[¹²³I] FP‐CIT spect study in vascular parkinsonism and Parkinson's disease

Abstract

There is substantial evidence to support a role for small vessel disease (SVD) as a cause for vascular parkinsonism (VP). Using [(123)I] FP-CIT SPECT (single photon emission computed tomography), we have tried to determine whether VP patients have pre-synaptic dopaminergic function similar to PD patients, and whether the severity of parkinsonian symptoms as well as the levodopa response in VP patients are correlated with pre-synaptic dopaminergic dysfunction. Thirteen patients fulfilling operational clinical criteria for VP had [(123)I] FP-CIT scans. Mean [(123)I] FP-CIT uptake in the basal ganglia was significantly lower in VP patients than in healthy controls, and the asymmetry index was not significantly different between these groups. In contrast, compared with the PD group, only the mean asymmetry index was significantly lower in VP patients. None of the parameters measured was significantly different between VP patients who had an insidious onset of parkinsonism (VPi) and those who had an acute onset (VPa). There was a significant correlation between the bilateral basal ganglia FP-CIT uptake reduction in the VP patients and UPDRS motor scores, but not with the mean % reduction in motor UPDRS after levodopa. We suggest that in the majority of VP patients, pre-synaptic dopaminergic function is reduced. The presence of a rather symmetrical FP-CIT uptake in the basal ganglia may help to distinguish VP from PD and could therefore be used as a criterion for the clinical diagnosis of VP.

A Study on the Clinical and Radiologic Profile of Patients with Vascular Parkinsonism

“…Statistically significant difference was noted in the neuroimaging findings like multiple territory involvement (p<0.001), periventricular white matter changes, subcortical white matter changes (p<0.001), basal ganglia ischemia (p<0.001). This is comparable to the findings reported in other studies 7,9 The most important neuroimaging findings reported in these studies were multiple vascular territory involvement, periventricular white matter changes, subcortical ischemic white matter changes, and ischemia of the basal ganglia and brainstem.…”

Vascular parkinsonism: a case series of 17 patients

“…Most specialists would argue that differentiation would be possible by means of assessing levodopa responsiveness and olfaction. To further complicate matters, Zijlmans et al 38 have reported good or excellent responses to levodopa in 12 of 17 patients with pathologically confirmed VP. The use of the University of Pennsylvania Smell Test may be a helpful discriminator since olfaction is appa rently preserved in patients with VP, whereas 80% of patients with PD are hyposmic 39 .…”

Nigrostriatal Dopamine Terminal Imaging with Dopamine Transporter SPECT: An Update

“…Reports on DAT binding in vascular PS provide heterogeneous results, which might indicate that vascular PS is a mixed entity that is not yet well characterized (40). Some authors have reported normal or only a slight but insignificant reduction of DAT binding in patients with suspected vascular PS (45,54,55); others have found significantly reduced binding values (56,57). This discrepancy may be attributed to differences in patient populations and the relatively small numbers of subjects investigated.…”