Dopamine transporter imaging is associated with long-term outcomes in Parkinson's disease.
Dopamine transporter imaging is associated with long-term outcomes in Parkinson's disease.
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DOI：
10.1002/mds.25157
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发表时间：
2012-09-15
期刊：
影响因子：
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通讯作者：
Shoulson I
中科院分区：
文献类型：
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作者：
Ravina B;Marek K;Eberly S;Oakes D;Kurlan R;Ascherio A;Beal F;Beck J;Flagg E;Galpern WR;Harman J;Lang AE;Schwarzschild M;Tanner C;Shoulson I
多巴胺 (DA) 转运蛋白 (DAT) 成像已被研究作为退行性帕金森病的诊断工具。我们的目的是衡量影像学对帕金森病 (PD) 运动和非运动结果的预后价值。在参加一项从头临床试验后，我们对帕金森病队列进行了前瞻性评估，该试验采用了一系列运动（UPDRS）、认知（蒙特利尔认知评估）和行为测量。在基线和 22 个月后使用 [123I][β]-CIT 和单光子发射计算机断层扫描 (SPECT) 进行 DAT 成像。总共，537 名受试者中有 491 名 (91%) 的基线扫描有 DA 缺乏的证据，与 PD 一致，并被纳入分析。该队列随访了 5.5 (0.8) 年，平均诊断时间为 6.3 (1.2) 年。基线时较低的纹状体结合与临床里程碑和疾病严重程度的较高风险独立相关，包括运动相关的残疾、跌倒和姿势不稳定、认知障碍、精神病和临床上重要的抑郁症状。与顶部四分位相比，纹状体结合位于底部四分位的受试者认知障碍的比值比（95% 置信区间）为 3.3（1.7，6.7），精神病的比值比为 12.9（2.6，62.4）。 22 个月后影像学相对基线的变化也与运动、认知和行为结果独立相关。在诊断 PD 后不久，使用 [123I][β]-CIT 和 SPECT 进行的 DAT 成像与临床上重要的长期运动和非运动结果独立相关。这些结果应被视为假设生成并需要确认。
Dopamine (DA) transporter (DAT) imaging has been studied as a diagnostic tool for degenerative parkinsonism. Our aim was to measure the prognostic value of imaging for motor and nonmotor outcomes in Parkinson’s disease (PD). We prospectively evaluated a Parkinson’s cohort after enrollment in a de novo clinical trial with a battery of motor (UPDRS), cognitive (Montreal Cognitive Assessment), and behavioral measures. DAT imaging with [123I][β]-CIT and single-photon emission computerized tomography (SPECT) was performed at baseline and after 22 months. In total, 491 (91%) of the 537 subjects had evidence of DA deficiency on their baseline scan, consistent with PD, and were included in the analyses. The cohort was followed for 5.5 (0.8) years, with a mean duration of diagnosis of 6.3 (1.2). Lower striatal binding at baseline was independently associated with higher risk for clinical milestones and measures of disease severity, including motor-related disability, falling and postural instability, cognitive impairment, psychosis, and clinically important depressive symptoms. Subjects in the bottom quartile for striatal binding, compared to the top quartile, had an odds ratio (95% confidence interval) of 3.3 (1.7, 6.7) for cognitive impairment and 12.9 (2.6, 62.4) for psychosis. Change from baseline in imaging after 22 months was also independently associated with motor, cognitive, and behavioral outcomes. DAT imaging with [123I][β]-CIT and SPECT, shortly after the diagnosis of PD, was independently associated with clinically important long-term motor and nonmotor outcomes. These results should be treated as hypothesis generating and require confirmation.