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Preserved noradrenergic function in Parkinson´s disease patients with rest tremor

Lookup NU author(s): Professor Nicola PaveseORCiD, Professor David BrooksORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


Noradrenergic neurotransmission may play an important role in tremor modulation through its innervation of key structures of the central tremor circuits. Here, Parkinson's disease (PD) patients with (PDT+) or without (PDT-) rest tremor had 11C-methylreboxetine(11C-MeNER) positron emission tomography (PET) to test the hypothesis that noradrenaline terminal function was relatively preserved in PDT+ compared to PDT-. Methods: Sixty-five PD patients and 28 healthy controls (HC) were scanned with 11C-MeNER PET. Patients were categorized as PDT+ if subscores in UPDRS-III item 3 or MDS-UPDRS-III item 17 was ≥ 2; remaining were categorized as PDT-. Simplified reference tissue model 2 distribution volume ratios (DVR) were calculated for thalamus, dorsal and median raphe, locus coeruleus (LC) and red nucleus using time activity curves (TACs) obtained from volumes of interest (VOI). Data were statistically interrogated with a general linear mixed model using ‘region’, and ‘group’ as factors and the interaction of ‘region x group’ was examined. Results: Tremor positive PD patients had a significantly higher mean 11C-MeNER DVR compared to PDT- in LC and thalamus. The PDT+ mean LC DVR was similar to that of HC. PDT+ mean 11C-MeNER DVRs were significantly lower than HC in the dorsal raphe while the PDT- group showed significantly lower mean 11C-MeNER DVR across all regions compared to HC. Conclusion: While both PD T+ and PD T- groups showed a significant loss of noradrenaline terminal function compared to controls, noradrenergic neurons were relatively preserved in PDT+ in LC and thalamus. The greater loss of noradrenergic transporters in PDT- in LC and thalamus compared with PDT+ is in line with earlier in-vitro studies and could potentially contribute to their tremor negative phenotype.

Publication metadata

Author(s): Kinnerup MB, Sommerauer M, Damholdt FM, Schaldemose JL, Ismail R, Terkelsen AJ, Stær K, Hansen A, Fedorova TD, Knudsen K, Skjærbæk C, Borghammer P, Pavese N, Brooks DJ, Nahimi A

Publication type: Article

Publication status: Published

Journal: Neurobiology of Disease

Year: 2021

Volume: 152

Print publication date: 01/05/2021

Online publication date: 05/02/2021

Acceptance date: 03/02/2021

Date deposited: 04/02/2021

ISSN (print): 0969-9961

ISSN (electronic): 1095-953X

Publisher: Academic Press


DOI: 10.1016/j.nbd.2021.105295


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