치매를 동반한 파킨슨병 환자에서 ^(99m)Tc-ECD SPECT를 이용한 국소 뇌혈류의 반정량적 분석 = Semiquantitative Analysis of Regional Cerebral Blood Flow Using ^(99m)Tc-ECD Brain SPECT in Parkinson's Disease Patients with Dementia

다국어 초록 (Multilingual Abstract)

Background: The basic pathology of Parkinson's disease (PD) is degeneration of dopaminergic neurons within the substantia nigra. Not only extrapyramidal symptoms but also cognitive dysfunction in PD may reflect the associations between subcortical basal ganglia and frontal cortex. Thus cortical and subcortical changes have been suggested for the possible causes of dementia in PD. Because the results of several regional cerebral blood flow (rCBF) studies to evaluate the abnormal cortical and subcortical function in PD with dementia were inconsistent, we studied patterns of rCBF using ^(99m)Tc-ECD SPECT in PD with dementia. Methods: ^(99m)Tc-ECD SPECT of brain was performed in 13 demented PD patients, 10 nondemented PD patients and 10 age matched normal controls to evaluate rCBF. Dementia was diagnosed with DSM-Ⅳ Revised criteria of dementia and general cognitive function was assessed by MMSE-K. For the semiquantitative analysis of rCBF, region of interests to cerebellar ratio were obtained. Results: Dementia was more common in females (84.6%) than males and demented group showed psychotic symptoms (38%) more frequently than non-demented group. Demented PD patients showed higher modified Hoehn and Yahr stage (p<0.05) and shorter duration of education (p<0.001) than nondemented PD patients and controls. However, there was not a statistical difference in disease duration between demented and nondemented PD patients. Significant frontal lobe hypoperfusion was observed in demented PD patients compared with those of nondemented PD patients and controls (p<0.01). Regional CBF of demented PD patients showed cignificant hypoperfusion in anterior temporal (p<0.01) and basal ganglia (p<0.05) compared with those of controls. Frontal rCBF of nondemented PD patients was decreased significantly than that of controls (p<0.05). Conclusions: Marked hypoperfusion in frontal lobe and basal ganglia in demented PD patients suggests that the cognitive impairment is more likely to be attributable to stiato-nigro-frontal cortical pathway abnormality. This may be a unique feature that can be distinguished from diffuse posterior hypoperfusion observed in the Alzheimer's disease. However, hypoperfusion in anterior temporal lobe in demented group reflects the coexistence of other pathology.