Journal
BRAIN
Volume 141, Issue -, Pages 2848-2854Publisher
OXFORD UNIV PRESS
DOI: 10.1093/brain/awy240
Keywords
apathy; parkinsonism; RBD; serotonin; prodromal
Categories
Funding
- Parkinson's UK
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre based at Oxford University Hospitals NHS Trust
- Dementias and Neurodegenerative Diseases Research Network (DeNDRoN)
- NIHR Oxford Health Clinical Research Facility
- Wellcome Trust [206330/Z/17/Z]
- Wellcome Trust
- GE Healthcare
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre based at Oxford Health NHS Foundation Trust
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre based at University of Oxford
- MRC [MC_EX_MR/N50192X/1, MR/M024962/1, MR/L023784/1] Funding Source: UKRI
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Apathy is a common and under-recognized disorder that often emerges in the prodromal phase of Parkinsonian diseases. The mechanism by which this occurs is not known, but recent evidence from patients with established Parkinson's disease suggests that serotonergic dysfunction may play a role. The integrity of the raphe serotonergic system can be assessed alongside dopaminergic basal ganglia imaging using the radioligand I-123-ioflupane, which binds both serotonin and dopamine transporters. To investigate the relative roles of these neurotransmitters in prodromal parkinsonism, we imaged patients with idiopathic rapid eye movement sleep behaviour disorder, the majority of whom will develop a parkinsonian disorder in future. Forty-three patients underwent brain imaging with I-123-ioflupane single photon emission computed tomography and structural MRL Apathy was quantified using the Lille Apathy Rating Scale. Other clinical parkinsonian features were assessed using standard measures. A negative correlation was observed between apathy severity and, serotonergic I-123-ioflupane signal in the dorsal raphe nucleus (r = -0.55, P < 0.001). There was no significant correlation between apathy severity and basal ganglia dopaminergic signal, nor between dorsal raphe si gnal and other neuropsychiatric scores. This specific association between apathy and raphe I-123-ioflupane signal suggests that the serotonergic system might represent a target for the treatment of apathy.
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