。他们的特征为：老年人（平均年龄75.5岁），病史长（发病年龄61.0岁；病程14.5年），且男性居多（14例男性，4例女性）。患者的神经学诊断为：10例为便秘/RBD，6例为便秘/RBD/PAF，2例为便秘/PAF。在随访期间，7例患者发展为PD或DLB。94%的患者MIBG结果异常，56%的患者DAT结果异常。
MIBG有可能成为在DAT扫描阴性期识别运动前期PD/DLB的有用标志物，但仍需进一步研究。
