Abstract
A subtle cognitive impairment can be detected early in the course of Parkinson's disease
(PD). Executive, memory and visuospatial functions are specifically affected, but
the underlying pathophysiological basis is not well elucidated yet and may be heterogeneous.
The recent identification of a PD-related cognitive metabolic pattern (PDCP), including
hypometabolism in associative frontal, parietal and posterior limbic structures, has
integrated the classical notion of a striato-frontal syndrome at the basis of cognitive
dys-function. Recent evidence suggests that whilst executive dys-function is seen
in virtually all PD patients, visuospatial and memory impairment may share a higher
risk for the subsequent development of dementia. By means of perfusion SPECT and [18F]FDG-PET,
cortical dys-function may be highlighted since the early stages, it is more evident
in PD patients with Mild Cognitive Impairment (MCI), and reaches the maximum in PD
dementia (PDD). Posterior temporo–parieto–occipital dys-function in associative and
limbic cortex, closely resembling that found in Alzheimer's disease patients, is found
in PDD, with a more severe occipital hypometabolism and a relatively milder hypometabolism
in medial temporal lobe structures. Furthermore, deficit of acetylcholinesterase (AchE)
can be found by means of [11C]MP4A-PET already in early stage of PD, especially in
posterior regions, then becoming more severe in PDD and in dementia with Lewy bodies
(DLB). Administration of AchE inhibitors to PDD patients increased brain metabolism
in bilateral frontal and left parietal regions, and left posterior cingulate. Finally,
the recent availability of radiopharmaceuticals able to disclose amyloid brain deposition
has allowed to demonstrate amyloid load in a part of patients with PDD, possibly due
to diffuse rather than neuritic plaques. Brain PET and SPECT have strongly contributed
to the understanding of the pathophysiology of cognitive impairment in PD and may
serve as probes to monitor the effects of therapeutic interventions.
Keywords
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Article info
Publication history
Published online: July 15, 2011
Accepted:
June 29,
2011
Received in revised form:
June 19,
2011
Received:
February 5,
2011
Identification
Copyright
© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
