Objective: To think about the usefulness of a dual-phase 18-F-FP-CIT PET in cases of dementia with bradykinesia.

Background: A classic 18-F-FP-CIT PET is useful in differentiating Parkinson’s disease from most secondary parkinsonian disorders, but not enough from atypical parkinsonism. A dual-phase 18-F-FP-CIT PET contains early perfusion imaging as well as routine DAT imaging. It can provide additional information for the perfusion status of each brain region. Herein, we report an Alzheimer’s dementia case with mild bradykinesia and rigidity that showed only cortical perfusion defects without presynaptic dopaminergic deficit on a dual-phase 18-F-FP-CIT PET.

Method: A case report.

Results: A 54-year-old male presented with a 1-year history of memory decline, and slowness. He could not remember what he just said. He became slow, but there was no laterality of slowness. He showed ideomotor apraxia and mild bradykinesia, considering his age. Mild rigidities were also found in all four extremities. During gait, base and step length were normal, but gait speed was slow. His MMSE score was 21 (the duration of education: 16 years), and its details were as follows: time orientation -1; place orientation -1; serial 7 subtraction -3; memory recall -3; and drawing pentagon -1. In the SNSB, verbal/visual memory and visuospatial function were remarkably impaired. Under the suspicion of possible cortico-basal syndrome or Alzheimer’s dementia with mild parkinsonism, he undertook 18-F-FP-CIT PET. It showed a typical uptake pattern on both basal ganglia. However, in the early phase image, the overall perfusion in both posterior parietal cortices and posterior cingulate gyri were symmetrically decreased. The T1-weighted image of brain MRI revealed bilateral posterior parietal atrophy in a sagittal view. However, atrophic changes were not definite on both posterior cingulate gyri.

Conclusion: In dementia patients with mild parkinsonism, a dual-phase 18-F-FP-CIT could be helpful by providing the information not only for whether the presynaptic dopaminergic deficit is evident but for whether the perfusion defect of cortical lesions is accompanied.
*This abstract was accepted as a poster presentation at the 2019 IC-KDA in Seoul and was presented on 31^th May 2019.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-usefulness-of-a-dual-phase-18-f-fp-cit-pet-in-a-case-of-alzheimers-disease-with-slow-movement/