New Findings and Imaging Techniques May Aid Diagnosis of Concomitant Alzheimer’s in Patients with Parkinson’s Disease Dementia
New Study Reported in the Journal of Parkinson's Disease
April 17, 2012
Dementia is a frequent complication of Parkinson’s disease (PD), but it is clinically impossible to distinguish PD dementia (PDD), which develops from the progression of the Lewy body pathology that underlies PD, from PD with coexistent Alzheimer’s disease (PDAD). Both have similar characteristics. A team of scientists has found that PDAD patients have much denser accumulations of amyloid plaques in the striatal area of the brain than PDD patients. The results suggest that recently developed imaging techniques may be able to identify striatal amyloid plaques in the living brain and could be useful for distinguishing PDD from PDAD. Their results are published in the April issue of the Journal of Parkinson’s Disease.
“We sought to determine if the presence, density, or type of striatal plaques were predictive of the presence of a clinicopathological diagnosis of Alzheimer’s disease in subjects with PD and dementia,” say lead investigators Thomas G. Beach, MD, PhD, of Banner Sun Health Research Institute, and Charles H. Adler, MD, PhD, of the Mayo Clinic. Dr. Brittany Dugger, first author, notes the ability to determine the cause of dementia in patients with PD is a crucial objective if effective treatments are to be developed.
Researchers performed autopsies on the brains of elderly subjects who had volunteered to be part of the Arizona Parkinson’s Disease Consortium and Banner Sun Health Research Institute Brain and Body Donation Program, a longitudinal clinicopathological study of normal aging, dementia, and parkinsonism. They evaluated the brains of patients with a diagnosis of PD without dementia (PDND), PDD without pathological AD, and PDAD. For comparative purposes, subjects from a previously published study of patients with AD without PD (AD), as well as non-demented normal control subjects without parkinsonism (NC), were also included. Amyloid plaque densities were graded at several sites in the brain and scored by the researchers as none, sparse, moderate, or frequent. Scores were derived by considering all types of plaques together – cored, neuritic, and diffuse – as well as separately for cored and neuritic plaques, without diffuse plaques.
Investigators found that the AD and PDAD cases had significantly higher cerebral cortex total and neuritic plaque density scores when compared to PDD, PDND, and NC. In patients with PD, the presence of any type of striatal plaques predicted the clinicopathological diagnosis of AD with 80% sensitivity and 80% specificity. In comparison, the presence of cerebral cortex plaques was 100% sensitive but only 48% specific when PDND, PDAD, and PDD were included; and only 55% specific when only the PDAD and PDD groups were included.
“The results suggest that, with the use of amyloid imaging, the presence of striatal plaques could help clinically distinguish PDD from PDAD,” notes Dr. Beach. “Large antemortem-postmortem correlative studies are needed to determine whether a positive striatal amyloid imaging signal would be a sensitive and specific marker of concurrent PD and AD and their clinical severities.”
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NOTES FOR EDITORS
“Presence of Striatal Amyloid Plaques in Parkinson’s Disease Dementia Predicts Concomitant Alzheimer’s Disease: Usefulness for Amyloid Imaging,” by B.N. Dugger, G.E. Serrano, L.I. Sue, et al. Journal of Parkinson’s Disease, 2(2012) 57-65. DOI: 10.3233/JPD-2012-11073. Published by IOS Press
Full text of the article is available to credentialed journalists. Contact Daphne Watrin, IOS Press, +31 20 688 3355, firstname.lastname@example.org. Journalists wishing to interview the authors should contact Brian Browne, Communications and Outreach Manager, Banner Research Institute, at 623-875-6536 or Brian.Browne@bannerhealth.com.
ABOUT THE JOURNAL OF PARKINSON’S DISEASE (JPD)
Launched in June 2011 the Journal of Parkinson’s Disease is dedicated to providing an open forum for original research in basic science, translational research and clinical medicine that will expedite our fundamental understanding and improve treatment of Parkinson’s disease. The journal is international and multidisciplinary and aims to promote progress in the epidemiology, etiology, genetics, molecular correlates, pathogenesis, pharmacology, psychology, diagnosis and treatment of Parkinson’s disease. It publishes research reports, reviews, short communications, and letters-to-the-editor and offers very rapid publication and an affordable open access option. www.journalofparkinsonsdisease.com
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