Positron emission tomography study in progressive supranuclear palsy. Brain hypometabolic pattern and clinicometabolic correlations
J. Blin, J. C. Baron, B. Dubois, B. Pillon, H. Cambon, J. Cambier and Y. Agid
Service Hospitalier Frederic Joliot, CEA, Departement de Biologie, Hopital d'Orsay, France.
In 41 patients with progressive supranuclear palsy (PSP) that was diagnosed
on the basis of eight clinical criteria (25 patients with all eight
criteria [probable PSP] and 16 with six or seven criteria [possible PSP]),
we studied cerebral energy metabolism by using positron emission tomography
and the fludeoxyglucose F 18 or the oxygen 15 method. Compared with
age-matched controls, each of the cortical and subcortical metabolic values
was significantly reduced, with a predominance in the frontal cortex, in
both groups of patients with probable and possible PSP, without a
difference between these two groups, suggesting similar underlying disease.
The frontal metabolic value decreased with disease duration, but the
relative frontal hypometabolism (expressed as the fronto-occipital
metabolic ratio) was apparently already present in the early stages of the
disease. The parkinsonian motor score was correlated with the caudate and
thalamic metabolic values. The intellectual deterioration index was
significantly correlated with both the frontal and the nonfrontal metabolic
values. Finally, the frontal neuropsychological score was significantly
correlated with only the fronto-occipital metabolic ratio. Hence, in PSP, a
degenerative brain disease with subcortical lesions, the prominent frontal
lobe-like syndrome essentially depends on the relative hypometabolism of
the frontal cortex.
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