Activities of daily living, cerebral glucose metabolism, and cognitive reserve in Lewy body and Parkinson's disease.
OBJECTIVE
(1) To investigate the neural substrate of impaired activities of daily living (ADL) in Lewy body-associated disorders, such as dementia with Lewy bodies, classical Parkinson's disease, and Parkinson's disease dementia, and (2) to explore the effect of education on the relationship between cerebral metabolic changes and ADL performance.


METHODS
Fifty-four patients with Lewy body-associated disorders underwent an extensive clinical evaluation including cerebral positron emission tomography with (18)F-fluoro-2-deoxy-glucose scanning. First, those brain areas were identified where ADL performance and glucose metabolism were significantly correlated. Second, brain regions were detected where the association between metabolic changes and ADL performance differed significantly between patients with a low and a high educational background.


RESULTS
There was a significant association between glucose hypometabolism and impaired ADL performance in the prefrontal, temporoparietal, and occipital association cortices and the precuneus. However, there was a significantly stronger association between hypometabolism and impaired ADL in the low education group compared with the high education group in the right middle occipital gyrus.


CONCLUSIONS
The study suggests (1) that brain metabolic alterations are significantly associated with the loss of everyday functioning in Lewy body-associated disorders and (2) that education modifies this association.
Perneczky
Robert
R
Department of Psychiatry and Psychotherapy, Technische Universität Munchen, Munich, Germany. robert.perneczky@lrz.tum.de
Drzezga
Alexander
A
Boecker
Henning
H
Ceballos-Baumann
Andres O
AO
Granert
Oliver
O
Förstl
Hans
H
Kurz
Alexander
A
Häussermann
Peter
P
D000203:Activities of Daily Living; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001923:Brain Chemistry / Q000502:physiology*; D003071:Cognition / Q000502:physiology*; D003627:Data Interpretation, Statistical; D003704:Dementia / Q000209:etiology / Q000378:metabolism / Q000523:psychology; D004493:Education; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007980:Levodopa / Q000627:therapeutic use; D020961:Lewy Body Disease / Q000378:metabolism* / Q000523:psychology*; D008297:Male; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications / Q000378:metabolism* / Q000523:psychology*; D049268:Positron-Emission Tomography
D000978:Antiparkinson Agents; D007980:Levodopa; D005947:Glucose