Abstract Details

Title Progression to Advanced Scores on the Hoehn and Yahr Scale in Parkinson Disease Is Not Explained by Degree of Dopaminergic Denervation

Topic Movement Disorders

Presentation(s) P06 - (-)

Poster/Presentation
Number 084

Objective

Background BACKGROUND: Disability with decline of functional mobility and loss of independent function starts to occur between Hoehn and Yahr (HY) stages 2 to 3 in Parkinson disease (PD). Therefore, the transition to Hoehn and Yahr stage 3 marks a pivotal milestone in PD, heralding significant disability. Although progression of disease in PD has been attributed to progressive loss of nigrostriatal nerve terminals, balance and gait related symptoms become less dopamine responsive with advancing disease.

Design/Methods DESIGN/METHODS: We performed a longitudinal dopaminergic neuroimaging study on 20 subjects with PD. All subjects had Hoehn and Yahr scores of less than 2.5 at enrollment and underwent a detailed clinical exam as well as [11C]dihydrotetrabenazine (DTBZ) positron emission tomography (PET) at baseline and at 4 year follow-up to assess the proportion of subjects who converted to balance-disabled PD, defined as HY stages ?3.

Results RESULTS: Nine subjects (45%) converted to HY stage 3 or greater at follow-up and 11 subjects remained at HY 2.5 or lower. Converters tended to be older than non-converters (Z=2.02, p =0.022) and showed a more rapid rate of change in Hoehn and Yahr scoring (Z=3.69, p =0.0002) at follow-up. There were no differences between converters and non-converters in duration of disease (Z= 0.30, p = 0.76) or rate of change in nigrostriatal dopaminergic denervation (Z=0.99, p=0.32) as assessed by striatal DTBZ DVR.

Conclusions CONCLUSIONS: Conversion to balance-disabled PD (HY stages ?3) cannot be explained by more prominent loss of dopaminergic nerve terminals per se and may reflect extranigral pathology.

Authors/Disclosures
Vikas Kotagal, MD, FAAN (University of Michigan) PRESENTER	Dr. Kotagal has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Movement Disorders Society. The institution of Dr. Kotagal has received research support from NIH. The institution of Dr. Kotagal has received research support from VA Healthcare System.
Martijn Muller, PhD (Critical Path Institute)	No disclosure on file
Nicolaas I. Bohnen, MD, PhD, FAAN (University of Michigan)	Dr. Bohnen has stock in Delta. The institution of Dr. Bohnen has received research support from NIH. The institution of Dr. Bohnen has received research support from VA. Dr. Bohnen has received research support from NIH. The institution of Dr. Bohnen has received research support from Parkinson fnd.
	No disclosure on file

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