Department of Neurology, National Hospital Organization Sendai-Nishitaga Hospital, Sendai, Japan.
Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
Mov Disord. 2023 Nov;38(11):2053-2063. doi: 10.1002/mds.29582. Epub 2023 Aug 28.
Parkinson's disease (PD) is a heterogeneous neurodegenerative disorder characterized by motor and nonmotor symptoms. Several features have prognostic importance and have been used as key indicators for identifying clinical subtypes. However, the symptom-based classification approach has limitations with respect to the stability of the obtained subtypes.
The purpose of this study was to identify subtypes of PD using nuclear imaging biomarkers targeting the cardiac sympathetic nervous and nigro-striatal systems and to compare patterns of cortical morphological change among obtained subtypes.
We performed unbiased hierarchical cluster analysis using I-metaiodobenzylguanidine cardiac scintigraphy and I-N-(3-fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl) nortropane single photon emission computed tomography data for 56 patients with PD. We compared clinical characteristics and the patterns of cortical atrophy in the obtained clusters.
Three clusters were identified and showed distinct characteristics in onset ages and dopamine-replacement therapy and deep brain stimulation requirements. According to the characteristics, clusters were classified into two subtypes, namely, "cardio-cortical impairment (CC)" and "dopaminergic-dominant dysfunction (DD)" subtype. The three clusters were named according to subtype and time since onset in which 14 patients were classified as "early DD," 25 as "advanced DD," and 17 as "early CC." Compared with the early DD subtype, the early CC subtype showed parietal-dominant diffuse cortical atrophy and the advanced DD subtype showed left-side predominant mild cortical atrophy.
Nuclear imaging biomarker-based classification can be used to identify clinically and pathologically relevant PD subtypes with distinct disease trajectories. © 2023 International Parkinson and Movement Disorder Society.
帕金森病（PD）是一种异质性神经退行性疾病，其特征为运动和非运动症状。有几个特征具有预后意义，并被用作识别临床亚型的关键指标。然而，基于症状的分类方法在获得的亚型的稳定性方面存在局限性。
本研究旨在使用针对心脏交感神经系统和黑质纹状体系统的核成像生物标志物来确定 PD 的亚型，并比较获得的亚型之间皮质形态变化的模式。
我们使用 I-间碘苄胍心脏闪烁显像和 I-N-（3-氟丙基）-2β-羰甲氧基-3β-（4-碘苯基）去甲托烷单光子发射计算机断层扫描数据对 56 例 PD 患者进行无偏分层聚类分析。我们比较了获得的聚类中的临床特征和皮质萎缩模式。
确定了三个聚类，它们在发病年龄、多巴胺替代治疗和深部脑刺激需求方面具有明显特征。根据特征，聚类分为两种亚型，即“心-皮质损伤（CC）”和“多巴胺能主导功能障碍（DD）”亚型。三个聚类根据亚型和发病后时间命名，其中 14 例被分类为“早期 DD”，25 例为“晚期 DD”，17 例为“早期 CC”。与早期 DD 亚型相比，早期 CC 亚型表现为顶叶为主的弥漫性皮质萎缩，而晚期 DD 亚型表现为左侧为主的轻度皮质萎缩。
基于核成像生物标志物的分类可用于识别具有不同疾病轨迹的临床和病理相关的 PD 亚型。
