Trinh Ilene, Muralidhar Angeni, Yang Justin, Phielipp Nicolás
Department of Neurology School of Medicine, University of California Irvine Irvine California USA.
Mov Disord Clin Pract. 2023 Apr 5;10(6):896-902. doi: 10.1002/mdc3.13726. eCollection 2023 Jun.
A hallmark of Parkinson's disease (PD) is progressive loss of dopamine terminals in the basal ganglia, with clinical symptoms including motor and non-motor manifestations such as bradykinesia, rigidity, and cognitive impairment. Dopamine transporter single-photon emission computed tomography (DaT-SPECT) can be used to assess dopaminergic denervation by detecting loss of striatal dopamine transporters (DaT).
We examined DaT binding scores' (DaTbs) association with motor outcomes in PD and explored its usefulness as a predictor of disease progression. Faster dopaminergic denervation in the basal ganglia was hypothesized to have stronger correlation and predictive value for poor motor outcomes.
Data was analyzed from the Parkinson's Progression Markers Initiative. DaTbs in the putamen and caudate nucleus were correlated with Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scores for walking and balance difficulties, gait difficulties, and presence of dyskinesias. A predictive model using baseline speed of drop in DaT binding score was performed for each motor outcome.
All motor outcomes had mild, significantly negative correlation with DaTbs in the putamen and caudate nucleus, with similar degree of correlation per region. Speed of drop was predictive of only substantial gait difficulties when evaluated in the putamen but not the caudate.
These findings suggest that analyzing speed of drop in DaTbs, which occurs early in the motor phase of the disease, may be helpful for predicting clinical outcomes in PD. Longer observation of this cohort may provide further data to investigate DaTbs as a prognostic marker in PD.
帕金森病（PD）的一个标志是基底神经节中多巴胺能终末的进行性丧失，其临床症状包括运动和非运动表现，如运动迟缓、僵硬和认知障碍。多巴胺转运体单光子发射计算机断层扫描（DaT-SPECT）可通过检测纹状体多巴胺转运体（DaT）的丧失来评估多巴胺能去神经支配。
我们研究了DaT结合分数（DaTbs）与PD运动结局的关联，并探讨其作为疾病进展预测指标的有用性。假设基底神经节中更快的多巴胺能去神经支配与不良运动结局具有更强的相关性和预测价值。
分析来自帕金森病进展标志物倡议项目的数据。壳核和尾状核中的DaTbs与运动障碍协会统一帕金森病评定量表（MDS-UPDRS）中关于步行和平衡困难、步态困难以及异动症存在情况的评分相关。针对每个运动结局，使用DaT结合分数下降的基线速度建立预测模型。
所有运动结局与壳核和尾状核中的DaTbs均呈轻度、显著负相关，每个区域的相关程度相似。仅在壳核中评估时，下降速度可预测严重的步态困难，而在尾状核中则不能。
这些发现表明，分析疾病运动期早期出现的DaTbs下降速度，可能有助于预测PD的临床结局。对该队列进行更长时间的观察，可能会提供更多数据，以研究DaTbs作为PD预后标志物的情况。
