title: Resting regional cerebral glucose metabolism in advanced Parkinson's disease studied in the off and on conditions with [(18)F]FDG-PET.
abstract: Studies of resting regional cerebral glucose consumption (rCMRGlc) in nondemented patients with Parkinson's disease (PD) have produced conflicting results, reporting both reduced and normal metabolism in advanced disease and reduced or normal metabolism after dopaminergic therapy. To investigate these issues, [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) was performed in 11 nondemented PD patients with advanced disease and 10 age-matched controls. PD patients were studied after withdrawal of all dopaminergic medication to produce a practically defined off condition, and a second time 1 hour after levodopa, resulting in a clinical on state. Dynamic PET scans and simultaneous arterialised venous blood samples of [(18)F] activity were obtained. A graphical approach was used to generate parametric images of rCMRGlc and statistical parametric mapping to localise significant metabolic changes in PD. Compared with controls, global rCMRGlc was reduced in the on but not in the off condition in PD. In both states, significant regional reductions of glucose uptake were found in the parietal, frontal, temporal cortex, and caudate nucleus. Reductions correlated with the severity of disability in frontal and temporal cortex. Direct comparison between on and off conditions revealed relatively greater reductions of uptake in the ventral/orbital frontal cortex and the thalamus during on. Results suggest that cortical and caudate hypometabolism are common in advanced PD and that caution is mandatory if [(18)F]FDG PET is being used to differentiate advanced PD from dementia and progressive supranuclear palsy where similar reductions are seen. Furthermore, in PD, administration of levodopa is associated with further hypometabolism in orbitofrontal cortex; an area known to be relevant for reversal learning where performance is typically impaired after dopaminergic treatment.
authors.affiliation: Department of Nuclear Medicine, University Medical School, Hannover, Germany. berding.georg@mh-hannover.de
authors.forename: G
authors.initials: G
authors.lastname: Berding
authors.forename: P
authors.initials: P
authors.lastname: Odin
authors.forename: D J
authors.initials: DJ
authors.lastname: Brooks
authors.forename: G
authors.initials: G
authors.lastname: Nikkhah
authors.forename: C
authors.initials: C
authors.lastname: Matthies
authors.forename: T
authors.initials: T
authors.lastname: Peschel
authors.forename: M
authors.initials: M
authors.lastname: Shing
authors.forename: H
authors.initials: H
authors.lastname: Kolbe
authors.forename: J
authors.initials: J
authors.lastname: van Den Hoff
authors.forename: H
authors.initials: H
authors.lastname: Fricke
authors.forename: R
authors.initials: R
authors.lastname: Dengler
authors.forename: M
authors.initials: M
authors.lastname: Samii
authors.forename: W H
authors.initials: WH
authors.lastname: Knapp
mesh_terms: D000328:Adult; D000978:Antiparkinson Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000378:metabolism*; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index; D014055:Tomography, Emission-Computed / Q000379:methods
chemical_list: D000978:Antiparkinson Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D007980:Levodopa; D005947:Glucose