Olfactory testing combined with dopamine transporter imaging as a method to detect prodromal Parkinson's disease
Olfactory testing combined with dopamine transporter imaging as a method to detect prodromal Parkinson's disease
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DOI：
10.1136/jnnp.2009.183715
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发表时间：
2010-04-01
影响因子：
11
通讯作者：
Berendse, Henk W.
中科院分区：
文献类型：
--
作者：
Ponsen, Mirthe M.;Stoffers, Diederick;Berendse, Henk W.
目的嗅觉功能障碍是帕金森病(PD)的早期常见症状。此前，作者证明帕金森病患者的一级亲属中的特发性嗅觉障碍与2年内发展为帕金森病的风险增加有关。本研究的目的是确定联合嗅觉测试和SPECT扫描在相同亲属群体中预测未来5年帕金森病的价值。方法在361名PD患者的非帕金森病、非痴呆一级亲属的队列中，使用嗅觉处理任务的组合来选择低血压者(n=40)和正常者(n=38)进行5年临床随访评估和SPECT序贯扫描，使用多巴胺转运体配基评估基线和基线后5年的黑质纹状体多巴胺能功能。在对其余283名亲属的随访中，采用了对帕金森病敏感的有效问卷。结果从基线开始的5年里，40名营养不良亲属中有5名符合帕金森病的临床诊断标准。其他349名可随访的亲属中没有一人患上帕金森病。所有患有帕金森病的患者都有异常的基线SPECT扫描。结论：在PD患者的一级亲属中，特发性低血症者在5年内发生临床帕金森病的风险增加12.5%。目前的数据表明，在低营养不良个体中使用嗅觉测试和SPECT扫描的两步法在检测帕金森病方面具有非常高的敏感性和特异性。这种两步法的有效性需要在更大的人群中得到证实。
Objective Olfactory dysfunction is an early and common symptom in Parkinson disease (PD). Previously, the authors demonstrated that idiopathic olfactory dysfunction in first-degree relatives of PD patients is associated with an increased risk of developing PD within 2 years. The aim of the present study was to determine the value of combined olfactory testing and SPECT scanning in predicting future PD in the same population of relatives over a 5-year period.Methods In a cohort of 361 non-parkinsonian, non-demented first-degree relatives of PD patients, a combination of olfactory processing tasks was used to select groups of hyposmic (n = 40) and normosmic (n = 38) individuals for a 5-year clinical follow-up evaluation and sequential SPECT scanning, using a dopamine transporter ligand to assess nigrostriatal dopaminergic function at baseline and 5 years from baseline. A validated questionnaire, sensitive to the presence of parkinsonism, was used in the follow-up of the remaining 283 relatives.Results Five years from baseline, five out of the 40 hyposmic relatives fulfilled clinical diagnostic criteria for PD. None of the other 349 relatives available for follow-up developed PD. All hyposmic individuals developing PD had an abnormal baseline SPECT scan.Discussion In conclusion, idiopathic hyposmia in first-degree relatives of PD patients is associated with an increased risk of developing clinical PD of 12.5% over a 5-year period. The present data suggest that a two-step approach using olfactory testing followed by SPECT scanning in hyposmic individuals has a very high sensitivity and specificity in detecting PD. The usefulness of this two-step approach needs to be confirmed in larger populations.