Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark.
Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
J Parkinsons Dis. 2023;13(4):515-523. doi: 10.3233/JPD-230001.
The α-syn Origin site and Connectome model (SOC) proposes that α-synucleinopathies can be divided into two categories: the asymmetrical brain-first, and more symmetrical body-first Lewy body disease. We have hypothesized that most patients with dementia with Lewy bodies (DLB) belong to the body-first subtype, whereas patients with Parkinson's disease (PD) more often belong to the brain-first subtype.
To compare asymmetry of striatal dopaminergic dysfunction in DLB and PD patients using [18F]-FE-PE2I positron emission tomography (PET).
We analyzed [18F]-FE-PE2I PET data from 29 DLB patients and 76 PD patients who were identified retrospectively during a 5-year period at Dept. of Neurology, Aarhus University Hospital. Additionally, imaging data from 34 healthy controls was used for age-correction and visual comparison.
PD patients showed significantly more asymmetry in specific binding ratios between the most and least affected putamen (p < 0.0001) and caudate (p = 0.003) compared to DLB patients. PD patients also had more severe degeneration in the putamen compared to the caudate in comparison to DLB patients (p < 0.0001) who had a more universal pattern of striatal degeneration.
Patients with DLB show significantly more symmetric striatal degeneration on average compared to PD patients. These results support the hypothesis that DLB patients may be more likely to conform to the body-first subtype characterized by a symmetrical spread of pathology, whereas PD patients may be more likely to conform to the brain-first subtype with more lateralized initial propagation of pathology.
α-突触核蛋白起源部位和连接组模型（SOC）提出，α-突触核蛋白病可以分为两类：不对称的以脑为主，以及更对称的以躯体为主的路易体病。我们假设，大多数路易体痴呆（DLB）患者属于以躯体为主的亚型，而帕金森病（PD）患者更常属于以脑为主的亚型。
使用 [18F]-FE-PE2I 正电子发射断层扫描（PET）比较 DLB 和 PD 患者纹状体多巴胺能功能障碍的不对称性。
我们分析了在 5 年内，于奥胡斯大学医院神经内科确诊的 29 例 DLB 患者和 76 例 PD 患者的 [18F]-FE-PE2I PET 数据。此外，还使用了 34 名健康对照者的影像学数据进行年龄校正和视觉比较。
与 DLB 患者相比，PD 患者的纹状体中受影响最严重和最不严重的壳核（p<0.0001）和尾状核（p=0.003）之间的特异性结合比值的不对称性更为显著。与 DLB 患者相比，PD 患者的壳核比尾状核的变性更为严重（p<0.0001），DLB 患者的纹状体变性呈更为普遍的模式。
与 PD 患者相比，DLB 患者的纹状体变性平均更为对称。这些结果支持这样的假设，即 DLB 患者可能更符合以躯体为主的亚型，其特征是病理的对称扩散，而 PD 患者可能更符合以脑为主的亚型，其病理的初始传播更具侧化性。
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