Misfolded protein deposits in Parkinson’s disease and Parkinson’s disease-related cognitive impairment, a [¹¹C]PBB3 study

Parkinson’s disease (PD) is associated with aggregation of misfolded α-synuclein and other proteins, including tau. We designed a cross-sectional study to quantify the brain binding of [¹¹C]PBB3 (a ligand known to bind to misfolded tau and possibly α-synuclein) as a proxy of misfolded protein aggregation in Parkinson’s disease (PD) subjects with and without cognitive impairment and healthy controls (HC). In this cross-sectional study, nineteen cognitively normal PD subjects (CN-PD), thirteen cognitively impaired PD subjects (CI-PD) and ten HC underwent [¹¹C]PBB3 PET. A subset of the PD subjects also underwent PET imaging with [¹¹C](+)DTBZ to assess dopaminergic denervation and [¹¹C]PBR28 to assess neuroinflammation. Compared to HC, PD subjects showed higher [¹¹C]PBB3 binding in the posterior putamen but not the substantia nigra. There was no relationship across subjects between [¹¹C]PBB3 and [¹¹C]PBR28 binding in nigrostriatal regions. [¹¹C]PBB3 binding was increased in the anterior cingulate in CI-PD compared to CN-PD and HC, and there was an inverse correlation between cognitive scores and [¹¹C]PBB3 binding in this region across all PD subjects. Our results support a primary role of abnormal protein deposition localized to the posterior putamen in PD. This suggests that striatal axonal terminals are preferentially involved in the pathophysiology of PD. Furthermore, our findings suggest that anterior cingulate pathology might represent a significant in vivo marker of cognitive impairment in PD, in agreement with previous neuropathological studies.