Association of 99MTC- Hmpao Spect Measured Regional Cerebral Blood Flow And Serum Vitamin D Level With Clinical Staging of Parkinson’s Disease

Abstract

Background: Parkinson’s disease (PD) is the most common neurodegenerative movement disorder. Diagnosis of PD can be made through Single-photon emission computed tomography (SPECT). Vitamin D deficiency has recently been proposed as a potential risk factor for PD. This study aimed to evaluate the association of ^99mTc- HMPAO SPECT image findings and vitamin D status with clinical staging of PD.

Methods: This cross-sectional study was conducted in Department of Neurology, Sir Salimullah Medical College Mitford Hospital for a period of 12 months. Total 66 diagnosed PD patients were included after taking informed written consent. Detailed demographic history and neurological examination were done. The severity of PD was assessed using the modified Hoehn and Yahr (H & Y) scale. Serum 25-Hydroxyvitamin D level was measured for each participant. ^99mTc- HMPAO SPECT imaging was done at Institute of Nuclear Medicine and Allied Sciences.

Results: The mean age of the studied respondents was 71±8.72 (SD) years wherein maximum were male (59.1%) and aged above 70 years. The most common symptoms among the patients were tremor (78.8%) and bradykinesia (75.5%).The mean duration of PD was 5.74±2.22 (SD) years. Majority of the patients were diagnosed to have stage-2 (30.3%) followed by stage-2.5 (24.2%), stage-3 (16.7%), stage-4 (7.6%), stage-1 (4.5%), and stage-5 (3%). As the clinical stage of PD advanced from stages 1-5, the HMPAO uptake reduced significantly in the basal ganglia (p=0.006) .Vitamin-D level decreased significantly as the disease severity progress from stage-1 (27.8 ng/ml) to stage-5 (19.5 ng/ml) (p-value=0.008).

Conclusion: Serum Vitamin-D level was inversely associated to severity of PD and decreased regional cerebral blood flow in basal ganglia in advanced stages of PD patients. However, further larger study is recommended.

Bangladesh J Medicine 2023; 34(2): 112-120