title: An imaging study of parkinsonism among African-Caribbean and Indian London communities.
abstract: We previously reported on 131 parkinsonian patients of African-Caribbean and Indian origin attending movement disorders clinics in six London Hospitals, of whom approximately 20% manifested atypical parkinsonism with a late-onset, akinetic-rigid predominant syndrome, postural instability and minimal resting tremor refractory to levodopa therapy and dopamine agonists (see Hu et al., Neurology 2000;54[Suppl.3]: A188 and Hu et al., Mov Disord 2000;15[Suppl.3]:S212). To better elucidate the phenotype of these atypical patients (18)FDG/(18)F-dopa positron emission tomography (PET) were performed in a subgroup to look for cortical and striatal metabolic changes suggestive of multiple system atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), or dementia with Lewy bodies. Magnetic resonance imaging (MRI) rating of cerebral vascular lesion load, putaminal atrophy, and neuropsychological testing were also performed. Discriminant function analysis of (18)F-dopa/(18)FDG striatal metabolism in 43 patients failed to separate atypical ethnic minority from typical Caucasian Parkinson's disease (PD) patients. Additionally, atypical Indian and African-Caribbean patients did not show cortical reductions in glucose metabolism suggestive of PSP, CBD, or DLB. Cerebral vascular lesion load rated in these patients did not differ between atypical and typical PD groups, and none of the atypical patients had MRI changes suggestive of MSA or PSP. Our results suggest the atypical parkinsonian phenotype seen in African-Caribbean and Indian patients represents a levodopa-refractory form of PD separate from MSA or PSP in most patients.
authors.affiliation: Movement Disorders Unit, Department of Neurology, Guy's, King's and St Thomas' School of Medicine and the Institute of Psychiatry, King's College London, London, United Kingdom. micheleh@foresthill32.fsnet.co.uk
authors.forename: Michele T M
authors.initials: MT
authors.lastname: Hu
authors.forename: K Ray
authors.initials: KR
authors.lastname: Chaudhuri
authors.forename: Jozef
authors.initials: J
authors.lastname: Jarosz
authors.forename: Lidia
authors.initials: L
authors.lastname: Yaguez
authors.forename: David J
authors.initials: DJ
authors.lastname: Brooks
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People; D001921:Brain / Q000000981:diagnostic imaging*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging; D003342:Corpus Striatum / Q000000981:diagnostic imaging; D003431:Cross-Cultural Comparison; D003937:Diagnosis, Differential; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007194:India / Q000208:ethnology; D020961:Lewy Body Disease / Q000000981:diagnostic imaging; D008131:London; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000000981:diagnostic imaging; D009483:Neuropsychological Tests; D020734:Parkinsonian Disorders / Q000000981:diagnostic imaging*; D011859:Radiography; D011877:Radionuclide Imaging; D013494:Supranuclear Palsy, Progressive / Q000000981:diagnostic imaging; D014900:West Indies / Q000208:ethnology; D044465:White People
chemical_list: D019788:Fluorodeoxyglucose F18