Objective: This study aimed to compare the clinical progression between brain-first and body-first PD groups using cardiac sympathetic denervation (CSD).

Background: Brain-first and body-first Parkinson’s disease (PD) are disease classifications based on the origin site of α-synuclein pathology.

Method: This study included 29 brain-first and 103 body-first PD patients. Using ¹²³I-meta-iodobenzylguanidine (¹²³I-MIBG) scintigraphy, heart to mediastium (H/M) ratio and wash-out rate were measured; and CSD was determined using the initial delayed H/M ratio. Clinical chracteristics, dopamine transporter activity, and non-motor manifestations were compared between the groups. Motor symptoms and cognitive function between initial presentation and 3.4 (± 1.5) years from initial tests were compared between the groups.

Results: Early and delayed H/M ratio decreased more steeply in brain-first PD than in body-first PD during the follow-up period. REM sleep behavioral disorder, excessive daytime sleepiness, constipation, orthostatic hypotension, and memory and frontal executive domain dysfunctions were more frequent in body-first PD than in brain-first PD. However, smell identification test scores were not different between the groups. Unified Parkinson’s Disease Rating Scale part III score was higher at initial presentation and increased more steeply in body-first PD patients than in brain-first PD patients during the follow-up period. However, no significant differences were found in cognitive scores during follow-up.

Conclusion: Our results demonstrate that brain-first and body-first PD based on CSD onset can be effective classifications. Patients in these classifications can experience different clinical presentations and progression in motor symptoms; body-first PD had more severe motor symptom at initial presentation and more steep motor deterioration than brain-first PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-disease-progression-in-patients-with-brain-first-versus-body-first-parkinsons-disease/