Neuropsychiatric symptoms and PET imaging characteristics in patients with Parkinson-plus syndromes

Abstract

Objective To explore the neuropsychiatric symptoms and ¹⁸F-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) PET imaging features of Parkinson-plus syndromes. Methods There were 8 patients with probable Parkinson-plus syndromes, including one case of multiple system atrophy-cerebellar predominant (MSA-C), 4 cases of progressive supranuclear palsy (PSP), one case of corticobasal ganglionic degeneration (CBD) and 2 cases of dementia with Lewy bodies (DLB). Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate cognitive function, Neuropsychiatric Inventory (NPI) was used to evaluate neuropsychiatric behaviors, and Hamilton Depression Rating Scale-21 Items (HAMD-21) was used to evaluate the emotional state of patients. Results One MSA-C patient showed only anxiety. Four PSP patients showed different degrees of cognitive disorders, of whom 3 cases also presented obvious depression, anxiety, irritability and sleep disorders. One case of CBD showed dysfunction in executive function, visual spatial ability, verbal function, attention and orientation, as well as depression, anxiety, irritability and sleep disorders. Two cases of DLB were found unable to copy pentagon in MMSE chart or draw a circle in Clock Drawing Test (CDT), and they also presented hallucination, depression and indifference. As for the result of ¹⁸F-FDG PET, one MSA-C patient showed cerebellarglucose hypometabolism; 4 PSP patients showed hypometabolism in bilateral symmetrical frontal lobes, anterior cingulate gyrus and parietal lobe, especially in thalamus, basal ganglia region and brain stem; one case of CBD showed hypometabolism in right lateral fronto-temporo-parieto-occipital lobes, left lateral parietal lobe, bilateral cingulate gyri and precuneus; 2 cases of DLB showed hypometabolism in bilateral temporo-occipital lobes. Conclusions Patients with early Parkinson-plus syndromes are easily misdiagnosed as mental illness and delayed treatment, in addition, their movement disorders and extrapyramidal symptoms would be aggravated due to misusage of sedative hypnotic drugs. Neuropsychological changes are found closely related to cognitive dysfunction. PET imaging has important clinical values to early diagnosis of Parkinson-plus syndromes.

DOI: 10.3969/j.issn.1672-6731.2017.01.008