Objective:

To investigate the pattern of hypometabolism observed on FDG-PET imaging in patients with early-onset Parkinson’s Disease (EOPD) and psychosis. 

Background:

Design/Methods:

We identified EOPD cases from 1990 to 2022 utilizing the Mayo Clinic Data Management tool. Medical records were reviewed by a movement disorder specialist (R.S.) to confirm the diagnosis of PD. The onset of PD was defined as the approximate date in which at least two of the four cardinal motor symptoms of PD (rest tremor, rigidity, bradykinesia, and impaired postural reflexes). Psychosis was defined as the presence of hallucinations, delusions or psychosis in the electronic medical records. 

Results:

A total of 830 EOPD patients were identified in this cohort. Twenty-two of these patients had a documented FDG-PET scan. We identified 4 patients with a history of psychosis and 18 patients without psychosis. The median age at the time of EOPD diagnosis was 46.5 years.  The median age at the onset of psychosis was 61 years. Among the four patients with psychosis, the predominant pattern of hypometabolism was asymmetric involvement of the frontal, parietal and temporal lobes, followed by basal ganglia involvement.  In contrast, among  the 18 paients without psychosis, the predominant pattern was asymmetric diffuse cerebral hypometablism, followed by asymmetric involvement of the frontal and parietal lobes.  

Conclusions:

Asymmetric cortical hypometabolism is the most prevalent pattern observed in EOPD patients with psychosis. Among all EOPD patients who underwent an FDG-PET maging, asymmetric diffuse cerebral involvement was the predominant pattern of hypometabolism.