Motor Progression and Nigrostriatal Neurodegeneration in Parkinson Disease

Objective The motor severity in Parkinson disease (PD) is believed to parallel dopaminergic terminal degeneration in the striatum, although the terminal was reported to be virtually absent by 4 years postdiagnosis. Meanwhile, neuromelanin‐laden dopamine neuron loss in the substantia nigra (SN) elucidated a variability at early stages and gradual loss with less variability 10 years postdiagnosis. Here, we aimed to clarify the correlation between motor impairments and striatal dopaminergic terminal degeneration and nigral neuromelanin‐laden dopamine neuron loss at early to advanced stages of PD. Methods Ninety‐three PD patients were divided into early and advanced subgroups based on motor symptom duration and whether motor fluctuation was present. Striatal dopaminergic terminal degeneration was evaluated using a presynaptic dopamine transporter tracer, 123I‐ioflupane single photon emission computed tomography (SPECT). Nigral neuromelanin‐laden dopamine neuron density was assessed by neuromelanin‐sensitive magnetic resonance imaging (NM‐MRI). Results In patients with early stage PD (motor symptoms for ≤8 or 10 years), motor dysfunction during the drug‐off state was paralleled by a decline in 123I‐ioflupane uptake in the striatum despite the absence of a correlation with reductions in NM‐MRI signals in SN. Meanwhile, in patients with advanced stage PD (motor symptoms for >8 or 10 years and with fluctuation), the degree of motor deficits during the drug‐off state was not correlated with 123I‐ioflupane uptake in the striatum, despite its significant negative correlation with NM‐MRI signals in SN. Interpretation We propose striatal dopaminergic terminal loss measured using 123I‐ioflupane SPECT and nigral dopamine neuron loss assessed with NM‐MRI as early stage and advanced stage motor impairment biomarkers, respectively. ANN NEUROL 2022;92:110–121