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Bradykinesia in early Huntington’s disease

From the Department of Neurology (Drs. Sánchez-Pernaute, del Barrio Alba, and de Yébenes), Fundación Jiménez Díaz, Madrid, Spain; the PET Unit (Drs. Künig, Vontobel, and Leenders), Paul Scherrer Institut, Villigen, Switzerland; and the Department of Neurology (Dr. Leenders), Academisch Ziekenhuis Groningen, the Netherlands.

Address correspondence and reprint requests to Dr. R. Sánchez-Pernaute, Laboratory of Molecular Medicine and Neuroscience, NINDS, Building 36, Room 5W21, 36, Convent Drive, Bethesda, MD 20892-4164; e-mail: pernaute{at}codon.nih.gov

BACKGROUND: Huntington’s disease (HD) is generally considered a hyperkinetic disorder, although hypokinetic features are part of the motor syndrome. Moreover, the striatum is considered to play a key role in initiating and executing motor programs and achieving optimal scheduling in response generation. Controversial results regarding the association between clinical features and markers of progression of the disease might be the result of inadequate restriction of clinical signs to the choreatic syndrome.

OBJECTIVE: To determine the relationship of neurologic motor and cognitive indices in patients with HD with intrinsic neuronal loss in the striatum, as measured using raclopride C11 and PET.

PATIENTS AND METHODS: A cross-sectional study was performed on 11 patients with mild HD (stages 0–2). Motor (Unified Huntington’s Disease Rating Scale [UHDRS], saccadic and tapping speed) and cognitive (verbal fluency, Trail Making Test, Stroop Test, Symbol Digit Modalities Test, Conditioned Associative Learning Test, and silhouette identification and object decision of the Visual Object and Space Perception battery) scores were correlated with raclopride C11 binding.

RESULTS: Bradykinesia (a summation of five items of the UHDRS motor scale) was the best predictor for stage, that is, functional capacity, and showed a highly significant relationship with putaminous D₂ binding (r = -0.94) and with CAG expansion length x years of age (r = 0.96). The exclusion of two patients with a rigid-akinetic HD variant did not alter these coefficients. Chorea was less well correlated than bradykinesia with D₂ binding in all striatal regions. Performance on different cognitive tests, especially in timed tasks, was highly correlated with raclopride C11 binding in caudate nucleus and ventral striatum.

CONCLUSION: Loss of D₂ binding in the striatum is highly correlated with the deficit in fast motor and cognitive processing in patients with early Huntington’s Disease. Thus, impairment of rapid execution of adequate responses to environmental changes seems to be a common manifestation of striatal disorders.

Key words: Huntington’s disease—Striatum—Raclopride C11—Bradykinesia—PET—D₂ receptor

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