Objective: To evaluate the relationship of motor and nonmotor symptoms with striatal dopaminergic denervation in a cohort of symptomatic PD patients with positive DAT-imaging

Background: In order to provide the most effective treatment to patients, an accurate diagnosis for Parkinson’s disease (PD) will require an understanding of the risk to develop nonmotor symptoms (i.e. cognitive and pychiatric disorders).

Methods: Thirty-seven patients at onset with positive DAT-scan were studied. Patients were divided into two groups depending on the evidence of dopaminergic denervetion in putamina alone (PD-p) or in putamina and caudates (PD-pc). The two groups were compared in terms demographics, motor phenotypes, disease severity based on the MDS-UPDRS III score and presence of sleep, psychiatric and cognitive symptoms.

Results: Twenty-one patients entered in the PD-pc group (M/F=14/7; mean age 62.33± 8.65 years; mean disease duration 1.76±1.09 years; mean UPDRS III 31.29±8.16) and 16 patients entered in the PD-p (M/F=5/11; mean age=64,31±8,5years; mean disease duration 3±2.68 mean UPDRS III 20.44±5.96). Group did not differed in terms of age, gender and disease duration. PD-pc group showed significant worse UPDRS scores (p<0.0001). Rigid phenotype was found in 66,7% of PD-pc and 12,5% in PD-c (p<0.0001); tremolous phenotype was found in 4,8% of PD-pc and 56,3% of PD-p (p<0.0001); mixed phenotypes was found in 28.6% of PD-pc and 31.3% of PD-p (n.s.). At the time of onset in the PD-pc group 47.5% of patients presented premotor symptoms for at least 3 years (depression and different disorders in the anxiety spectrum), 71.4% of patients showed psychiatric symptoms (generalized anxiety, panic attacks, phobia, obsessive-compulsive disorder, moderate to severe depression) and 47.6% showed mild executive dysfunction at onset. In the PD-p group none of the patients had cognitive issues, 31.3% had psychiatric symptoms (mild depression and/or anxiety) and 12.5%had premotor symptoms (mild anxiety).

Conclusions: The evidence of early dopaminergic denervation in the caudates correlates with a more complex phenotype of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dat-imaging-and-clinical-phenotypes-of-parkinsons-disease/