Abstract
Significant progress has been made in our understanding of the neurobiology of Parkinson’s disease (PD). Post-mortem studies are an important step and could help to comprehend not only the progression of motor symptoms, but also the involvement of other clinical domains, including cognition, behavior and impulse control disorders (ICDs). The correlation of neuropathological extension of the disease with the clinical stages remains challenging. Molecular imaging, including positron emission tomography (PET) and single photon computed tomography (SPECT), could allow for bridging the gap by providing in vivo evidence of disease extension. In the last decade, we have observed a plethora of reports describing improvements in the sensitivity of neuroimaging techniques. These data contribute to increasing the accuracy of PD diagnosis, differentiating PD from other causes of parkinsonism and also obtaining a surrogate marker of disease progression. FDG-PET has been used to measure cerebral metabolic rates of glucose, a proxy for neuronal activity, in PD. Many studies have shown that this technique could be used in early PD, where reduced metabolic activity correlates with disease progression and could predict histopathological diagnosis. The aim of this work is to report two particular cases of PD in which the assessment of brain metabolic activity (from FDG-PET) has been combined with clinical aspects of non-motor symptoms. Integration of information on neuropsychological and metabolic imaging allows us to improve the treatment of PD patients irrespective of age.
Highlights
Parkinson’s disease (PD) is an age-related neurodegenerative disorder that affects as many as 1–2% of people aged 60 years and older [1]
Diagnosis of PD was made according to Movement Disorders Society (MDS) criteria [22], while all cognitive tests included in the neuropsychology battery have norms and cut-offs available for the Italian population [21]
Meso-Limbic and prefrontal cortex-ventral striatal systems, where are mainly found D3 and D4 dopaminergic receptors, which are responsible for the positive symptoms of schizophrenia such as hallucinations and delusions
Summary
Parkinson’s disease (PD) is an age-related neurodegenerative disorder that affects as many as 1–2% of people aged 60 years and older [1]. The incidence and prevalence of this disease are constantly growing, mainly due to the aging of the population [2]. The prevalence of the disease increases with age. In a meta-analysis of four North American populations, the prevalence of the disease was shown to increase from nearly 1% in the first 55 years of life to over 4% in men over 85 years of age. Lower prevalence values were found in women with “only” 2% of women affected by the disease when over 85 years of age [5]. Despite the serious impact on the quality of life of patients, which can be mitigated by the treatments that will be discussed later, the mortality in these patients is equal to those unaffected by PD in the first ten years from diagnosis, and tends to increase later [6]
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