Miyamoto Masayuki, Miyamoto Tomoyuki, Saitou Junichi, Sato Toshihiko
Department of Neurology, Center of Sleep Medicine, Dokkyo Medical University, Japan.
Department of Neurology, Dokkyo Medical University Saitama Medical Center, Japan.
Sleep Med. 2020 Apr;68:50-56. doi: 10.1016/j.sleep.2019.09.013. Epub 2019 Oct 4.
To determine if nigrostriatal dopaminergic system function, evaluated by aromatic l-amino acid decarboxylase (AADC) activity using 6-[F]fluoro-meta-tyrosine brain positron emission tomography (FMT-PET) can accurately and efficiently identify idiopathic rapid-eye-movement behavior disorder (IRBD) individuals at risk for conversion to a clinical diagnosis of Parkinson's disease (PD) or dementia with Lewy bodies (DLB).
We assessed prospectively striatal aromatic l-amino acid decarboxylase activity using FMT brain PET imaging in IRBD patients who were followed systematically every 1-3 months for 1-10 years. IRBD patients (n = 27) were enrolled in this prospective cohort study starting in 2009. Those who underwent follow-up scans between January 2011 and September 2014 (n = 24) were analyzed in the present study.
Of the 24 IRBD patients with baseline and follow-up FMT-PET scans, 11 (45.8%) developed PD (n = 6) or DLB (n = 5). Compared to IRBD patients who were still disease-free, those who developed PD (n = 5) or DLB with parkinsonism (n = 1) had significantly reduced bilateral putaminal FMT uptake during the follow-up. Furthermore, the rate of FMT decline between baseline and follow-up scans was higher in all converted patients, even for those with DLB without parkinsonism, than in IRBD patients who remained disease-free.
FMT-PET, which represents a dynamic change in AADC activity over time, may also be a useful predictor for the risk of conversion to PD or DLB over short-term clinical follow-up periods, or when testing neuroprotective and restorative strategies in the prodromal phases of PD or DLB.
通过使用6-[F]氟间酪氨酸脑正电子发射断层扫描（FMT-PET）评估芳香族L-氨基酸脱羧酶（AADC）活性来确定黑质纹状体多巴胺能系统功能是否能够准确且有效地识别有转化为帕金森病（PD）临床诊断或路易体痴呆（DLB）风险的特发性快速眼动睡眠行为障碍（IRBD）个体。
我们对IRBD患者进行前瞻性评估，使用FMT脑PET成像来检测纹状体芳香族L-氨基酸脱羧酶活性，这些患者每1至3个月进行一次系统随访，为期1至10年。2009年起，27名IRBD患者被纳入这项前瞻性队列研究。本研究分析了2011年1月至2014年9月期间接受随访扫描的患者（n = 24）。
在24名有基线和随访FMT-PET扫描的IRBD患者中，11名（45.8%）发展为PD（n = 6）或DLB（n = 5）。与仍未患病的IRBD患者相比，发展为PD（n = 5）或伴有帕金森综合征的DLB（n = 1）的患者在随访期间双侧壳核FMT摄取显著降低。此外，所有转化患者，即使是那些无帕金森综合征的DLB患者，基线和随访扫描之间FMT下降率均高于未患病的IRBD患者。
FMT-PET代表了AADC活性随时间的动态变化，在短期临床随访期间，或者在PD或DLB前驱期测试神经保护和恢复策略时，它可能也是预测转化为PD或DLB风险的有用指标。
