This study will use positron emission tomography (PET) to compare how people with Gaucher disease or Gaucher disease carriers with parkinsonism, and their family members, use dopamine in their brains in comparison with healthy normal volunteers and people who have Parkinson disease. PET assesses organ function by measuring metabolism. In this study, magnetic resonance imaging (MRI) is used in conjunction with PET to help better interpret and understand the information gleaned from PET.
People 21 years of age and older with the following conditions may be eligible for this study:
- Gaucher disease and parkinsonism
- Parkinsonism and a family history of Gaucher disease
- Gaucher disease and a family history of parkinsonism
- Gaucher disease carriers who have parkinsonism or a family history of parkinsonism
- Unaffected people with a family history of Gaucher disease and parkinsonism
- Healthy volunteers
Participants undergo the following tests and procedures:
- Personal and family medical history
- Physical examination
- PET scan: The subject lies on a table that slides into the PET scanner until his or her head is positioned properly in the scanner. A catheter is inserted into a vein. An initial scan is done to obtain images before radionuclides are injected. Radioactive water is then injected through the catheter and the subject is asked questions in order to stimulate blood flow in certain areas of the brain to show what parts of the brain are activated. Fluorodopa is then infused through the catheter over 3 minutes. The PET scan can last up to 2 hours.
- MRI scan: This test uses a magnetic field and radio waves to obtain images of organs. The subject lies still on a bed in the middle of a circular scanner for about 30 minutes.
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An association between Gaucher disease and parkinsonism has been demonstrated by the concurrence of parkinsonian manifestations in patients with Gaucher disease and an increased incidence of glucocerebrosidase (GBA) mutations in subjects with parkinsonism of various ethnicities. Furthermore, there is a significant number of obligate and confirmed Gaucher carriers with parkinsonian manifestations. Thus, alterations in GBA appear to be a more common risk factor than previously thought for the development of sporadic Parkinson disease and related disorders. However, in affected and at-risk individuals, the identification and characterization of early parkinsonian manifestations, and the rate of progression of symptoms have not been studied objectively. We propose an in-vivo study that will employ multiple imaging modalities to better define the phenotype in GBA-associated parkinsonism, follow disease progression, and identify at-risk individuals. The subjects include patients with Gaucher disease and Gaucher carriers with parkinsonian manifestations, and clinically unaffected but at-risk individuals carrying GBA mutations, and have/ a first degree relative with parkinsonism. The control groups consist of individuals with Gaucher disease but no parkinsonian symptoms, relatives of probands without GBA mutations, PD patients without GBA mutations, and healthy volunteers. Positron emission tomography (PET) with 6-[F-18] Fluoro-L-Dopa (6FD) will be used to evaluate presynaptic dopaminergic function, where 6FD uptake in putamen and striatum will be employed as a measure of neuronal structural integrity in substantia nigra. Each subject will be screened with an MRI to rule-out anatomic brain abnormalities, and to further delineate areas of interest in the PET scans. Subjects will also undergo transcranial ultrasonography (TCS) to assess the substantia nigra non-invasively. The results of both the PET scans and TCS will be kept confidential, and will not be communicated to the individuals or families involved in the study. In addition to the imaging studies, all patients will undergo a physical and neurological examination, neurocognitive evaluation, and olfactory testing.