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Early bilateral caudate involvement in Parkinson's disease is predictive of cognitive decline

Rory Durcan, Louise Wiblin, Morten Gersel Stokholm, Lynn Rochester, David J. Brooks1, David J. Burn, Nicola Pavese
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To establish the prevalence of early caudate dopaminergic dysfunction in a large cohort of recently diagnosed (<2 years disease duration) and untreated patients with Parkinson's disease (PD) using 123I-FP-CIT SPECT. Additionally, to determine if differential patterns of early caudate dopaminergic dysfunction correlate with subsequent clinical outcomes.


PD patients and healthy controls (HC) were identified from the Parkinson's Progression Markers Initiative (PPMI) database. We investigated the numbers of PD patients with early impaired caudate function as determined by reduced caudate 123I-FP-CIT binding; in one caudate alone (PD-UC group), both caudates (PD-BC group) and no reduced binding (PD-NC group).


Imaging was available on 405 PD patients and 177 HC. Of PD patients, 53.1% had no impaired caudate function (PD-NC), 24.4% had a unilateral impaired caudate function (PD-UC) and 22.5% had a bilaterally impaired caudate (PD-BC). At 4 year follow-up, the prevalence of cognitive impairment was higher in the PD-BC (45.7%) group compared to the PD-NC (20%, p=0.005) and PD-UC (17.6%, p=0.012). Depression was more prevalent in the PD-BC compared with PD-NC (34.3% vs 13.8%, p=0.011). Furthermore, gait impairment was more severe in the PD-BC compared to the PD-NC but had similar severity to PD-UC. All PD patients with reduced caudate binding on baseline 123I-FP-CIT SPECT retained a diagnosis of PD at follow-up.


We observed that early bilateral caudate involvement on 123I-FP-CIT SPECT, seen in a subgroup of PD patients, is associated with increased risk of subsequent cognitive decline, depression and gait impairment