The Metabolic Activity of Caudate and Prefrontal Cortex Negatively Correlates with the Severity of Idiopathic Parkinson's Disease

Abstract

Positron emission tomography (PET) scan with tracer [¹⁸F]-fluorodeoxy-glucose (¹⁸F-FDG) is widely used to measure the glucose metabolism in neurodegenerative disease such as Idiopathic Parkinson's disease (IPD). Previous studies using ¹⁸F-FDG PET mainly focused on the motor or non-motor symptoms but not the severity of IPD. In this study, we aimed to determine the metabolic patterns of ¹⁸F-FDG in different stages of IPD defined by Hoehn and Yahr rating scale (H-Y rating scale) and to identify regions in the brain that play critical roles in disease progression. Fifty IPD patients were included in this study. They were 29 men and 21 women (mean±SD, age 57.7±11.1 years, disease duration 4.0±3.8 years, H-Y 2.2±1.1). Twenty healthy individuals were included as normal controls. Following ¹⁸F-FDG PET scan, image analysis was performed using Statistical Parametric Mapping (SPM) and Resting-State fMRI Data Analysis Toolkit (REST). The metabolic feature of IPD and regions-of-interests (ROIs) were determined. Correlation analysis between ROIs and H-Y stage was performed. SPM analysis demonstrated a significant hypometabolic activity in bilateral putamen, caudate and anterior cingulate as well as left parietal lobe, prefrontal cortex in IPD patients. In contrast, hypermetabolism was observed in the cerebellum and vermis. There was a negative correlation (p=0.007, r=-0.412) between H-Y stage and caudate metabolic activity. Moreover, the prefrontal area also showed a negative correlation with H-Y (P=0.033, r=-0.334). Thus, the uptake of FDG in caudate and prefrontal cortex can potentially be used as a surrogate marker to evaluate the severity of IPD.

Keywords: 18F-FDG PET; Parkinson's disease; Statistical Parametric Mapping; metabolic activity.

Fig 1.

The metabolism of FDG in IPD patients compared to healthy controls. Brain areas with increased/decreased glucose metabolism are superimposed on the Montreal Neurological Institute template (Top row) (p < 0.001, uncorrected) and the 3D render (Bottom row). A) Significant hypometabolism in bilateral putamen, caudate, anterior cingulate, parietal lobe and prefrontal cortex was identified. B) The relative hypermetabolism was identified in the cerebellum and vermis.

Figure 2.. The relationship between the metabolic activity of ROIs and H-Y stages

A) In caudate, the metabolic activity decreased as H-Y stages increased (p=0.004 r=-0.441). B) Similar to caudate, prefrontal metabolic activity also decreased as H-Y stages increased (p=0.004 r=-0.441). C, D, E and F, show no correlation in vermis (C), angular (D), occipital (E) and temporal lobes (F). The Pearson correlation analysis was performed using SPSS software.