Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Cerebral glucose metabolism and cognitive impairment in tremor-dominant and akinetic-rigid subtypes of Parkinson’s disease

Full Text:


Parkinson’s disease (PD) is a disease characterized by marked phenotypic heterogeneity. The akinetic-rigid (AR) and tremor-dominant (TD) types of PD differ not only in motor manifestations, but also in the severity of non-motor symptoms, including cognitive impairment (CI). It is the PD heterogeneity study that can achieve the task of creating a modern personalized therapy for this disease.

Objective: to study the characteristics of cerebral glucose metabolism in CI in patients with AR and TD PD.

Patients and methods. Examinations were made in 69 patients with PD (the TD and AR subtypes were in 23 and 46 patients, respectively). Their cognitive status was assessed using the Mini-mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Clock Drawing Test. 18F-fluorodeoxyglucose positron emission tomography was performed according to the standard procedure; glucose metabolism rate (GMR) was determined in different Brodmann areas (BA).

Results and discussion. GMR in the frontal areas (right BA 6, 8, 9, 46 and left BA 46) was lower in the AR group that in the TD one (p< 0.05). The severity of CI in the AR group correlated with GMR in the parietal and posterior cingulate cortex (BA 7, 23, 26, 29, 30, and 31). The TD group showed correlations of the values of cognitive tests mainly with GMR in the frontal and anterior cingulate cortex (BA 6, 8–11, 24), and in the parietal (BA 7) and temporal cortices (BA 22). The only area, in which GMR correlated with cognitive performance in both groups, was BA 7.

Conclusion. Two distinct patterns of GMR were identified in AR and TD within the general pattern of decreased cerebral glucose metabolism, which was specific for CI in PD. The findings may suggest that there are two different CI pathogenetic mechanisms associated with the clinical subtypes of PD.

About the Authors

I. V. Miliukhina
N.P. Bechtereva Institute of Human Brain, Russian Academy of Sciences; Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

Irina Valentinovna Miliukhina

9, Academician Pavlov St., Petersburg 197376,

6-8, Lev Tolstoy St., Saint Petersburg 197022

Yu. G. Khomenko
N.P. Bechtereva Institute of Human Brain, Russian Academy of Sciences
Russian Federation

9, Academician Pavlov St., Petersburg 197376

E. V. Gracheva
N.P. Bechtereva Institute of Human Brain, Russian Academy of Sciences
Russian Federation

9, Academician Pavlov St., Petersburg 197376

G. V. Kataeva
N.P. Bechtereva Institute of Human Brain, Russian Academy of Sciences
Russian Federation

9, Academician Pavlov St., Petersburg 197376

E. A. Gromova
N.P. Bechtereva Institute of Human Brain, Russian Academy of Sciences
Russian Federation

9, Academician Pavlov St., Petersburg 197376


1. Miliukhina IV, Karpenko MN, Timofeeva AA, Skoromec AA. The clinical heterogenity of Parkinson’s disease. Zhurnal nevrologii i psihiatrii. 2014;(8):13-8 (In Russ.).

2. Levin OS, Illarioshkin SN, editors. Rukovodstvo po diagnostike i lecheniju bolezni Parkinsona [Parkinson's Disease Diagnosis and Treatment Guide]. Moscow: Medpress; 2017. 336 p. (In Russ.).

3. Sapronova MR, Shnayder NA. The epidemiological, clinical, and genetic characteristics of Parkinson's disease (in case of Zheleznogorsk). Nevrologiya, neyropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;6(4):59-64. doi: 10.14412/2074-2711-2014-4-59-64 (In Russ.).

4. Eggers C, Kahraman D, Fink GR, et al. Akinetic-rigid and tremor-dominant Parkinson's disease patients show different patterns of FPCIT single photon emission computed tomography. Mov Disord. 2011 Feb 15;26(3):416-23. doi: 10.1002/mds.23468. Epub 2011 Jan 24.

5. Lyros E, Messinis L, Papathanasopoulos P. Does motor subtype influence neurocognitive performance in Parkinson's disease without dementia? Eur J Neurol. 2008 Mar;15(3):262-7. doi: 10.1111/j.1468-1331.2007.02046.x. Epub 2008 Jan 9.

6. Domellöf ME, Elgh E, Forsgren L. The relation between cognition and motor dysfunction in drug-naive newly diagnosed patients with Parkinson's disease. Mov Disord. 2011 Oct;26(12):2183-9. doi: 10.1002/mds.23814. Epub 2011 Jun 9.

7. Seichepine DR, Neargarder S, Miller IN, et al. Relation of Parkinson's disease subtypes to visual activities of daily living. J Int Neuropsychol Soc. 2011 Sep;17(5):841-52. doi: 10.1017/S1355617711000853. Epub 2011 Aug 4.

8. Jankovic J, McDermott M, Carter J, et al. Variable expression of Parkinson's disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology. 1990 Oct;40(10):1529-34. doi: 10.1212/wnl.40.10.1529

9. Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord. 2015 Oct;30(12):1591-601. doi: 10.1002/mds.26424

10. Statistical Parametric Mapping. Available from: (accessed 10.01.2020).

11. WFU PickAtlas. Available from: (accessed 10.01.2020).

12. Gratwicke J, Jahanshahi M, Foltynie T. Parkinson’s disease dementia: a neural networks perspective. Brain. 2015 Jun;138(Pt 6):1454-76. doi: 10.1093/brain/awv104. Epub 2015 Apr 16.

13. Khomenko YuG, Susin DS, Kataeva GV, et al. Characteristics of cerebral glucose metabolism in patients with cognitive impairment in Parkinson’s disease. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017;117(5):46- 51. doi: 10.17116/jnevro20171175146-51 (In Russ.).

14. Smith CR, Cullen B, Sheridan MP, et al. Cognitive impairment in Parkinson's disease is multifactorial: A neuropsychological study. Acta Neurol Scand. 2020 Jun;141(6):500-8. doi: 10.1111/ane.13226. Epub 2020 Feb 27.

15. Zhang L, Li T-N, Yuan Y-S, et al. The Neural Basis of Postural Instability Gait Disorder Subtype of Parkinson’s Disease: A PET and fMRI Study. CNS Neurosci Ther. 2016 May;22(5):360-7. doi: 10.1111/cns.12504. Epub 2016 Feb 4.

16. Kübler A, Dixon V, Garavan H. Automaticity and reestablishment of executive control-an fMRI stu dy. J Cogn Neurosci. 2006 Aug;18(8):1331-42. doi: 10.1162/jocn.2006.18.8.1331

17. Marras C, Chaudhuri KR. Nonmotor features of Parkinson's disease subtypes. Mov Disord. 2016 Aug;31(8):1095-102. doi: 10.1002/mds.26510. Epub 2016 Feb 10.

18. Prodoehl J, Planetta PJ, Kurani AS, et al. Differences in brain activation between tremorand nontremor-dominant Parkinson disease. JAMA Neurol. 2013 Jan;70(1):100-6. doi: 10.1001/jamaneurol.2013.582

19. Barbagallo G, Caligiuri ME, Arabia G, et al. Structural connectivity differences in motor network between tremor-dominant and nontremor Parkinson's disease. Hum Brain Mapp. 2017 Sep;38(9):4716-29. doi: 10.1002/hbm.23697. Epub 2017 Jun 20.

20. Bohnen NI, Muller ML, Zarzhevsky N, et al. Leucoaraiosis, nigrostriatal denervation and motor symptoms in Parkinson's disease. Brain. 2011 Aug;134(Pt 8):2358-65. doi: 10.1093/brain/awr139. Epub 2011 Jun 8.

21. Leech R, Sharp DJ. Posterior cingulate cortex in cognition. Brain. 2014 Jan; 137(Pt 1):12-32. doi: 10.1093/brain/awt162. Epub 2013 Jul 18.

22. Reijnders JS, Ehrt U, Lousberg R, et al. The association between motor subtypes and psychopathology in Parkinson's disease. Parkinsonism Relat Disord. 2009 Jun;15(5):379- 82. doi: 10.1016/j.parkreldis.2008.09.003. Epub 2008 Oct 31.

23. Miliukhina IV, Gracheva EV. Modern views on gait impairment in Parkinson`s disease and its correction. Zhurnal nevrologii i psihiatrii im. S.S. Korsakova. 2018;118(6):96-101. doi: 10.17116/jnevro20181186196 (in Russ.).

24. Alves G, Larsen JP, Emre M, et al. Changes in motor subtype and risk for incident dementia in Parkinson's disease. Mov Disord. 2006 Aug;21(8):1123-30. doi: 10.1002/mds.20897

25. Karunanayaka PR, Lee EY, Lewis MM, et al. Default mode network differences between rigidity- and tremor-predominant Parkinson's disease. Cortex. 2016 Aug;81:239-50. doi: 10.1016/j.cortex.2016.04.021. Epub 2016 May 6.

For citation:

Miliukhina I.V., Khomenko Yu.G., Gracheva E.V., Kataeva G.V., Gromova E.A. Cerebral glucose metabolism and cognitive impairment in tremor-dominant and akinetic-rigid subtypes of Parkinson’s disease. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(6):42-48. (In Russ.)

Views: 184

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)