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NEUROLOGY 2010;74:77-84
© 2010 American Academy of Neurology

In vivo amyloid imaging in autopsy-confirmed Parkinson disease with dementia

M. A. Burack, MD, PhD, J. Hartlein, MSN, H. P. Flores, MS, L. Taylor-Reinwald, BA, J. S. Perlmutter, MD and N. J. Cairns, PhD

From the Departments of Neurology (M.A.B.) and Pediatrics (M.A.B.), University of Rochester School of Medicine and Dentistry, Rochester, NY; and Alzheimer's Disease Research Center (L.T.-R., N.J.C.), Department of Neurology (M.A.B., J.H., H.P.F., L.T.-R., J.S.P., N.J.C.), Department of Pathology & Immunology (N.J.C.), Program in Physical Therapy (J.S.P.), Department of Radiology (J.S.P.), Program in Occupational Therapy (J.S.P.), and Department of Anatomy & Neurobiology (J.S.P.), Washington University School of Medicine, St. Louis, MO.

Address correspondence and reprint requests to Dr. Michelle A. Burack, Department of Neurology and Pediatrics, 601 Elmwood Avenue, Box 673, University of Rochester Medical Center, Rochester, NY 14642 michelle_burack{at}urmc.rochester.edu

Objective: To investigate the specificity of in vivo amyloid imaging with [¹¹C]–Pittsburgh Compound B (PIB) in Parkinson disease dementia (PDD).

Methods: We performed detailed neuropathologic examination for 3 individuals with PDD who had PIB PET imaging within 15 months of death.

Results: We observed elevated cortical uptake of [¹¹C]-PIB on in vivo PET imaging in 2 of the 3 cases. At autopsy, all 3 individuals had abundant cortical Lewy bodies (Braak PD stage 6), and were classified as low-probability Alzheimer disease (AD) based on NIA-Reagan criteria. The 2 PIB-positive individuals had abundant diffuse Aβ plaques but only sparse neuritic plaques and intermediate neurofibrillary tangle pathology. The PIB-negative individual had rare diffuse plaques, no neuritic plaques, and low neurofibrillary tangle burden.

Conclusions: [¹¹C]–Pittsburgh Compound B (PIB) PET is specific for fibrillar Aβ molecular pathology but not for pathologic diagnosis of comorbid Alzheimer disease in individuals with Parkinson disease dementia. The ability to specifically identify fibrillar Aβ amyloid in the setting of -synucleinopathy makes [¹¹C]-PIB PET a valuable tool for prospectively evaluating how the presence of Aβ amyloid influences the clinical course of dementia in patients with Lewy body disorders.

Abbreviations: AD = Alzheimer disease; BP = binding potentials; CDR = Clinical Dementia Rating; DAT = dementia of the Alzheimer type; DLB = dementia with Lewy bodies; DV = distribution volume; MMSE = Mental State Examination; NPI-Q = Neuropsychiatric Inventory Questionnaire; PDD = Parkinson disease dementia; PIB = Pittsburgh Compound B; UPDRS = Unified Parkinson's Disease Rating Scale.

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Supplemental data at www.neurology.org

Disclosure: Author disclosures are provided at the end of the article.

Received June 18, 2009. Accepted in final form October 12, 2009.

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