title: Putaminal dopamine turnover in de novo Parkinson disease predicts later motor complications.
abstract: OBJECTIVE
  To investigate the predictive value of striatal dopamine turnover in patients with de novo Parkinson disease (PD) for the onset of later motor complications.
  
  
  METHODS
  This retrospective, observer-blinded cohort study followed up 31 patients with early PD who completed quantitative (18)F-dopa PET imaging to measure striatal (18)F-dopa uptake (Kocc) and effective distribution volume ratio (EDVR) as the inverse of dopamine turnover prior to antiparkinsonian treatment. The onset of wearing-off and dyskinesias was determined based on blinded clinical assessments and patient records. The predictive value of baseline PET measures for motor complications was evaluated using Cox proportional hazard models.
  
  
  RESULTS
  During a mean follow-up time of 6.8 years, 18 (58.1%) patients developed wearing-off, 11 (35.5%) dyskinesia, and 20 (64.5%) any motor complication. Patients with dyskinesia and any motor complication showed lower baseline EDVR (higher dopamine turnover) in the putamen than those without dyskinesias and any motor complication, with differences most markedly present in the posterior putamen. Baseline EDVR in the whole and the posterior putamen predicted development of motor complications with an increasing risk with lower EDVR (higher dopamine turnover), whereas EDVR in other regions and Kocc did not correlate with motor complications. Correspondingly, Kaplan-Meier curves showed reduced survival from motor complications in patients with lower baseline EDVR (higher dopamine turnover) in the posterior putamen with ongoing levodopa treatment and disease duration.
  
  
  CONCLUSIONS
  Elevated putaminal dopamine turnover in de novo PD is associated with an increased risk for later motor complications and comprises a disease-intrinsic predisposing factor for their development.
authors.affiliation: From the Division of Neurodegenerative Diseases (M.L., J.M., M.W., A.S.), Department of Neurology (H.R.), and the Department of Nuclear Medicine (B.B.-B., L.O., J.K.), Technische Universität Dresden; the Department of Neurology (M.W.), Elblandklinikum Meißen; the Positron Emission Tomography Division (B.B.-B., J.v.d.H.), Helmholtz-Zentrum Dresden-Rossendorf; and the German Centre for Neurodegenerative Diseases (DZNE) (M.L., A.S.), Rostock, Germany. M.L. and A.S. are currently with the Department of Neurology, University of Rostock, Germany. matthias.loehle@med.uni-rostock.de alexander.storch@med.uni-rostock.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Löhle
authors.affiliation: From the Division of Neurodegenerative Diseases (M.L., J.M., M.W., A.S.), Department of Neurology (H.R.), and the Department of Nuclear Medicine (B.B.-B., L.O., J.K.), Technische Universität Dresden; the Department of Neurology (M.W.), Elblandklinikum Meißen; the Positron Emission Tomography Division (B.B.-B., J.v.d.H.), Helmholtz-Zentrum Dresden-Rossendorf; and the German Centre for Neurodegenerative Diseases (DZNE) (M.L., A.S.), Rostock, Germany. M.L. and A.S. are currently with the Department of Neurology, University of Rostock, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Mende
authors.affiliation: From the Division of Neurodegenerative Diseases (M.L., J.M., M.W., A.S.), Department of Neurology (H.R.), and the Department of Nuclear Medicine (B.B.-B., L.O., J.K.), Technische Universität Dresden; the Department of Neurology (M.W.), Elblandklinikum Meißen; the Positron Emission Tomography Division (B.B.-B., J.v.d.H.), Helmholtz-Zentrum Dresden-Rossendorf; and the German Centre for Neurodegenerative Diseases (DZNE) (M.L., A.S.), Rostock, Germany. M.L. and A.S. are currently with the Department of Neurology, University of Rostock, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wolz
authors.affiliation: From the Division of Neurodegenerative Diseases (M.L., J.M., M.W., A.S.), Department of Neurology (H.R.), and the Department of Nuclear Medicine (B.B.-B., L.O., J.K.), Technische Universität Dresden; the Department of Neurology (M.W.), Elblandklinikum Meißen; the Positron Emission Tomography Division (B.B.-B., J.v.d.H.), Helmholtz-Zentrum Dresden-Rossendorf; and the German Centre for Neurodegenerative Diseases (DZNE) (M.L., A.S.), Rostock, Germany. M.L. and A.S. are currently with the Department of Neurology, University of Rostock, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Beuthien-Baumann
authors.affiliation: From the Division of Neurodegenerative Diseases (M.L., J.M., M.W., A.S.), Department of Neurology (H.R.), and the Department of Nuclear Medicine (B.B.-B., L.O., J.K.), Technische Universität Dresden; the Department of Neurology (M.W.), Elblandklinikum Meißen; the Positron Emission Tomography Division (B.B.-B., J.v.d.H.), Helmholtz-Zentrum Dresden-Rossendorf; and the German Centre for Neurodegenerative Diseases (DZNE) (M.L., A.S.), Rostock, Germany. M.L. and A.S. are currently with the Department of Neurology, University of Rostock, Germany.
authors.forename: Liane
authors.initials: L
authors.lastname: Oehme
authors.affiliation: From the Division of Neurodegenerative Diseases (M.L., J.M., M.W., A.S.), Department of Neurology (H.R.), and the Department of Nuclear Medicine (B.B.-B., L.O., J.K.), Technische Universität Dresden; the Department of Neurology (M.W.), Elblandklinikum Meißen; the Positron Emission Tomography Division (B.B.-B., J.v.d.H.), Helmholtz-Zentrum Dresden-Rossendorf; and the German Centre for Neurodegenerative Diseases (DZNE) (M.L., A.S.), Rostock, Germany. M.L. and A.S. are currently with the Department of Neurology, University of Rostock, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: van den Hoff
authors.affiliation: From the Division of Neurodegenerative Diseases (M.L., J.M., M.W., A.S.), Department of Neurology (H.R.), and the Department of Nuclear Medicine (B.B.-B., L.O., J.K.), Technische Universität Dresden; the Department of Neurology (M.W.), Elblandklinikum Meißen; the Positron Emission Tomography Division (B.B.-B., J.v.d.H.), Helmholtz-Zentrum Dresden-Rossendorf; and the German Centre for Neurodegenerative Diseases (DZNE) (M.L., A.S.), Rostock, Germany. M.L. and A.S. are currently with the Department of Neurology, University of Rostock, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Kotzerke
authors.affiliation: From the Division of Neurodegenerative Diseases (M.L., J.M., M.W., A.S.), Department of Neurology (H.R.), and the Department of Nuclear Medicine (B.B.-B., L.O., J.K.), Technische Universität Dresden; the Department of Neurology (M.W.), Elblandklinikum Meißen; the Positron Emission Tomography Division (B.B.-B., J.v.d.H.), Helmholtz-Zentrum Dresden-Rossendorf; and the German Centre for Neurodegenerative Diseases (DZNE) (M.L., A.S.), Rostock, Germany. M.L. and A.S. are currently with the Department of Neurology, University of Rostock, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.affiliation: From the Division of Neurodegenerative Diseases (M.L., J.M., M.W., A.S.), Department of Neurology (H.R.), and the Department of Nuclear Medicine (B.B.-B., L.O., J.K.), Technische Universität Dresden; the Department of Neurology (M.W.), Elblandklinikum Meißen; the Positron Emission Tomography Division (B.B.-B., J.v.d.H.), Helmholtz-Zentrum Dresden-Rossendorf; and the German Centre for Neurodegenerative Diseases (DZNE) (M.L., A.S.), Rostock, Germany. M.L. and A.S. are currently with the Department of Neurology, University of Rostock, Germany. matthias.loehle@med.uni-rostock.de alexander.storch@med.uni-rostock.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Storch
mesh_terms: D000368:Aged; D004295:Dihydroxyphenylalanine / Q000493:pharmacokinetics; D004298:Dopamine / Q000378:metabolism*; D015259:Dopamine Agents / Q000493:pharmacokinetics*; D020820:Dyskinesias / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011699:Putamen / Q000000981:diagnostic imaging*; D016037:Single-Blind Method
chemical_list: D015259:Dopamine Agents; D019788:Fluorodeoxyglucose F18; D004295:Dihydroxyphenylalanine; D004298:Dopamine