- Email: [email protected]
P1.209 How to treat dementia in Parkinsonian patients?
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Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
P1.206 Frontal systems behavioural syndromes in older Parkinson’s disease patients L. Loftus1 , A. Davies1 , E. Thornton1 , C. Turnbull2 . 1 The University of Liverpool, Liverpool, 2 Arrowe Park Hospital, Wirral, UK Objective: To assess the frequency of behavioural syndromes (apathy, disinhibition and executive dysfunction) in older Parkinson disease (PD) patients and to identify factors influencing these behaviours. Method: Ninety-six PD patients (71.9% male, mean age 74.8±5.4 years) and their caregiver spouses took part in the study. The mean duration of PD was 5.6±4.2 years and the UPDRS-III was used to assess illness severity. Patients also completed the Mini-Mental State Examination (MMSE). Their spouses completed the Frontal Systems Behaviour Scale (FrSBe-family version) and the Caregiver Distress Scale (CDS). Data analysis included descriptive statistics and multiple regression models. Results: According to their spousal caregivers, a large proportion of patients exhibited behavioural abnormality in terms of apathy (60 patients, 63.8%) and executive dysfunction (37 patients, 56.2%). By contrast, only 9 patients (9.6%) were reported to show abnormal levels of disinhibition. Paired t-tests between premorbid (retrospective) and current assessments of behaviour showed that caregivers perceived a significant increase in scores on all three subscales following PD diagnosis. The mean difference was the largest for the apathy subscale (t = −13.24), followed by executive dysfunction (t = −9.41), and disinhibition subscale (t = −6.98, all p < 0.001). There was a strong correlation between patient behavioural abnormality and caregiver distress (r = 0.62, p < 0.001). PD motor severity and MMSE scores explained 23% of variance in the overall FrSBe score, but illness duration did not add unique variance. Conclusion: A significant proportion of PD patients exhibit abnormal levels of apathy and executive dysfunction and these behaviours are strongly associated with caregiver distress. P1.207 Visual related cognitive assessments in Parkinson disease and MCI patients Y. Li. Neurology, Peking Union Medical College Hospital, Beijing, China Objective: To assess the visual space cognitive function in the patients with Parkinson disease (PD) and mild cognitive impairment (MCI). Methods: Clock drawing test (CDT), block design test (BDT) and trail making test (TMT) were conducted in 27 cases of early-stage PD, 14 cases of MCI and 20 cases of normal control, respectively. Results: The scores of CDT and BDT were declined in PD and MCI patients, as comparing to the normal control and the TMT showed no difference in these three groups. The CDT and BDT led to the similar result when examined the PD patients and MCI patients. Conclusions: The decline of the CDT and BDT scores in PD and MCI patients might suggest impairment of visual space cognitive which might be the early presentation of dementia in these patients. P1.208 Randomized placebo-controlled trial of memantine for dementia in Parkinson’s disease L. Marsh1,2,3 , K. Biglan3,4 , J.R. Williams5 . 1 Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 2 Department of Psychiatry and Behavioral Sciences, 3 Department of Neurology and Neurological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 4 Department of Neurology, University of Rochester Medical Center, Rochester, NY, 5 Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA Objective: This pilot study evaluated the safety and efficacy of memantine, an uncompetitive NMDA receptor antagonist,
in patients with idiopathic Parkinson’s disease and DSM-IV-TR dementia (PDD). Methods: 20 PDD patients enrolled in a 24-week randomized, double-blind, placebo-controlled trial of memantine 20 mg daily. The primary cognitive efficacy measure was the Dementia Rating Scale (DRS) Memory subscore. The primary clinical efficacy measure was the Clinician’s Interview-Based Impression of Change Plus Caregiver Input (CIBIC-Plus). Secondary cognitive outcome measures included the Alzheimer Disease Assessment Scale Cognitive Subscale (ADAS-Cog), other DRS subscores, and tests of verbal and nonverbal memory, attention, psychomotor speed, and verbal fluency. Secondary clinical and safety outcomes assessed psychiatric, functional, and motor status, caregiver burden, and adverse events. Results: All 10 memantine-treated subjects and 8 of 10 placebotreated subjects completed the trial. Compared to controls, memantine-treated subjects improved (p < 0.5) on the CIBIC-Plus, DRS total, Memory and Initiation-Perseveration scores, Brief Test of Attention, and semantic verbal fluency. Measures of depressive symptoms, bradykinesia, axial impairment, complications of therapy, and physical and instrumental activities of daily living (ADLs, IADLs) also improved (p < 0.5) in the memantine group. The most common adverse events were sleepiness in the memantine group and reduced sleep among placebo subjects. Conclusions: Memantine is tolerable in PDD and has beneficial effects that are associated with selective improvements in memory, executive functions, ADLs and IADLs, mood symptoms, and motor function. Memantine has utility as a PDD treatment and warrants further study as a treatment for select cognitive deficits in PD. P1.209 How to treat dementia in Parkinsonian patients? F.-M. Werner1 , R. Covenas2 . 1 HBFS f¨ ur Altenpflege und Ergotherapie, Euro-Schulen P¨ oßneck, P¨ oßneck, Germany; 2 Institute of Neuroscience, University of Salamanca, Salamanca, Spain About 10% of Parkinsonian patients develop dementia, being important to find treatments compatible for both diseases. In Parkinson’s disease a dopamine deficiency and an acetylcholine and glutamate surplus occurs in the extrapyramidal system. In the nucleus caudatus, dopaminergic neurons transmit a weak postsynaptic excitatory impulse via D2 receptors to GABAergic neurons in the globus pallidus which weakly inhibit muscarinic cholinergic neurons in the putamen via GABAA receptors. The latter neurons transmit a strong activating impulse through M4 receptors to glutaminergic neurons in the putamen which strongly inhibit dopaminergic neurons via NMDA receptors. Glutaminergic neurons transmit an excitotoxic postsynaptic impulse via NMDA receptors to muscarinic cholinergic neurons. In dementia, cell death occurs due to neurotransmitter deficiencies. Acetylcholine and dopamine hypoactivities are pro-apoptotic. In the hippocampus and temporal cortex, muscarinic cholinergic neurons transmit a weak activating impulse via M1 receptors to GABAergic neurons which weakly inhibit noradrenergic neurons via GABAA receptors. Noradrenergic neurons transmit a strong activating impulse to glutaminergic neurons via alpha-1 receptors, and the latter neurons strongly inhibit muscarinic cholinergic neurons via NMDA receptors. In the treatment of both diseases, the following drugs can be administered: – Combined l-dopa: this enhances dopamine concentrations in the extrapyramidal system, which is anti-apoptotic – Selegiline – NMDA antagonists: these enhance dopamine and acetylcholine concentrations, respectively, in the extrapyramidal system and in the temporal cortex
Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
– Cholinesterase inhibitors (galantamin . . . ): these do not interfere with M4 receptors in the extrapyramidal system – Anticholinergics should not be administered, because they enhance acetylcholine deficiency in dementia. P1.210 Negative reactions to receiving spousal care in older Parkinson’s disease patients: the role of depression L. Loftus1 , A. Davies1 , E. Thornton1 , C. Turnbull2 . 1 Psychology, The University of Liverpool, Liverpool, 2 Arrowe Park Hospital, Wirral, UK Objective: To determine the extent to which Parkinson’s disease (PD) patients experience negative reactions to receiving care (NRRC, Newsom et al., 1998) from their spouses and to investigate whether patient depression is significantly associated with these reactions. Method: Ninety-six PD patients (71.9% male, mean age 74.8±5.4 years) and their caregiver spouses were referred to the study by their consultant. The mean duration of PD was 5.6±4.2 years and the Unified Parkinson’s disease Rating Scale was used to assess illness severity. Patients also completed the following measures: Neuroticism (NEO), Depression (GDS-30) and the NRRC questionnaire. Their spouses completed the Frontal Systems Behavior Scale (FrSBe-family version) and the Caregiver Distress Scale (CDS). Data analysis included descriptive statistics and multiple regression models. Results: Approximately 1 in 5 patients (21.6%) ‘agreed’ or ‘strongly agreed’ with items of the NRRC questionnaire, indicating feelings of ‘loss of self-esteem’, ‘indebtedness’ and ‘negative perceptions of carer behaviour’. Patient depression, patient neuroticism and their spousal caregivers’ distress explained 60% of the variance in the NRRC, with depression accounting for 22% of the unique variance. Additionally, patient depression mediated the associations between illness variables (motor severity and frontal systems behaviors) and the NRRC. Conclusion: A significant proportion of older patients with PD reported negative reactions to receiving care from their spouses. Patient depression was an important direct contributor to these negative reactions, in addition to mediating associations between illness variables and negative reactions to care. P1.211 Preventing falls in Parkinson’s disease: the GETuP trial V. Goodwin1 , S. Richards1 , P. Ewings2 , A. Taylor3 , J. Campbell1 . 1 Primary Care Research Group, Peninsula College of Medicine and Dentistry, Exeter, 2 NIHR Research Design Service (South West), Taunton, 3 School of Sport and Health Sciences, University of Exeter, Exeter, UK Introduction: Falls are a common problem affecting up to two thirds of people with Parkinson’s disease (PD) each year. Strength and balance training has been shown to be effective at reducing falls among community dwelling older people but, to date, there is no evidence of effective interventions for people with PD. Objective: o establish the effectiveness of an exercise intervention, compared with usual care, on falls with people with PD who have a history of falling. Design: Pragmatic randomised controlled trial. Methods: Potential participants were identified by specialist clinicians, general practitioners and PD support groups. Falls and injuries were monitored by weekly, prospective diaries for 30 weeks. The intervention comprised 10 weeks of supervised group strength and balance training plus unsupervised home exercises. The control arm comprised usual care. Analysis was undertaken on an intention to treat basis. Negative binomial regression was used to analyse the between group difference in the number of falls. Results: 130 participants were recruited. Seven people did not complete the study. The intervention group showed a 33% (95% CI 2 to 54%) reduction in falls (p = 0.039) at 20 weeks. At 30 weeks
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the reduction was 28% (95% CI −8 to 52%, p = 0.11). Significant improvements were observed in Berg Balance scale, Falls Efficacy Scale-International and recreational physical activity. Conclusions: A 10-week strength and balance programme has demonstrated potential to reduce falls and improve balance, fear of falling and recreational physical activity among people with PD who have a history of falling. P1.212 Primary progressive freezing gait – A clinical study from South India R. Mathew, S. Raj, T. Iype. Neurology, Medical College, Trivandrum, India Introduction: Primary progressive freezing gait (PPFG) disorder is considered to be a distinct clinical entity that manifests predominantly as a progressive freezing gait. However, confusion remains about its clinical presentation, natural history, and classification. Objective: To examine the clinical and brain imaging characteristics of patients with PPFG. Materials and Methods; Patients who had freezing gait as an early manifestation of their disease were identified. Medical records were reviewed, and those fulfilling the diagnostic criteria for PPFG were included: (1) Early freezing gait (onset within 3 years of the onset of their disorder). (2) Gait freezing as the primary feature of their disease. (3) No clinical findings consistent with a diagnosis of Parkinsons Disease or a known Parkinson-plus syndrome. Results: Five patients fulfilling the criteria were included (4 males and 1 female). Age ranged from 58 to 84 years and duration of illness 2–7 years. All the patients had predominantly gait abnormality. All the patients had mild bradykinesia and rigidity. The Parkinsonism was mild even in the patient examined after 7 years. One patient had subtle pyramidal signs. All the patients had normal neuroimaging. The gait abnormality was disabling and all the patients except one could just walk without support. All the patients had already been tried on Levodopa without significant improvement. None of the patients were given the diagnostic label of PPFG prior to the study. Conclusion: PPFG is a distinct clinical entity and is probably under diagnosed. The clinical features of the disease appeared similar to that in patients described earlier. P1.213 Demonstration of F-18 FDG-PET protocol for imaging neuronal activation: human motor cortex activation using F-18 FDG-PET S. Kim1 , S.B. Pyun2 , K.W. Park3 , Y.M. Hwang4 , K. Nam4 , J.H. Lee5 , J.G. Choe6 . 1 Departments of Nuclear Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, 2 Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea; 3 Neurology, Korea University Anam Hospital, 4 Department of Psychology, Korea University College of Liberal Arts, 5 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul Metropolitan Goverment Seoul National University Boramae Medical Center, 6 Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Republic of Korea Aims: This study was to demonstrate the human motor cortex activation using F-18 FDG PET (FDG-PET) and to develop the FDG-PET protocol for imaging neuronal activation. Methods: A volunteer underwent rest/activation FDG-PET as follows: on day 1, 20 minutes of PET/CT was performed after 20 minutes resting; on day 2, it was performed after 20 minutes of a motor task (grasp and release right hand) (Figure 1). Subtraction of resting PET image from activation PET image was performed using a SISCOM method.
Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
P1.206 Frontal systems behavioural syndromes in older Parkinson’s disease patients L. Loftus1 , A. Davies1 , E. Thornton1 , C. Turnbull2 . 1 The University of Liverpool, Liverpool, 2 Arrowe Park Hospital, Wirral, UK Objective: To assess the frequency of behavioural syndromes (apathy, disinhibition and executive dysfunction) in older Parkinson disease (PD) patients and to identify factors influencing these behaviours. Method: Ninety-six PD patients (71.9% male, mean age 74.8±5.4 years) and their caregiver spouses took part in the study. The mean duration of PD was 5.6±4.2 years and the UPDRS-III was used to assess illness severity. Patients also completed the Mini-Mental State Examination (MMSE). Their spouses completed the Frontal Systems Behaviour Scale (FrSBe-family version) and the Caregiver Distress Scale (CDS). Data analysis included descriptive statistics and multiple regression models. Results: According to their spousal caregivers, a large proportion of patients exhibited behavioural abnormality in terms of apathy (60 patients, 63.8%) and executive dysfunction (37 patients, 56.2%). By contrast, only 9 patients (9.6%) were reported to show abnormal levels of disinhibition. Paired t-tests between premorbid (retrospective) and current assessments of behaviour showed that caregivers perceived a significant increase in scores on all three subscales following PD diagnosis. The mean difference was the largest for the apathy subscale (t = −13.24), followed by executive dysfunction (t = −9.41), and disinhibition subscale (t = −6.98, all p < 0.001). There was a strong correlation between patient behavioural abnormality and caregiver distress (r = 0.62, p < 0.001). PD motor severity and MMSE scores explained 23% of variance in the overall FrSBe score, but illness duration did not add unique variance. Conclusion: A significant proportion of PD patients exhibit abnormal levels of apathy and executive dysfunction and these behaviours are strongly associated with caregiver distress. P1.207 Visual related cognitive assessments in Parkinson disease and MCI patients Y. Li. Neurology, Peking Union Medical College Hospital, Beijing, China Objective: To assess the visual space cognitive function in the patients with Parkinson disease (PD) and mild cognitive impairment (MCI). Methods: Clock drawing test (CDT), block design test (BDT) and trail making test (TMT) were conducted in 27 cases of early-stage PD, 14 cases of MCI and 20 cases of normal control, respectively. Results: The scores of CDT and BDT were declined in PD and MCI patients, as comparing to the normal control and the TMT showed no difference in these three groups. The CDT and BDT led to the similar result when examined the PD patients and MCI patients. Conclusions: The decline of the CDT and BDT scores in PD and MCI patients might suggest impairment of visual space cognitive which might be the early presentation of dementia in these patients. P1.208 Randomized placebo-controlled trial of memantine for dementia in Parkinson’s disease L. Marsh1,2,3 , K. Biglan3,4 , J.R. Williams5 . 1 Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, 2 Department of Psychiatry and Behavioral Sciences, 3 Department of Neurology and Neurological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 4 Department of Neurology, University of Rochester Medical Center, Rochester, NY, 5 Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA Objective: This pilot study evaluated the safety and efficacy of memantine, an uncompetitive NMDA receptor antagonist,
in patients with idiopathic Parkinson’s disease and DSM-IV-TR dementia (PDD). Methods: 20 PDD patients enrolled in a 24-week randomized, double-blind, placebo-controlled trial of memantine 20 mg daily. The primary cognitive efficacy measure was the Dementia Rating Scale (DRS) Memory subscore. The primary clinical efficacy measure was the Clinician’s Interview-Based Impression of Change Plus Caregiver Input (CIBIC-Plus). Secondary cognitive outcome measures included the Alzheimer Disease Assessment Scale Cognitive Subscale (ADAS-Cog), other DRS subscores, and tests of verbal and nonverbal memory, attention, psychomotor speed, and verbal fluency. Secondary clinical and safety outcomes assessed psychiatric, functional, and motor status, caregiver burden, and adverse events. Results: All 10 memantine-treated subjects and 8 of 10 placebotreated subjects completed the trial. Compared to controls, memantine-treated subjects improved (p < 0.5) on the CIBIC-Plus, DRS total, Memory and Initiation-Perseveration scores, Brief Test of Attention, and semantic verbal fluency. Measures of depressive symptoms, bradykinesia, axial impairment, complications of therapy, and physical and instrumental activities of daily living (ADLs, IADLs) also improved (p < 0.5) in the memantine group. The most common adverse events were sleepiness in the memantine group and reduced sleep among placebo subjects. Conclusions: Memantine is tolerable in PDD and has beneficial effects that are associated with selective improvements in memory, executive functions, ADLs and IADLs, mood symptoms, and motor function. Memantine has utility as a PDD treatment and warrants further study as a treatment for select cognitive deficits in PD. P1.209 How to treat dementia in Parkinsonian patients? F.-M. Werner1 , R. Covenas2 . 1 HBFS f¨ ur Altenpflege und Ergotherapie, Euro-Schulen P¨ oßneck, P¨ oßneck, Germany; 2 Institute of Neuroscience, University of Salamanca, Salamanca, Spain About 10% of Parkinsonian patients develop dementia, being important to find treatments compatible for both diseases. In Parkinson’s disease a dopamine deficiency and an acetylcholine and glutamate surplus occurs in the extrapyramidal system. In the nucleus caudatus, dopaminergic neurons transmit a weak postsynaptic excitatory impulse via D2 receptors to GABAergic neurons in the globus pallidus which weakly inhibit muscarinic cholinergic neurons in the putamen via GABAA receptors. The latter neurons transmit a strong activating impulse through M4 receptors to glutaminergic neurons in the putamen which strongly inhibit dopaminergic neurons via NMDA receptors. Glutaminergic neurons transmit an excitotoxic postsynaptic impulse via NMDA receptors to muscarinic cholinergic neurons. In dementia, cell death occurs due to neurotransmitter deficiencies. Acetylcholine and dopamine hypoactivities are pro-apoptotic. In the hippocampus and temporal cortex, muscarinic cholinergic neurons transmit a weak activating impulse via M1 receptors to GABAergic neurons which weakly inhibit noradrenergic neurons via GABAA receptors. Noradrenergic neurons transmit a strong activating impulse to glutaminergic neurons via alpha-1 receptors, and the latter neurons strongly inhibit muscarinic cholinergic neurons via NMDA receptors. In the treatment of both diseases, the following drugs can be administered: – Combined l-dopa: this enhances dopamine concentrations in the extrapyramidal system, which is anti-apoptotic – Selegiline – NMDA antagonists: these enhance dopamine and acetylcholine concentrations, respectively, in the extrapyramidal system and in the temporal cortex
Poster presentations / Parkinsonism and Related Disorders 15S2 (2009) S29–S199
– Cholinesterase inhibitors (galantamin . . . ): these do not interfere with M4 receptors in the extrapyramidal system – Anticholinergics should not be administered, because they enhance acetylcholine deficiency in dementia. P1.210 Negative reactions to receiving spousal care in older Parkinson’s disease patients: the role of depression L. Loftus1 , A. Davies1 , E. Thornton1 , C. Turnbull2 . 1 Psychology, The University of Liverpool, Liverpool, 2 Arrowe Park Hospital, Wirral, UK Objective: To determine the extent to which Parkinson’s disease (PD) patients experience negative reactions to receiving care (NRRC, Newsom et al., 1998) from their spouses and to investigate whether patient depression is significantly associated with these reactions. Method: Ninety-six PD patients (71.9% male, mean age 74.8±5.4 years) and their caregiver spouses were referred to the study by their consultant. The mean duration of PD was 5.6±4.2 years and the Unified Parkinson’s disease Rating Scale was used to assess illness severity. Patients also completed the following measures: Neuroticism (NEO), Depression (GDS-30) and the NRRC questionnaire. Their spouses completed the Frontal Systems Behavior Scale (FrSBe-family version) and the Caregiver Distress Scale (CDS). Data analysis included descriptive statistics and multiple regression models. Results: Approximately 1 in 5 patients (21.6%) ‘agreed’ or ‘strongly agreed’ with items of the NRRC questionnaire, indicating feelings of ‘loss of self-esteem’, ‘indebtedness’ and ‘negative perceptions of carer behaviour’. Patient depression, patient neuroticism and their spousal caregivers’ distress explained 60% of the variance in the NRRC, with depression accounting for 22% of the unique variance. Additionally, patient depression mediated the associations between illness variables (motor severity and frontal systems behaviors) and the NRRC. Conclusion: A significant proportion of older patients with PD reported negative reactions to receiving care from their spouses. Patient depression was an important direct contributor to these negative reactions, in addition to mediating associations between illness variables and negative reactions to care. P1.211 Preventing falls in Parkinson’s disease: the GETuP trial V. Goodwin1 , S. Richards1 , P. Ewings2 , A. Taylor3 , J. Campbell1 . 1 Primary Care Research Group, Peninsula College of Medicine and Dentistry, Exeter, 2 NIHR Research Design Service (South West), Taunton, 3 School of Sport and Health Sciences, University of Exeter, Exeter, UK Introduction: Falls are a common problem affecting up to two thirds of people with Parkinson’s disease (PD) each year. Strength and balance training has been shown to be effective at reducing falls among community dwelling older people but, to date, there is no evidence of effective interventions for people with PD. Objective: o establish the effectiveness of an exercise intervention, compared with usual care, on falls with people with PD who have a history of falling. Design: Pragmatic randomised controlled trial. Methods: Potential participants were identified by specialist clinicians, general practitioners and PD support groups. Falls and injuries were monitored by weekly, prospective diaries for 30 weeks. The intervention comprised 10 weeks of supervised group strength and balance training plus unsupervised home exercises. The control arm comprised usual care. Analysis was undertaken on an intention to treat basis. Negative binomial regression was used to analyse the between group difference in the number of falls. Results: 130 participants were recruited. Seven people did not complete the study. The intervention group showed a 33% (95% CI 2 to 54%) reduction in falls (p = 0.039) at 20 weeks. At 30 weeks
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the reduction was 28% (95% CI −8 to 52%, p = 0.11). Significant improvements were observed in Berg Balance scale, Falls Efficacy Scale-International and recreational physical activity. Conclusions: A 10-week strength and balance programme has demonstrated potential to reduce falls and improve balance, fear of falling and recreational physical activity among people with PD who have a history of falling. P1.212 Primary progressive freezing gait – A clinical study from South India R. Mathew, S. Raj, T. Iype. Neurology, Medical College, Trivandrum, India Introduction: Primary progressive freezing gait (PPFG) disorder is considered to be a distinct clinical entity that manifests predominantly as a progressive freezing gait. However, confusion remains about its clinical presentation, natural history, and classification. Objective: To examine the clinical and brain imaging characteristics of patients with PPFG. Materials and Methods; Patients who had freezing gait as an early manifestation of their disease were identified. Medical records were reviewed, and those fulfilling the diagnostic criteria for PPFG were included: (1) Early freezing gait (onset within 3 years of the onset of their disorder). (2) Gait freezing as the primary feature of their disease. (3) No clinical findings consistent with a diagnosis of Parkinsons Disease or a known Parkinson-plus syndrome. Results: Five patients fulfilling the criteria were included (4 males and 1 female). Age ranged from 58 to 84 years and duration of illness 2–7 years. All the patients had predominantly gait abnormality. All the patients had mild bradykinesia and rigidity. The Parkinsonism was mild even in the patient examined after 7 years. One patient had subtle pyramidal signs. All the patients had normal neuroimaging. The gait abnormality was disabling and all the patients except one could just walk without support. All the patients had already been tried on Levodopa without significant improvement. None of the patients were given the diagnostic label of PPFG prior to the study. Conclusion: PPFG is a distinct clinical entity and is probably under diagnosed. The clinical features of the disease appeared similar to that in patients described earlier. P1.213 Demonstration of F-18 FDG-PET protocol for imaging neuronal activation: human motor cortex activation using F-18 FDG-PET S. Kim1 , S.B. Pyun2 , K.W. Park3 , Y.M. Hwang4 , K. Nam4 , J.H. Lee5 , J.G. Choe6 . 1 Departments of Nuclear Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, 2 Physical Medicine and Rehabilitation, Korea University Anam Hospital, Korea; 3 Neurology, Korea University Anam Hospital, 4 Department of Psychology, Korea University College of Liberal Arts, 5 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul Metropolitan Goverment Seoul National University Boramae Medical Center, 6 Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Republic of Korea Aims: This study was to demonstrate the human motor cortex activation using F-18 FDG PET (FDG-PET) and to develop the FDG-PET protocol for imaging neuronal activation. Methods: A volunteer underwent rest/activation FDG-PET as follows: on day 1, 20 minutes of PET/CT was performed after 20 minutes resting; on day 2, it was performed after 20 minutes of a motor task (grasp and release right hand) (Figure 1). Subtraction of resting PET image from activation PET image was performed using a SISCOM method.