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February 21, 2017; 88 (8) Article

Decreased intestinal acetylcholinesterase in early Parkinson disease

An 11C-donepezil PET study

Tatyana D. Fedorova, Louise B. Seidelin, Karoline Knudsen, Anna C. Schacht, Jacob Geday, Nicola Pavese, David J. Brooks, Per Borghammer
First published January 18, 2017, DOI: https://doi.org/10.1212/WNL.0000000000003633
Tatyana D. Fedorova
From the Department of Nuclear Medicine and PET-Centre (T.D.F., L.B.S., K.K., A.C.S., N.P., D.J.B., P.B.) and Department of Neurology (J.G.), Aarhus University Hospital, Denmark.
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Louise B. Seidelin
From the Department of Nuclear Medicine and PET-Centre (T.D.F., L.B.S., K.K., A.C.S., N.P., D.J.B., P.B.) and Department of Neurology (J.G.), Aarhus University Hospital, Denmark.
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Karoline Knudsen
From the Department of Nuclear Medicine and PET-Centre (T.D.F., L.B.S., K.K., A.C.S., N.P., D.J.B., P.B.) and Department of Neurology (J.G.), Aarhus University Hospital, Denmark.
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Anna C. Schacht
From the Department of Nuclear Medicine and PET-Centre (T.D.F., L.B.S., K.K., A.C.S., N.P., D.J.B., P.B.) and Department of Neurology (J.G.), Aarhus University Hospital, Denmark.
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Jacob Geday
From the Department of Nuclear Medicine and PET-Centre (T.D.F., L.B.S., K.K., A.C.S., N.P., D.J.B., P.B.) and Department of Neurology (J.G.), Aarhus University Hospital, Denmark.
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Nicola Pavese
From the Department of Nuclear Medicine and PET-Centre (T.D.F., L.B.S., K.K., A.C.S., N.P., D.J.B., P.B.) and Department of Neurology (J.G.), Aarhus University Hospital, Denmark.
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David J. Brooks
From the Department of Nuclear Medicine and PET-Centre (T.D.F., L.B.S., K.K., A.C.S., N.P., D.J.B., P.B.) and Department of Neurology (J.G.), Aarhus University Hospital, Denmark.
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Per Borghammer
From the Department of Nuclear Medicine and PET-Centre (T.D.F., L.B.S., K.K., A.C.S., N.P., D.J.B., P.B.) and Department of Neurology (J.G.), Aarhus University Hospital, Denmark.
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Citation
Decreased intestinal acetylcholinesterase in early Parkinson disease
An 11C-donepezil PET study
Tatyana D. Fedorova, Louise B. Seidelin, Karoline Knudsen, Anna C. Schacht, Jacob Geday, Nicola Pavese, David J. Brooks, Per Borghammer
Neurology Feb 2017, 88 (8) 775-781; DOI: 10.1212/WNL.0000000000003633

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Abstract

Objective: To investigate systemic levels of acetylcholinesterase in early Parkinson disease (PD) with 11C-donepezil PET, a potential marker of parasympathetic innervation.

Methods: This was a cross-sectional study with 19 patients with early-stage PD (disease duration 1.5 ± 0.6 years) and 16 age-matched controls who had clinical assessments, olfaction tests, and 11C-donepezil PET to measure acetylcholinesterase density in peripheral organs.

Results: The patients with PD showed significantly reduced 11C-donepezil uptake in the small intestine (−14%, p = 0.018), colon (−22%, p < 0.001), and kidneys (−14%, p = 0.028). No difference in myocardial or pancreatic acetylcholinesterase levels was seen.

Conclusion: We found significantly decreased 11C-donepezil signal in the intestine and kidneys of patients with early PD, suggesting that parasympathetic denervation is present early in the disease course.

GLOSSARY

AUC=
area under the curve;
HU=
Hounsfield units;
MMSE=
Mini-Mental State Examination;
PD=
Parkinson disease;
PNS=
parasympathetic nervous system;
ROC=
receiver-operating characteristic;
SUV=
standardized uptake value;
UPDRS=
Unified Parkinson's Disease Rating Scale;
VOI=
volume of interest

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received May 25, 2016.
  • Accepted in final form November 29, 2016.
  • © 2017 American Academy of Neurology
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