Cardiac sympathetic denervation and its association with cognitive deficits in Parkinson's disease

Background: There is growing evidence to suggest that cognitive decline in patients with Parkinson's disease (PD) is associated with autonomic involvement, although the clinical and pathological correlations have not been firmly established. Objective: We prospectively investigated the pattern of myocardial sympathetic denervation deficits in PD and its correlation with cognitive decline. Methods: Twenty-eight patients with PD who underwent myocardial I-123-metaiodobenzylguanidine (MIBG) scintigraphy, clinical assessment of stage and severity of PD and detailed neuropsychological investigation were included in the study. Results: There were significant differences in the MIBG uptake between the PD patients with cognitive deficits and those who did not have cognitive deficits. Conclusion: These findings confirm that cognitive decline in patients with PD is associated with autonomic involvement and raises the possibility that the topographical spread of synuclein pathology involving the neocortical areas might be linked to the autonomic system in PD. (C) 2009 Elsevier Ltd. All rights reserved.