Title:Utilization of the DaT-SCAN SPECT in the Diagnosis of Parkinson's Disease in Older Subjects
VOLUME: 12 ISSUE: 8
Author(s):Fulvio Lauretani, Livia Ruffini, Augusto Scaglioni, Carla Cidda, Chiara Guareschi, Anna Nardelli, Gian Paolo Ceda and Marcello Maggio
Affiliation:Geriatric Unit and Laboratory of Movement Analysis, Geriatric-Rehabilitation Department, University Hospital of Parma, Parma, Italy.
Keywords:DAT-SPECT, Parkinson's disease, Vascular Parkinsonism, Parkinsonism, Older Persons, diagnosis.
Abstract:The diagnosis of parkinsonism is essentially made by the presence of typical features including bradykinesia,
plastic rigidity and resting tremor. However, in older persons, where the prevalence of parkinsonism is higher, the diagnosis
is often inaccurate. The utilization of new radiological techniques, such as the DaT-SCAN SPECT, can improve the
early diagnosis and treatment of these patients. However, no data are available at this moment in older population. Aims
of this study were to investigate the role of the DaT-SCAN SPECT in the diagnosis of parkinsonism in older persons, and
to propose a new diagnostic algorithm on DaT-SCAN SPECT to be used in older persons with parkinsonism. Patients
evaluated at the Nuclear Medicine Unit of the University Hospital of Parma for diagnosis of parkinsonism from January
2009 to June 2012 who underwent clinical evaluation, and radiological assessment with DaT-SCAN SPECT, brain CT
and MRI. A total of 267 patients, 147 men (55.06%) and 120 women(44.94%) with a mean age of 73.12 ± 5.08 years were
enrolled in the study. In the multivariate linear regression analysis including age, sex, and bradykinesia, the presence of
cerebral vascular lesions in the CT or MRI was the most significant predictive factor of abnormal DaT-SCAN SPECT uptake
(beta± SE, p=0.002). The presence of bradykinesia remained also significantly associated with the DaT- SCAN
SPECT uptake. In older subjects, the CT or MRI detection of cerebral vascular lesions and the presence of bradykinesia
are the most significant predictors of abnormal DaT-SCANTM SPECT uptake. The timing of scan execution and the coexistence
of motor and cognitive deficits, are key elements to improve the accuracy of early detection of altered nigrostriatal
system, for avoiding misdiagnosis and side-effects of medications inappropriately started in older persons. This
study could facilitate clinicians to treat older persons with Parkinson's disease and to ameliorate the accuracy of the diagnosis
for testing the effects of new drugs affecting the natural history of this neurodegenerative disease. The accuracy of
the diagnosis could permit an early identification of these diseases, and could permit to test neuroprotective drugs in early
phase of patients with Parkinson's disease.
