In vivo imaging of synaptic function in the central nervous system: I. Movement disorders and dementia.

This review gives an overview of those in vivo imaging studies on synaptic neurotransmission, which so far have been performed on patients with movement disorders and/or dementia. Thereby, the focus is on disease-related deficiencies within the functional entity of the dopaminergic, serotonergic, cholinergic, glutamatergic, GABAergic or opioid synapse. In vivo investigations have yielded highly consistent results on the dysfunction of synaptic constituents in the majority of diseases covered by this overview. Findings show presynaptic dysfunctions in idiopathic as well as early-onset Parkinson's disease with decreases in striatal dopamine synthesis (57 out of a total of 59 reports on both types of Parkinson's disease), storage (nine out of nine reports), release (two out of three reports) and transporter binding (95 out of 95 reports). In contrast, the "Parkinson plus" syndromes multiple system atrophy and progressive supranuclear palsy are characterized by both pre- and postsynaptic deficiencies with reductions in striatal dopamine synthesis (11 out of a total of 11 reports on both types of "Parkinson plus" syndromes), storage (four of four reports), and transporter binding (27 out of 27 reports) as well as D1 (two out of two reports) and D2 receptor binding (34 out of 36 reports). This does not hold for the "Parkinson plus" syndromes dementia with Lewy bodies and corticobasal degeneration. For these diseases, for the time being, firm evidence of alterations in D1 and/or D2 receptor binding is lacking. In patients with Huntington's disease, mainly postsynaptic dysfunctions with reductions of striatal D1 (six out of six reports) and D2 receptor binding (15 out of 15 reports) were observed. Alzheimer's disease is characterized by both pre-and postsynaptic deficiencies of the cholinergic system with decreases of cortical acetylcholine storage (one out of two reports) and both musarinic (seven out of 10 reports) and nicotinic cholinergic receptor binding (three out of six reports). Moreover, reductions in cortical (one out of three reports) and limbic 5-HT1A (three out of three reports) and cortical (four out of four reports) and limbic 5-HT2A receptor binding (one out of two reports) were observed. Moreover, there is evidence for a cortical (four out of six reports) and cingulate (three out of three reports) increase of peripheral benzodiazepine receptor binding indicative of microglial activation. In the majority of investigations on patients with Alzheimer's disease, no alterations of presynaptic dopamine function were found, whereas all other forms of dementia including corticobasal degeneration, dementia with Lewy bodies, Parkinson's disease dementia and frontotemporal dementia were characterized by presynaptic dopaminergic deficiencies with reductions in striatal dopamine synthesis (10 out of a total of 10 reports on these types of dementia), storage (four out of four reports) and transporter binding (29 out of 29 reports). Taken together, in vivo imaging methods can be employed for the diagnosis of idiopathic and early-onset Parkinson's disease as well as "Parkinson plus" syndromes and Huntington's disease. Moreover, differentiation is feasible between, firstly, Parkinson's disease and the "Parkinson plus" syndromes multiple system atrophy and progressive supranuclear palsy, secondly, multiple system atrophy/progressive supranuclear palsy and the other "Parkinson plus" syndromes dementia with Lewy bodies and corticobasal degeneration, and, thirdly, Alzheimer's disease and other forms of dementia.