Missed Insights for Earlier Management of Parkinson's Disease and the Value of Dopamine Transporter (DAT) Scans

Abstract

Background/Objectives: This retrospective study focused on the role of Dopamine Transporter (DAT) scans in diagnosing Parkinson's Disease (PD) in older adults with cognitive impairment (CI). Methods: We retrospectively analyzed brain imaging of 6483 individuals aged 60 and above with CI. Among these, 297 underwent a DAT scan, with 189 testing positive and 89 starting dopamine therapy. In contrast, 173 patients exhibited PD-associated structural changes on CT or MRI without receiving DAT scans or treatment. Results: Of these patients, 50 (29%) experienced falls. This points towards a potential missed diagnosis of PD, which can respond to therapy in the early stages. Conclusions: Our results suggest that providers may overlook subtle signs of parkinsonism in patients with CI, resulting in symptoms worsening and treatment delay. Since CI is often first brought to the attention of PCPs, our findings call for an increased effort to inform PCPs of the role of DAT scans in aiding the diagnosis of dopamine deficiency states. By understanding PD-related structural changes seen on brain imaging and using a DAT scan to confirm dopamine deficiency, treatment for PD or related states might be started earlier or a timely referral made to a specialist, reducing patient disability and improving their quality of life.

Keywords: Parkinson’s disease; cognitive impairment; dopamine transporter scan; early diagnosis; falls; geriatric neurology; neuroimaging.

Figure 1

Showcases the difference in the number of patients who experienced falls between the DAT+ and the Missed Diagnosis groups. The significant increase in the percentage of falls could potentially be attributed to unmanaged Parkinsonian symptoms due to a lack of dopamine optimization therapy in the Missed Diagnosis group in comparison to the DAT+ group.

Figure 2

To navigate and view the multimorbidities present in the Missed Diagnosis group, an upset plot was generated to view and quantify the presence of other etiological causes of symptoms.

Figure 3

This violin plot illustrates the age distribution of patients in the DAT+ and Missed Diagnosis groups. The width of each violin represents the density of patients at different ages within each group. The plot highlights the spread and central tendency of ages, providing a demographic visual for the two groups.