Comparison of disease progression between brain-predominant Parkinson's disease versus Parkinson's disease with body-involvement phenotypes

• Published in: Neurobiology of disease Vol. 174; p. 105883
• Main Authors: Ryu, Dong-Woo, Yoo, Sang-Won, Oh, Yoon-Sang, Lee, Kwang-Soo, Ha, Seunggyun, Kim, Joong-Seok
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2022; Elsevier
• Subjects: Brain - diagnostic imaging; Cardiac sympathetic denervation; Disease Progression; Humans; Parkinson Disease - diagnostic imaging; Parkinson's disease; Phenotype; REM Sleep Behavior Disorder; Phenotype; Parkinson's disease; CSD; RBD; Disease progression; Cardiac sympathetic denervation; br-PD; OH; SUVR; bo-PD
• ISSN: 0969-9961; 1095-953X
• DOI: 10.1016/j.nbd.2022.105883

Recently, new disease phenotyping has been proposed based on the origin site of α-synuclein pathology in Parkinson's disease (PD). In addition, a great deal of evidences suggested of parallel degeneration in the central nervous system and peripheral nervous system in PD. The myocardial uptake pattern of 123I-meta-iodobenzylguanidine can be a surrogate imaging biomarker for the peripheral nervous system involvement in PD. This study aimed to compare the clinical progression between brain-predominant PD (br-PD) and PD with body-involvement (bo-PD) phenotypes according to the onset of cardiac sympathetic denervation (CSD); the bo-PD group was defined as having the early onset of CSD and the br-PD phenotype was defined as those without initial CSD but later developed CSD in subsequent scans (the delayed onset of CSD). Clinical chracteristics, dopamine transporter activity, and non-motor manifestations were compared between the groups. Motor symptoms and cognitive functions at the initial and follow-up tests [3.1 (±1.4) years interval] were compared between the groups. This study included 29 br-PD and 103 bo-PD patients. Symptoms of rapid-eye-movement sleep behavior disorder, excessive daytime sleepiness, constipation, and orthostatic hypotension were more frequent in the bo-PD than in the br-PD group. The Unified Parkinson's Disease Rating Scale part III score was higher at the initial and increased more steeply during the follow-up period in the bo-PD patients than in the br-PD patients. Although the general cognitive status was not much different between the groups at initial and follow-up, each group showed statistically different cognitive domain profiles and progression patterns. The results demonstrated that the bo-PD group had more severe initial symptoms and steeper motor deterioration than the br-PD group, which indicated that there may be the more pathological involvements of central and peripheral nervous systems in the bo-PD group. •Cardiac sympathetic denervation can be a surrogate marker for PNS involvement of PD.•PD was divided into brain-predominant PD (br-PD) and PD with body-involvement (bo-PD) by PNS involvement.•The bo-PD phenotype had more severe symptoms and steeper motor deterioration.•This represents more widespread pathological involvements in the bo-PD phenotype.