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Aging and disease    2015, Vol. 6 Issue (6) : 426-436     DOI: 10.14336/AD.2015.0204
Original Article |
Low Cerebral Glucose Metabolism: A Potential Predictor for the Severity of Vascular Parkinsonism and Parkinson’s Disease
Xu Yunqi1, Wei Xiaobo1, Liu Xu1, Liao Jinchi1, Lin Jiaping2, Zhu Cansheng1, Meng Xiaochun4, Xie Dongsi4, Chao Dongman3, J Fenoy Albert3, Cheng Muhua4, Tang Beisha5, Zhang Zhuohua5, Xia Ying3,*(), Wang Qing1,*()
1Department of Neurology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangdong 510630, China
2Department of Neurosurgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangdong 510080, China
3Department of Neurosurgery, the University of Texas Medical School at Houston, Houston, TX 77030, USA
4Department of Radiology and Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
5The State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan 410078, China
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Abstract  

This study explored the association between cerebral metabolic rates of glucose (CMRGlc) and the severity of Vascular Parkinsonism (VP) and Parkinson’s disease (PD). A cross-sectional study was performed to compare CMRGlc in normal subjects vs. VP and PD patients. Twelve normal subjects, 22 VP, and 11 PD patients were evaluated with the H&Y and MMSE, and underwent 18F-FDG measurements. Pearson’s correlations were used to identify potential associations between the severity of VP/PD and CMRGlc. A pronounced reduction of CMRGlc in the frontal lobe and caudate putamen was detected in patients with VP and PD when compared with normal subjects. The VP patients displayed a slight CMRGlc decrease in the caudate putamen and frontal lobe in comparison with PD patients. These decreases in CMRGlc in the frontal lobe and caudate putamen were significantly correlated with the VP patients’ H&Y, UPDRS II, UPDRS III, MMSE, cardiovascular, and attention/memory scores. Similarly, significant correlations were observed in patients with PD. This is the first clinical study finding strong evidence for an association between low cerebral glucose metabolism and the severity of VP and PD. Our findings suggest that these changes in glucose metabolism in the frontal lobe and caudate putamen may underlie the pathophysiological mechanisms of VP and PD. As the scramble to find imaging biomarkers or predictors of the disease intensifies, a better understanding of the roles of cerebral glucose metabolism may give us insight into the pathogenesis of VP and PD.

Keywords Vascular Parkinsonism      Parkinson’s disease      cerebral glucose metabolism      frontal lobe      caudate putamen      non-motor symptoms     
Corresponding Authors: Xia Ying,Wang Qing     E-mail: Ying.Xia@UTH.TMC.edu;denniswq@yahoo.com
About author:

present address: Kunming Biomed International, Kunming, Yunnan, 650500, China

Issue Date: 01 December 2015
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Xu Yunqi
Wei Xiaobo
Liu Xu
Liao Jinchi
Lin Jiaping
Zhu Cansheng
Meng Xiaochun
Xie Dongsi
Chao Dongman
J Fenoy Albert
Cheng Muhua
Tang Beisha
Zhang Zhuohua
Xia Ying
Wang Qing
Cite this article:   
Xu Yunqi,Wei Xiaobo,Liu Xu, et al. Low Cerebral Glucose Metabolism: A Potential Predictor for the Severity of Vascular Parkinsonism and Parkinson’s Disease[J]. Aging and disease, 2015, 6(6): 426-436.
URL:  
http://www.aginganddisease.org/EN/10.14336/AD.2015.0204     OR     http://www.aginganddisease.org/EN/Y2015/V6/I6/426
Clinical parametersPDVP
Mean (SD)MinMaxMean (SD)MinMax
Gender (n)Male n (%)6(54.55)11(50)
Female n (%)5(45.55)11(50)
Age (years)59.18(16.29)397465.80(9.83)5181
Disease duration (years)4.96(4.43)0.6154.1 (2.47)0.18
H&Y2.36(1.2)152.55 (1.13)14
MMSE22.54(6.9)63024.21(3.67)1830
Daily L-dopa dosage (mg)355.77(166.65)125875247.82(131.66)125600
Infarction Volume(mm3)00016923.27(3683.62)12098.0925588.57
UPDRS36.63(14.76)116434.95(14.54)1374
UPRDRS(I)3.0(1.31)153.59(1.94)07
UPRDRS(II)13(6.76)42511.9(6.92)534
UPRDRS(III)20.63(8.15)33619.45(7.86)735
NMSS (total)77.93(48.26)618899.73(5.20)18235
Cardiovascular4.27(3.6)0123.81(2.13)06
Sleep/Fatigue16.45(8.73)13619.72(10.26)742
Mood18.63(12.82)25517.77(8.39)332
Perceptual problem4.27(6.06)0191.5(3.16)012
Attention/memory10.0(9.6)22610.81(6.6)321
Gastrointestina12.0(7.32)0269.45(6.69)019
Urinar8.63(6.34)0368.63(5.19)024
Sexual function4.72(5.72)0216.81(6.10)016
Miscellaneous7.81(8.7)0367.95(6.37)038
Table 1  Demographic, motor, and non-motor parameters of patients with VP and PD.
Figure 1.  MRI Imaging scans for VP and PD patients and normal subjects. (A) Normal subjects, (B) PD patients, (C) VP patients. The extent of white matter hyperintensities and multiple infarctions in the basal ganglia in the VP patients are shown in T2-weighted and FLAIR images. Arrows indicate the infarction.
Figure 2.  Measurements of CMRGlc in various brain regions in VP, PD, and normal subjects. Significant relative hypometabolism in patients with VP and PD was detected in the frontal lobe and caudate putamen compared to normal subjects (A and B). The images are horizontal brain sections. The changes in glucose metabolism are indicated by high (red) to low (blue) tracer uptake or binding in the scale.
GroupNfrontal lobe /cerebellumCpu/ cerebellum
Normal121.26±0.11.29±0.09
PD111.11±0.111.09±0.17
VP221.06±0.141.07±0.11
P valueVP vs. normal0.000***0.000***
PD vs. normal0.007♀♀0.001♀♀
PD vs VP0.2720.6
Table 2  The difference in CMRGlc in the frontal lobes and caudate putamen between normal subjects vs. VP and PD patients (Mean ± SD).
frontal lobe/cerebellaCpu/cerebella
rprp
UP1-.387.075-.236.290
UP2-.479*.024-.604**.003
UP3-.585**.004-.565**.006
UPDRS-.596**.003-.625**.002
H&Y-.734**.000-.701**.000
MMSE.632**.002.421.051
Cardiovascular-.245.271-.482*.023
Sleep/Fatigue-.366.094-.380.081
Mood-.490*.021-.351.110
Perceptual problem-.149.508-.117.603
Attention/memory-.533*.011-.605**.003
Gastrointestina-.170.450-.506*.016
Urinar-.501*.018-.460*.031
Sexual function-.420.052-.226.312
Miscellaneous-.359.101-.227.310
NMSS-.472*.027-.451*.035
Disease duration (years).219.328-.047.837
Daily L-dopa dosage (mg)-.130.565.142.528
infarction volume-.460*0.031-.565**0.003
Table 3  Spearman’s rank correlation coefficient (rs) between CMRGlc and clinical parameters in VP patients.
Frontal lobe/cerebellaCpu/cerebella
rprp
UP1-0.450.17-0.460.16
UP2-.729*0.01-.727*0.01
UP3-0.460.15-.831**0.00
UPDRS-.630*0.04-.834**0.00
H&Y-.894**0.00-.668*0.02
MMSE.701*0.020.380.25
Cardiovascular-.649*0.03-0.510.11
Sleep/Fatigue-.886**0.00-.634*0.04
Mood-.803**0.00-.634*0.04
Perceptual problem-0.120.72-0.200.57
Attention/memory-.742**0.01-.664*0.03
Gastrointestina-.636*0.04-.620*0.04
Urinar-.780**0.00-.679*0.02
Sexual function-.681*0.02-0.560.07
Miscellaneous-.769**0.01-0.360.28
NMSS-.809**0.00-.645*0.03
Disease duration (years)-0.210.54-.660*0.03
Daily L-dopa dosage (mg)-.640*0.03-0.570.06
Table 4  Spearman’s rank correlation coefficient (rs) between CMRGlc and clinical parameters in PD patients.
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