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Ye R, Goodheart AE, Locascio JJ, Peterec E, Properzi M, Thibault EG, Chuba E, Johnson KA, Brickhouse MJ, Touroutoglou A, Growdon JH, Dickerson BC, Gomperts SN. Differential Vulnerability of Hippocampal Subfields to Amyloid and Tau Deposition in the Lewy Body Diseases. Neurology 2024; 102:e209460. [PMID: 38815233 DOI: 10.1212/wnl.0000000000209460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Alzheimer disease (AD) copathologies of β-amyloid and tau are common in the Lewy body diseases (LBD), dementia with Lewy bodies (DLB) and Parkinson disease (PD), and target distinct hippocampal subfields compared with Lewy pathology, including subiculum and CA1. We investigated the hypothesis that AD copathologies impact the pattern of hippocampal subregion volume loss and cognitive function in LBD. METHODS This was a cross-sectional and longitudinal, single-center, observational cohort study. Participants underwent neuropsychological testing and 3T-MRI with hippocampal segmentation using FreeSurferV7. PiB-PET and flortaucipir-PET imaging of comorbid β-amyloid (A) and tau (T) were acquired. The association of functional cognition, β-amyloid, and tau loads with hippocampal subregion volume was assessed. The contribution of subregion volumes to the relationship of AD-related deposits on functional cognition was examined with mediation analysis. The effects of AD-related deposits on the rate of subregion atrophy were evaluated with mixed-effects models. RESULTS Of 103 participants (mean age: 70.3 years; 37.3% female), 52 had LBD with impaired cognition (LBD-I), 26 had normal cognition (LBD-N), and 25 were A- healthy controls (HCs). Volumes of hippocampal subregions prone to AD copathologies, including subiculum (F = 6.9, p = 0.002), presubiculum (F = 7.3, p = 0.001), and parasubiculum (F = 5.9, p = 0.004), were reduced in LBD-I compared with LBD-N and HC. Volume was preserved in CA2/3, Lewy pathology susceptible subregions. In LBD-I, reduced CA1, subiculum, and presubiculum volumes were associated with greater functional cognitive impairment (all p < 0.05). Compared with HC, subiculum volume was reduced in A+T+ but not A-T- participants (F = 2.62, p = 0.043). Reduced subiculum volume mediated the effect of amyloid on functional cognition (0.12, 95% CI: 0.005 to 0.26, p = 0.040). In 26 longitudinally-evaluated participants, baseline tau deposition was associated with faster CA1 (p = 0.021) and subiculum (p = 0.002) atrophy. DISCUSSION In LBD, volume loss in hippocampal output subregions-particularly the subiculum-is associated with functional cognition and AD-related deposits. Tau deposition appears to accelerate subiculum and CA1 atrophy, whereas Aβ does not. Subiculum volume may have value as a biomarker of AD copathology-mediated neurodegeneration and disease progression.
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Affiliation(s)
- Rong Ye
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Anna E Goodheart
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Joseph J Locascio
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Erin Peterec
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Michael Properzi
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Emma G Thibault
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Erin Chuba
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Keith A Johnson
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Michael J Brickhouse
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Alexandra Touroutoglou
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - John H Growdon
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Bradford C Dickerson
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
| | - Stephen N Gomperts
- From the Department of Neurology (R.Y., A.E.G., J.J.L., E.P., M.P., E.G.T., E.C., K.A.J., M.J.B., A.T., J.G., B.C.D., S.N.G.), Massachusetts General Hospital, Boston; Mass General Institute of Neurodegenerative Disease (R.Y., A.E.G., E.P., S.N.G.), Charlestown; Lewy Body Dementia Unit (R.Y., A.E.G., E.P., S.N.G.) and Frontotemporal Disorders Unit (M.J.B., A.T., B.C.D.), Massachusetts General Hospital, Boston
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Milán-Tomás Á, Fernández-Matarrubia M, Rodríguez-Oroz MC. Lewy Body Dementias: A Coin with Two Sides? Behav Sci (Basel) 2021; 11:94. [PMID: 34206456 PMCID: PMC8301188 DOI: 10.3390/bs11070094] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
Lewy body dementias (LBDs) consist of dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), which are clinically similar syndromes that share neuropathological findings with widespread cortical Lewy body deposition, often with a variable degree of concomitant Alzheimer pathology. The objective of this article is to provide an overview of the neuropathological and clinical features, current diagnostic criteria, biomarkers, and management of LBD. Literature research was performed using the PubMed database, and the most pertinent articles were read and are discussed in this paper. The diagnostic criteria for DLB have recently been updated, with the addition of indicative and supportive biomarker information. The time interval of dementia onset relative to parkinsonism remains the major distinction between DLB and PDD, underpinning controversy about whether they are the same illness in a different spectrum of the disease or two separate neurodegenerative disorders. The treatment for LBD is only symptomatic, but the expected progression and prognosis differ between the two entities. Diagnosis in prodromal stages should be of the utmost importance, because implementing early treatment might change the course of the illness if disease-modifying therapies are developed in the future. Thus, the identification of novel biomarkers constitutes an area of active research, with a special focus on α-synuclein markers.
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Affiliation(s)
- Ángela Milán-Tomás
- Department of Neurology, Clínica Universidad de Navarra, 28027 Madrid, Spain;
| | - Marta Fernández-Matarrubia
- Department of Neurology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - María Cruz Rodríguez-Oroz
- Department of Neurology, Clínica Universidad de Navarra, 28027 Madrid, Spain;
- Department of Neurology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIMA, Center of Applied Medical Research, Universidad de Navarra, Neurosciences Program, 31008 Pamplona, Spain
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Goldman JG, Forsberg LK, Boeve BF, Armstrong MJ, Irwin DJ, Ferman TJ, Galasko D, Galvin JE, Kaufer D, Leverenz J, Lippa CF, Marder K, Abler V, Biglan K, Irizarry M, Keller B, Munsie L, Nakagawa M, Taylor A, Graham T. Challenges and opportunities for improving the landscape for Lewy body dementia clinical trials. Alzheimers Res Ther 2020; 12:137. [PMID: 33121510 PMCID: PMC7597002 DOI: 10.1186/s13195-020-00703-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/08/2020] [Indexed: 01/05/2023]
Abstract
Lewy body dementia (LBD), including dementia with Lewy bodies and Parkinson's disease dementia, affects over a million people in the USA and has a substantial impact on patients, caregivers, and society. Symptomatic treatments for LBD, which can include cognitive, neuropsychiatric, autonomic, sleep, and motor features, are limited with only two drugs (cholinesterase inhibitors) currently approved by regulatory agencies for dementia in LBD. Clinical trials represent a top research priority, but there are many challenges in the development and implementation of trials in LBD. To address these issues and advance the field of clinical trials in the LBDs, the Lewy Body Dementia Association formed an Industry Advisory Council (LBDA IAC), in addition to its Research Center of Excellence program. The LBDA IAC comprises a diverse and collaborative group of experts from academic medical centers, pharmaceutical industries, and the patient advocacy foundation. The inaugural LBDA IAC meeting, held in June 2019, aimed to bring together this group, along with representatives from regulatory agencies, to address the topic of optimizing the landscape of LBD clinical trials. This review highlights the formation of the LBDA IAC, current state of LBD clinical trials, and challenges and opportunities in the field regarding trial design, study populations, diagnostic criteria, and biomarker utilization. Current gaps include a lack of standardized clinical assessment tools and evidence-based management strategies for LBD as well as difficulty and controversy in diagnosing LBD. Challenges in LBD clinical trials include the heterogeneity of LBD pathology and symptomatology, limited understanding of the trajectory of LBD cognitive and core features, absence of LBD-specific outcome measures, and lack of established standardized biologic, imaging, or genetic biomarkers that may inform study design. Demands of study participation (e.g., travel, duration, and frequency of study visits) may also pose challenges and impact trial enrollment, retention, and outcomes. There are opportunities to improve the landscape of LBD clinical trials by harmonizing clinical assessments and biomarkers across cohorts and research studies, developing and validating outcome measures in LBD, engaging the patient community to assess research needs and priorities, and incorporating biomarker and genotype profiling in study design.
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Affiliation(s)
- Jennifer G Goldman
- Parkinson's Disease and Movement Disorders Program, Shirley Ryan AbilityLab and Departments of Physical Medicine and Rehabilitation and Neurology, Northwestern University Feinberg School of Medicine, 355 E. Erie Street, Chicago, IL, 60611, USA.
| | | | | | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - David J Irwin
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Doug Galasko
- Department of Neurosciences, UC San Diego, San Diego, CA, USA
| | - James E Galvin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel Kaufer
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
| | - James Leverenz
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carol F Lippa
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Karen Marder
- Department of Neurology, Taub Institute, Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Kevin Biglan
- Neuroscience Research, Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Leanne Munsie
- Neuroscience Research, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Angela Taylor
- Lewy Body Dementia Association, S.W., Lilburn, GA, USA
| | - Todd Graham
- Lewy Body Dementia Association, S.W., Lilburn, GA, USA
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de Schipper LJ, Hafkemeijer A, van der Grond J, Marinus J, Henselmans JML, van Hilten JJ. Regional Structural Hippocampal Differences Between Dementia with Lewy Bodies and Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 9:775-783. [PMID: 31524178 PMCID: PMC6839604 DOI: 10.3233/jpd-191600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Dementia with Lewy bodies (DLB) and Parkinson’s disease (PD) are considered subtypes of the α-synucleinopathy continuum that show similar and dissimilar clinical and morphological features. Objective: To further our understanding of brain abnormalities that might differentiate both disorders more clearly, we performed quantitative magnetic resonance (MR) imaging of the subcortical and cortical grey matter. Methods: Three-dimensional T1 weighted 3 tesla MR images of 14 DLB and 62 age- and gender-matched PD patients were examined to study cortical and subcortical grey matter structure. We used volumetric measurements to study total grey matter, and volumes of the pallidum, amygdala, putamen, caudate nucleus, thalamus and hippocampus. Whole-brain and structural network-based methods were used to identify local differences in grey matter and vertex-based shape analysis was used to assess focal hippocampal changes. Results: Volumetric, whole-brain and network-based analyses showed reduced hippocampal (p = 0.008) and right parahippocampal region volumes (p = 0.030) in DLB compared to PD patients. Shape analysis showed atrophy in the head and body of the right (p = 0.040) and in the head of the left (p = 0.030) hippocampus of DLB patients. Conclusion: DLB patients showed atrophy of the hippocampus and parahippocampal gyrus compared to PD patients with a differential involvement of the head and body of the hippocampus. Further studies should examine if these group-based findings can be used to differentiate both disorders on an individual level.
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Affiliation(s)
- Laura J de Schipper
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne Hafkemeijer
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Gmitterová K, Gawinecka J, Llorens F, Varges D, Valkovič P, Zerr I. Cerebrospinal fluid markers analysis in the differential diagnosis of dementia with Lewy bodies and Parkinson's disease dementia. Eur Arch Psychiatry Clin Neurosci 2020; 270:461-470. [PMID: 30083957 DOI: 10.1007/s00406-018-0928-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/16/2018] [Indexed: 01/18/2023]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) share a couple of clinical similarities that is often a source of diagnostic pitfalls. We evaluated the discriminatory potential of brain-derived CSF markers [tau, p-tau (181P), Aβ1-42, NSE and S100B] across the spectrum of Lewy body disorders and assessed whether particular markers are associated with cognitive status in investigated patients. The tau CSF level, amyloid β1-42 and p-tau/tau ratio were helpful in the distinction between DLB and PDD (p = 0.04, p = 0.002 and p = 0.02, respectively) as well as from PD patients (p < 0.001, p = 0.001 and p = 0.002, respectively). Furthermore, the p-tau/tau ratio enabled the differentiation of DLB with mild dementia from PDD patients (p = 0.02). The CSF tau and p-tau levels in DLB and CSF tau and p-tau/tau ratio in PDD patients reflected the severity of dementia. Rapid disease course was associated with the decrease of Aβ1-42 in DLB but not in PDD. Elevation of S100B in DLB (p < 0.0001) as well as in PDD patients (p = 0.002) in comparison to controls was estimated. Hence, with the appropriate clinical context; the CSF marker profile could be helpful in distinguishing DLB from PDD patients even in early stages of dementia.
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Affiliation(s)
- Karin Gmitterová
- Department of Neurology, Clinical Dementia Center and DZNE, National TSE Reference Centre, University Medical School, Georg-August University, Robert-Koch-Str. 40, 37073, Göttingen, Germany
- Second Department of Neurology, Comenius University, Bratislava, Slovakia
| | - Joanna Gawinecka
- Department of Neurology, Clinical Dementia Center and DZNE, National TSE Reference Centre, University Medical School, Georg-August University, Robert-Koch-Str. 40, 37073, Göttingen, Germany
- Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland
| | - Franc Llorens
- Department of Neurology, Clinical Dementia Center and DZNE, National TSE Reference Centre, University Medical School, Georg-August University, Robert-Koch-Str. 40, 37073, Göttingen, Germany
| | - Daniela Varges
- Department of Neurology, Clinical Dementia Center and DZNE, National TSE Reference Centre, University Medical School, Georg-August University, Robert-Koch-Str. 40, 37073, Göttingen, Germany
| | - Peter Valkovič
- Second Department of Neurology, Comenius University, Bratislava, Slovakia
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center and DZNE, National TSE Reference Centre, University Medical School, Georg-August University, Robert-Koch-Str. 40, 37073, Göttingen, Germany.
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Zhang W, Zhang Q, Yang Q, Liu P, Sun T, Xu Y, Qian X, Qiu W, Ma C. Contribution of Alzheimer's disease neuropathologic change to the cognitive dysfunction in human brains with Lewy body-related pathology. Neurobiol Aging 2020; 91:56-65. [PMID: 32224069 DOI: 10.1016/j.neurobiolaging.2020.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/09/2020] [Accepted: 02/22/2020] [Indexed: 12/31/2022]
Abstract
This study investigated the clinicopathological relationship between cognitive dysfunction and Lewy body-related pathology (LRP), and the role of Alzheimer's disease neuropathologic change (ADNC) in affecting this relationship in the Chinese population. A total of 127 brains with antemortem cognition assessment were collected. The postmortem neuropathological classification of LRP and staging of ADNC were evaluated. Pairwise correlation and ordered logistic regression analysis showed that LRP had a moderate correlation with Global Everyday Cognition scores. The proportion of the people with intermediate and high levels of comorbid ADNC increased with the deterioration of LRP. The fit of the cognition prediction model improved when we incorporated both LRP and ADNC into the model compared with LRP alone. Our study indicated that comorbid ADNC can variably present in patients with Lewy body disease. A combination of LRP and concurrent ADNC improves the prediction of cognitive dysfunction compared with LRP alone. These findings may suggest the potential benefit of combined therapeutic approaches targeting concurrent pathological pathways for the Lewy body diseases in the Chinese population.
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Affiliation(s)
- Wanying Zhang
- Institute of Basic Medical Sciences, Neuroscience Center, National Human Brain Bank for Development and Function, Chinese Academy of Medical Sciences, Beijing, China; Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College, Beijing, China; Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, China; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Qing Zhang
- Institute of Basic Medical Sciences, Neuroscience Center, National Human Brain Bank for Development and Function, Chinese Academy of Medical Sciences, Beijing, China; Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Qian Yang
- Institute of Basic Medical Sciences, Neuroscience Center, National Human Brain Bank for Development and Function, Chinese Academy of Medical Sciences, Beijing, China; Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College, Beijing, China; Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, China
| | - Pan Liu
- Institute of Basic Medical Sciences, Neuroscience Center, National Human Brain Bank for Development and Function, Chinese Academy of Medical Sciences, Beijing, China; Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College, Beijing, China; Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, China
| | - Tianyi Sun
- Institute of Basic Medical Sciences, Neuroscience Center, National Human Brain Bank for Development and Function, Chinese Academy of Medical Sciences, Beijing, China; Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College, Beijing, China; Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, China
| | - Yuanyuan Xu
- National Experimental Teaching Demonstration Center of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xiaojing Qian
- Institute of Basic Medical Sciences, Neuroscience Center, National Human Brain Bank for Development and Function, Chinese Academy of Medical Sciences, Beijing, China; Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Wenying Qiu
- Institute of Basic Medical Sciences, Neuroscience Center, National Human Brain Bank for Development and Function, Chinese Academy of Medical Sciences, Beijing, China; Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College, Beijing, China.
| | - Chao Ma
- Institute of Basic Medical Sciences, Neuroscience Center, National Human Brain Bank for Development and Function, Chinese Academy of Medical Sciences, Beijing, China; Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College, Beijing, China; Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, China.
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Ye R, Touroutoglou A, Brickhouse M, Katz S, Growdon JH, Johnson KA, Dickerson BC, Gomperts SN. Topography of cortical thinning in the Lewy body diseases. NEUROIMAGE-CLINICAL 2020; 26:102196. [PMID: 32059167 PMCID: PMC7016450 DOI: 10.1016/j.nicl.2020.102196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 11/15/2022]
Abstract
Objective Regional cortical thinning in dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD) may underlie some aspect of their clinical impairments; cortical atrophy likely reflects extensive Lewy body pathology with alpha-synuclein deposits, as well as associated Alzheimer's disease co-pathologies, when present. Here we investigated the topographic distribution of cortical thinning in these Lewy body diseases compared to cognitively normal PD and healthy non-PD control subjects, explored the association of regional thinning with clinical features and evaluated the impact of amyloid deposition. Methods Twenty-one participants with dementia with Lewy bodies (DLB), 16 with Parkinson disease (PD) - associated cognitive impairment (PD-MCI and PDD), and 24 cognitively normal participants with PD underwent MRI, PiB PET, and clinical evaluation. Cortical thickness across the brain and in regions of interest (ROIs) was compared across diagnostic groups and across subgroups stratified by amyloid status, and was related to clinical and cognitive measures. Results DLB and PD-impaired groups shared a similar distribution of cortical thinning that included regions characteristic of AD, as well as the fusiform, precentral, and paracentral gyri. Elevated PiB retention in DLB and PD-impaired but not in PD-normal participants was associated with more extensive and severe cortical thinning, in an overlapping topography that selectively affected the medial temporal lobe in DLB participants. In DLB, greater thinning in AD signature and fusiform regions was associated with greater cognitive impairment. Conclusions The pattern of cortical thinning is similar in DLB and PD-associated cognitive impairment, overlapping with and extending beyond AD signature regions to involve fusiform, precentral, and paracentral regions. Cortical thinning in AD signature and fusiform regions in these diseases reflects cognitive impairment and is markedly accentuated by amyloid co-pathology. Further work will be required to determine whether the distinct topography of cortical thinning in DLB and PD-associated cognitive impairment might have value as a diagnostic and/ or outcome biomarker in clinical trials.
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Affiliation(s)
- Rong Ye
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Alexandra Touroutoglou
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Michael Brickhouse
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Samantha Katz
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - John H Growdon
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Keith A Johnson
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Stephen N Gomperts
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA.
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Palermo G, Tommasini L, Aghakhanyan G, Frosini D, Giuntini M, Tognoni G, Bonuccelli U, Volterrani D, Ceravolo R. Clinical Correlates of Cerebral Amyloid Deposition in Parkinson’s Disease Dementia: Evidence from a PET Study. J Alzheimers Dis 2019; 70:597-609. [DOI: 10.3233/jad-190323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Giovanni Palermo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luca Tommasini
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gayanè Aghakhanyan
- Regional Center of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniela Frosini
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Giuntini
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gloria Tognoni
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ubaldo Bonuccelli
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Duccio Volterrani
- Regional Center of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Ceravolo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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9
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Shirvan J, Clement N, Ye R, Katz S, Schultz A, Johnson KA, Gomez-Isla T, Frosch M, Growdon JH, Gomperts SN. Neuropathologic correlates of amyloid and dopamine transporter imaging in Lewy body disease. Neurology 2019; 93:e476-e484. [PMID: 31243072 DOI: 10.1212/wnl.0000000000007855] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/14/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To develop imaging biomarkers of diseases in the Lewy body spectrum and to validate these markers against postmortem neuropathologic findings. METHODS Four cognitively normal participants with Parkinson disease (PD), 4 with PD with cognitive impairments, and 10 with dementia with Lewy bodies underwent amyloid imaging with [11C]Pittsburgh compound B (PiB) and dopamine transporter (DAT) imaging with [11C]Altropane. All 18 had annual neurologic examinations. All cognitively normal participants with PD developed cognitive impairment before death. Neuropathologic examinations assessed and scored Braak Lewy bodies, Thal distribution of amyloid, Consortium to Establish a Registry for Alzheimer's Disease neuritic amyloid plaques, Braak neurofibrillary tangles, and cerebral amyloid angiopathy, as well as total amyloid plaque burden in the superior frontal, superior parietal, occipital, and inferior temporal cortical regions. PET data were expressed as the standardized uptake value ratio with cerebellar reference. Analyses accounted for the interval between imaging and autopsy. RESULTS All 18 patients met neuropathologic criteria for Lewy body disease; the DAT concentration was low in each case. All patients with elevated [11C]PiB retention measured in a neocortical aggregate had β-amyloid deposits at autopsy. [11C]PiB retention significantly correlated with neuritic plaque burden and with total plaque burden. [11C]PiB retention also significantly correlated with the severity of both Braak stages of neurofibrillary tangle and Lewy body scores. Neuritic plaque burden was significantly associated with neurofibrillary tangle pathology. CONCLUSION Antemortem [11C]Altropane PET is a sensitive measure of substantia nigra degeneration. [11C]PiB scans accurately reflect cortical amyloid deposits seen at autopsy. These findings support the use of molecular imaging in the evaluation of patients with Lewy body diseases.
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Affiliation(s)
- Julia Shirvan
- From the Departments of Neurology (J.S., R.Y., K.A.J., T.G.-I., J.H.G., S.N.G.), Pathology (N.C., M.F.), and Radiology (S.K., A.S., K.A.J.), Massachusetts General Hospital, Boston
| | - Nathan Clement
- From the Departments of Neurology (J.S., R.Y., K.A.J., T.G.-I., J.H.G., S.N.G.), Pathology (N.C., M.F.), and Radiology (S.K., A.S., K.A.J.), Massachusetts General Hospital, Boston
| | - Rong Ye
- From the Departments of Neurology (J.S., R.Y., K.A.J., T.G.-I., J.H.G., S.N.G.), Pathology (N.C., M.F.), and Radiology (S.K., A.S., K.A.J.), Massachusetts General Hospital, Boston
| | - Samantha Katz
- From the Departments of Neurology (J.S., R.Y., K.A.J., T.G.-I., J.H.G., S.N.G.), Pathology (N.C., M.F.), and Radiology (S.K., A.S., K.A.J.), Massachusetts General Hospital, Boston
| | - Aaron Schultz
- From the Departments of Neurology (J.S., R.Y., K.A.J., T.G.-I., J.H.G., S.N.G.), Pathology (N.C., M.F.), and Radiology (S.K., A.S., K.A.J.), Massachusetts General Hospital, Boston
| | - Keith A Johnson
- From the Departments of Neurology (J.S., R.Y., K.A.J., T.G.-I., J.H.G., S.N.G.), Pathology (N.C., M.F.), and Radiology (S.K., A.S., K.A.J.), Massachusetts General Hospital, Boston
| | - Teresa Gomez-Isla
- From the Departments of Neurology (J.S., R.Y., K.A.J., T.G.-I., J.H.G., S.N.G.), Pathology (N.C., M.F.), and Radiology (S.K., A.S., K.A.J.), Massachusetts General Hospital, Boston
| | - Matthew Frosch
- From the Departments of Neurology (J.S., R.Y., K.A.J., T.G.-I., J.H.G., S.N.G.), Pathology (N.C., M.F.), and Radiology (S.K., A.S., K.A.J.), Massachusetts General Hospital, Boston
| | - John H Growdon
- From the Departments of Neurology (J.S., R.Y., K.A.J., T.G.-I., J.H.G., S.N.G.), Pathology (N.C., M.F.), and Radiology (S.K., A.S., K.A.J.), Massachusetts General Hospital, Boston
| | - Stephen N Gomperts
- From the Departments of Neurology (J.S., R.Y., K.A.J., T.G.-I., J.H.G., S.N.G.), Pathology (N.C., M.F.), and Radiology (S.K., A.S., K.A.J.), Massachusetts General Hospital, Boston.
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Sestini S, Alongi P, Berti V, Calcagni ML, Cecchin D, Chiaravalloti A, Chincarini A, Cistaro A, Guerra UP, Pappatà S, Tiraboschi P, Nobili F. The role of molecular imaging in the frame of the revised dementia with Lewy body criteria. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00321-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Mak E, Donaghy PC, McKiernan E, Firbank MJ, Lloyd J, Petrides GS, Thomas AJ, O'Brien JT. Beta amyloid deposition maps onto hippocampal and subiculum atrophy in dementia with Lewy bodies. Neurobiol Aging 2018; 73:74-81. [PMID: 30339962 DOI: 10.1016/j.neurobiolaging.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Abstract
Although dementia with Lewy bodies (DLB) is a synucleinopathy, it is frequently accompanied by beta amyloid (Aβ) accumulation. Elucidating the relationships of Aβ with gray matter atrophy in DLB may yield insights regarding the contributions of comorbid Alzheimer's disease to its disease progression. Twenty healthy controls and 25 DLB subjects underwent clinical assessment, [18F]-Florbetapir, and 3T magnetic resonance imaging. FreeSurfer was used to estimate cortical thickness and subcortical volumes, and PetSurfer was used to quantify [18F]-Florbetapir standardized uptake value ratio. Principal component analysis was used to identify the dominant Aβ component for correlations with regional cortical thickness, hippocampal subfields, and subcortical structures. Relative to healthy controls, the DLB group demonstrated increased Aβ in widespread regions encompassing the frontal and temporoparietal cortices, whereas cortical thinning was restricted to the temporal lobe. Among DLB subjects, the Aβ component was significantly associated with more severe hippocampal and subiculum atrophy. These findings may reflect an early process of superimposed AD-like atrophy in DLB, thereby conferring support for the therapeutic potential of anti-Aβ interventions in people with DLB.
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Affiliation(s)
- Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paul C Donaghy
- Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - Michael J Firbank
- Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - George S Petrides
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Institute for Ageing and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK.
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12
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Jellinger KA, Korczyn AD. Are dementia with Lewy bodies and Parkinson's disease dementia the same disease? BMC Med 2018; 16:34. [PMID: 29510692 PMCID: PMC5840831 DOI: 10.1186/s12916-018-1016-8] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/30/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), which share many clinical, neurochemical, and morphological features, have been incorporated into DSM-5 as two separate entities of major neurocognitive disorders with Lewy bodies. Despite clinical overlap, their diagnosis is based on an arbitrary distinction concerning the time of onset of motor and cognitive symptoms, namely as early cognitive impairment in DLB and later onset following that of motor symptoms in PDD. Their morphological hallmarks - cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies - are similar, but clinical differences at onset suggest some dissimilar profiles. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is provided herein. DISCUSSION The clinical constellations of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and postmortem studies have revealed a more pronounced cortical atrophy, elevated cortical and limbic Lewy body pathologies, higher Aβ and tau loads in cortex and striatum in DLB compared to PDD, and earlier cognitive defects in DLB. Conversely, multitracer PET studies have shown no differences in cortical and striatal cholinergic and dopaminergic deficits. Clinical management of both DLB and PDD includes cholinesterase inhibitors and other pharmacologic and non-drug strategies, yet with only mild symptomatic effects. Currently, no disease-modifying therapies are available. CONCLUSION DLB and PDD are important dementia syndromes that overlap in many clinical features, genetics, neuropathology, and management. They are currently considered as subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), from incidental Lewy body disease and non-demented Parkinson's disease to PDD, DLB, and DLB with Alzheimer's disease at the most severe end. Cognitive impairment in these disorders is induced not only by α-synuclein-related neurodegeneration but by multiple regional pathological scores. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with Alzheimer's disease and other proteinopathies. While we prefer to view DLB and PDD as extremes on a continuum, there remains a pressing need to more clearly differentiate these syndromes and to understand the synucleinopathy processes leading to either one.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150, Vienna, Austria.
| | - Amos D Korczyn
- Tel-Aviv University, Sackler Faculty of Medicine, Ramat Aviv, Israel
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13
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Lyoo CH, Cho H, Choi JY, Ryu YH, Lee MS. Tau Positron Emission Tomography Imaging in Degenerative Parkinsonisms. J Mov Disord 2018; 11:1-12. [PMID: 29381890 PMCID: PMC5790630 DOI: 10.14802/jmd.17071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/20/2017] [Indexed: 01/08/2023] Open
Abstract
In recent years, several radiotracers that selectively bind to pathological tau proteins have been developed. Evidence is emerging that binding patterns of in vivo tau positron emission tomography (PET) studies in Alzheimer’s disease (AD) patients closely resemble the distribution patterns of known neurofibrillary tangle pathology, with the extent of tracer binding reflecting the clinical and pathological progression of AD. In Lewy body diseases (LBD), tau PET imaging has clearly revealed cortical tau burden with a distribution pattern distinct from AD and increased cortical binding within the LBD spectrum. In progressive supranuclear palsy, the globus pallidus and midbrain have shown increased binding most prominently. Tau PET patterns in patients with corticobasal syndrome are characterized by asymmetrical uptake in the motor cortex and underlying white matter, as well as in the basal ganglia. Even in the patients with multiple system atrophy, which is basically a synucleinopathy, 18F-flortaucipir, a widely used tau PET tracer, also binds to the atrophic posterior putamen, possibly due to off-target binding. These distinct patterns of tau-selective radiotracer binding in the various degenerative parkinsonisms suggest its utility as a potential imaging biomarker for the differential diagnosis of parkinsonisms.
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Affiliation(s)
- Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Yong Choi
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Division of RI-Convergence Research, Korea Institute Radiological and Medical Sciences, Seoul, Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Sik Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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14
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Jellinger KA. Dementia with Lewy bodies and Parkinson's disease-dementia: current concepts and controversies. J Neural Transm (Vienna) 2017; 125:615-650. [PMID: 29222591 DOI: 10.1007/s00702-017-1821-9] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease-dementia (PDD), although sharing many clinical, neurochemical and morphological features, according to DSM-5, are two entities of major neurocognitive disorders with Lewy bodies of unknown etiology. Despite considerable clinical overlap, their diagnosis is based on an arbitrary distinction between the time of onset of motor and cognitive symptoms: dementia often preceding parkinsonism in DLB and onset of cognitive impairment after onset of motor symptoms in PDD. Both are characterized morphologically by widespread cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is given. The clinical features of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and post-mortem studies revealed more pronounced cortical atrophy, elevated cortical and limbic Lewy pathologies (with APOE ε4), apart from higher prevalence of Alzheimer pathology in DLB than PDD. These changes may account for earlier onset and greater severity of cognitive defects in DLB, while multitracer PET studies showed no differences in cholinergic and dopaminergic deficits. DLB and PDD sharing genetic, neurochemical, and morphologic factors are likely to represent two subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), beginning with incidental Lewy body disease-PD-nondemented-PDD-DLB (no parkinsonism)-DLB with Alzheimer's disease (DLB-AD) at the most severe end, although DLB does not begin with PD/PDD and does not always progress to DLB-AD, while others consider them as the same disease. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with AD and other proteinopathies. Cognitive impairment is not only induced by α-synuclein-caused neurodegeneration but by multiple regional pathological scores. Recent animal models and human post-mortem studies have provided important insights into the pathophysiology of DLB/PDD showing some differences, e.g., different spreading patterns of α-synuclein pathology, but the basic pathogenic mechanisms leading to the heterogeneity between both disorders deserve further elucidation. In view of the controversies about the nosology and pathogenesis of both syndromes, there remains a pressing need to differentiate them more clearly and to understand the processes leading these synucleinopathies to cause one disorder or the other. Clinical management of both disorders includes cholinesterase inhibitors, other pharmacologic and nonpharmacologic strategies, but these have only a mild symptomatic effect. Currently, no disease-modifying therapies are available.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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15
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Lee SH, Cho H, Choi JY, Lee JH, Ryu YH, Lee MS, Lyoo CH. Distinct patterns of amyloid-dependent tau accumulation in Lewy body diseases. Mov Disord 2017; 33:262-272. [DOI: 10.1002/mds.27252] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/25/2017] [Accepted: 10/02/2017] [Indexed: 01/06/2023] Open
Affiliation(s)
- Seung Ha Lee
- Department of Neurology, Gangnam Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Jae Yong Choi
- Department of Nuclear Medicine, Gangnam Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
- Division of RI-Convergence Research; Korea Institute Radiological and Medical Sciences; Seoul Republic of Korea
| | - Jae Hoon Lee
- Department of Nuclear Medicine, Gangnam Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Myung Sik Lee
- Department of Neurology, Gangnam Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital; Yonsei University College of Medicine; Seoul Republic of Korea
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Weil RS, Lashley TL, Bras J, Schrag AE, Schott JM. Current concepts and controversies in the pathogenesis of Parkinson's disease dementia and Dementia with Lewy Bodies. F1000Res 2017; 6:1604. [PMID: 28928962 PMCID: PMC5580419 DOI: 10.12688/f1000research.11725.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 02/03/2023] Open
Abstract
Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) are relentlessly progressive neurodegenerative disorders that are likely to represent two ends of a disease spectrum. It is well established that both are characterised pathologically by widespread cortical Lewy body deposition. However, until recently, the pathophysiological mechanisms leading to neuronal damage were not known. It was also not understood why some cells are particularly vulnerable in PDD/DLB, nor why some individuals show more aggressive and rapid dementia than others. Recent studies using animal and cell models as well as human post-mortem analyses have provided important insights into these questions. Here, we review recent developments in the pathophysiology in PDD/DLB. Specifically, we examine the role of pathological proteins other than α-synuclein, consider particular morphological and physiological features that confer vulnerabilities on some neurons rather than others, and finally examine genetic factors that may explain some of the heterogeneity between individuals with PDD/DLB.
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Affiliation(s)
- Rimona S. Weil
- Dementia Research Centre, UCL Institute of Neurology, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Tammaryn L. Lashley
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- Queen Square Brain Bank for Neurological diseases, UCL Institute of Neurology, London, UK
| | - Jose Bras
- Dementia Research Centre, UCL Institute of Neurology, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Anette E. Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK
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Spires-Jones TL, Attems J, Thal DR. Interactions of pathological proteins in neurodegenerative diseases. Acta Neuropathol 2017; 134:187-205. [PMID: 28401333 PMCID: PMC5508034 DOI: 10.1007/s00401-017-1709-7] [Citation(s) in RCA: 259] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/30/2017] [Accepted: 04/01/2017] [Indexed: 02/06/2023]
Abstract
Neurodegenerative diseases such as Alzheimer's disease (AD), frontotemporal lobar degeneration (FTD), Lewy body disease (LBD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS) have in common that protein aggregates represent pathological hallmark lesions. Amyloid β-protein, τ-protein, α-synuclein, and TDP-43 are the most frequently aggregated proteins in these disorders. Although they are assumed to form disease-characteristic aggregates, such as amyloid plaques and neurofibrillary tangles in AD or Lewy bodies in LBD/PD, they are not restricted to these clinical presentations. They also occur in non-diseased individuals and can co-exist in the same brain without or with a clinical picture of a distinct dementing or movement disorder. In this review, we discuss the co-existence of these pathologies and potential additive effects in the human brain as well as related functional findings on cross-seeding and molecular interactions between these aggregates/proteins. We conclude that there is evidence for interactions at the molecular level as well as for additive effects on brain damage by multiple pathologies occurring in different functionally important neurons. Based upon this information, we hypothesize a cascade of events that may explain general mechanisms in the development of neurodegenerative disorders: (1) distinct lesions are a prerequisite for the development of a distinct disease (e.g., primary age-related tauopathy for AD), (2) disease-specific pathogenic events further trigger the development of a specific disease (e.g., Aβ aggregation in AD that exaggerate further Aβ and AD-related τ pathology), (3) the symptomatic disease manifests, and (4) neurodegenerative co-pathologies may be either purely coincidental or (more likely) have influence on the disease development and/or its clinical presentation.
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Affiliation(s)
- Tara L Spires-Jones
- Centre for Dementia Prevention, and Euan MacDonald Centre for Motor Neurone Disease, The University of Edinburgh Centre for Cognitive and Neural Systems, 1 George Square, Edinburgh, EH8 9JZ, UK.
| | - Johannes Attems
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Dietmar Rudolf Thal
- Departement Neurowetenschappen, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium
- Departement Pathologische Ontleedkunde, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium
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Wang M, Gao M, Xu Z, Zheng QH. Synthesis of [11C]HG-10-102-01 as a new potential PET agent for imaging of LRRK2 enzyme in Parkinson’s disease. Bioorg Med Chem Lett 2017; 27:1351-1355. [DOI: 10.1016/j.bmcl.2017.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 12/17/2022]
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Lemstra AW, de Beer MH, Teunissen CE, Schreuder C, Scheltens P, van der Flier WM, Sikkes SAM. Concomitant AD pathology affects clinical manifestation and survival in dementia with Lewy bodies. J Neurol Neurosurg Psychiatry 2017; 88:113-118. [PMID: 27794030 DOI: 10.1136/jnnp-2016-313775] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/14/2016] [Accepted: 09/27/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate whether concomitant Alzheimer's disease (AD) pathology, reflected by cerebrospinal fluid (CSF) biomarkers, has an impact on dementia with Lewy bodies (DLB) in terms of clinical presentation, cognitive decline, nursing home admittance and survival. PARTICIPANTS We selected 111 patients with probable DLB and CSF available from the Amsterdam Dementia Cohort. On the basis of the AD biomarker profile (CSF tau/amyloid-β 1-42 (Aβ42) ratio >0.52), we divided patients into a DLB/AD+ and DLB/AD- group. Of the 111 patients, 42 (38%) had an AD CSF biomarker profile. We investigated differences between groups in memory, attention, executive functions, language and visuospatial functions. Difference in global cognitive decline (repeated Mini-Mental State Examination (MMSE)) was investigated using linear mixed models. Cox proportional hazard analyses were used to investigate the effects of the AD biomarker profile on time to nursing home admittance and time to death. RESULTS Memory performance was worse in DLB/AD+ patients compared with DLB/AD- patients (p<0.01), also after correction for age and sex. Hallucinations were more frequent in DLB/AD+ (OR=3.34, 95% CI 1.22-9.18). There was no significant difference in the rate of cognitive decline. DLB/AD+ patients had a higher mortality risk (HR=3.13, 95% CI 1.57 to 6.24) and nursing home admittance risk (HR=11.70, 95% CI 3.74 to 36.55) compared with DLB/AD- patients. CONCLUSIONS DLB-patients with a CSF AD profile have a more severe manifestation of the disease and a higher risk of institutionalisation and mortality. In clinical practice, CSF biomarkers may aid in predicting prognosis in DLB. In addition, DLB-patients with positive AD biomarkers could benefit from future treatment targeting AD pathology.
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Affiliation(s)
- A W Lemstra
- Alzheimer Center & Department of Neurology, VU University Medical Center and Neuroscience Campus, Amsterdam, The Netherlands
| | - M H de Beer
- Alzheimer Center & Department of Neurology, VU University Medical Center and Neuroscience Campus, Amsterdam, The Netherlands.,HagaZiekenhuis, Haga Hospital, The Hague, The Netherlands
| | - C E Teunissen
- Department of Clinical Chemistry, VU University Medical Center & Alzheimer Center, Amsterdam, The Netherlands
| | - C Schreuder
- Department of Medical Psychology & Alzheimer center, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - P Scheltens
- Alzheimer Center & Department of Neurology, VU University Medical Center and Neuroscience Campus, Amsterdam, The Netherlands
| | - W M van der Flier
- Alzheimer center & Department of Neurology and Department of Epidemiology and Biostatistics, VU University Medical Center and Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - S A M Sikkes
- Alzheimer center & Department of Epidemiology and Biostatistics, VU University Medical Center and Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
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Mathews PM, Levy E. Cystatin C in aging and in Alzheimer's disease. Ageing Res Rev 2016; 32:38-50. [PMID: 27333827 DOI: 10.1016/j.arr.2016.06.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/08/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022]
Abstract
Under normal conditions, the function of catalytically active proteases is regulated, in part, by their endogenous inhibitors, and any change in the synthesis and/or function of a protease or its endogenous inhibitors may result in inappropriate protease activity. Altered proteolysis as a result of an imbalance between active proteases and their endogenous inhibitors can occur during normal aging, and such changes have also been associated with multiple neuronal diseases, including Amyotrophic Lateral Sclerosis (ALS), rare heritable neurodegenerative disorders, ischemia, some forms of epilepsy, and Alzheimer's disease (AD). One of the most extensively studied endogenous inhibitor is the cysteine-protease inhibitor cystatin C (CysC). Changes in the expression and secretion of CysC in the brain have been described in various neurological disorders and in animal models of neurodegeneration, underscoring a role for CysC in these conditions. In the brain, multiple in vitro and in vivo findings have demonstrated that CysC plays protective roles via pathways that depend upon the inhibition of endosomal-lysosomal pathway cysteine proteases, such as cathepsin B (Cat B), via the induction of cellular autophagy, via the induction of cell proliferation, or via the inhibition of amyloid-β (Aβ) aggregation. We review the data demonstrating the protective roles of CysC under conditions of neuronal challenge and the protective pathways induced by CysC under various conditions. Beyond highlighting the essential role that balanced proteolytic activity plays in supporting normal brain aging, these findings suggest that CysC is a therapeutic candidate that can potentially prevent brain damage and neurodegeneration.
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Affiliation(s)
- Paul M Mathews
- Departments of Psychiatry, New York University School of Medicine, USA; Center for Dementia Research, Nathan S. Kline Institute, Orangeburg, NY 10962, USA
| | - Efrat Levy
- Departments of Psychiatry, New York University School of Medicine, USA; Biochemistry and Molecular Pharmacology, New York University School of Medicine, USA; Center for Dementia Research, Nathan S. Kline Institute, Orangeburg, NY 10962, USA.
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Gomperts SN, Locascio JJ, Makaretz SJ, Schultz A, Caso C, Vasdev N, Sperling R, Growdon JH, Dickerson BC, Johnson K. Tau Positron Emission Tomographic Imaging in the Lewy Body Diseases. JAMA Neurol 2016; 73:1334-1341. [PMID: 27654968 PMCID: PMC5287290 DOI: 10.1001/jamaneurol.2016.3338] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE The causes of cognitive impairment in dementia with Lewy bodies (DLB) and Parkinson disease (PD) are multifactorial. Tau pathologic changes are commonly observed at autopsy in individuals with DLB and PD dementia, but their contribution to these diseases during life is unknown. OBJECTIVE To contrast tau aggregation in DLB, cognitively impaired persons with PD (PD-impaired), cognitively normal individuals with PD (PD-normal), and healthy persons serving as control participants, and to evaluate the association between tau aggregation, amyloid deposition, and cognitive function. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from January 1, 2014, to April 28, 2016, in a tertiary care center's memory and movement disorders units. Twenty-four patients with Lewy body disease (7 DLB, 8 PD-impaired, and 9 PD-normal) underwent multimodal brain imaging, cognitive testing, and neurologic evaluation, and imaging measures were compared with those of an independently acquired group of 29 controls with minimal brain amyloid burden as measured with carbon 11-labeled Pittsburgh Compound B ([11C]PiB) positron emission tomography (PET). EXPOSURES Imaging with fluorine 18-labeled AV-1451 ([18F]AV-1451) (formerly known as [18F]T807), [11C]PiB PET, magnetic resonance imaging (MRI), neurologic examination, and detailed cognitive testing using the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating scale. MAIN OUTCOMES AND MEASURES Main outcomes were differentiation of diagnostic groups on the basis of [18F]AV-1451 binding, the association of [18F]AV-1451 binding with [11C]PiB binding, and the association of [18F]AV-1451 binding with cognitive impairment. All but 3 individuals underwent amyloid imaging with [11C]PiB PET. The hypotheses being tested were formulated before data collection. Mini-Mental State Examination (range, 0-30, with 30 being best) and Clinical Dementia Rating scale sum-of-boxes scale (range, 0-18, with 0 being best) were used for assessment of cognitive function. RESULTS In patients with DLB, cortical [18F]AV-1451 uptake was highly variable and greater than in the controls, particularly in the inferior temporal gyrus and precuneus. Foci of increased [18F]AV-1451 binding in the inferior temporal gyrus and precuneus were also evident in PD-impaired patients. Elevated cortical [18F]AV-1451 binding was observed in 4 of 17 patients with Lewy body disease with low cortical [11C]PiB retention. For DLB and PD-impaired patients, greater [18F]AV-1451 uptake in the inferior temporal gyrus and precuneus was associated with increased cognitive impairment as measured with the MMSE and the Clinical Dementia Rating scale sum-of-boxes score. CONCLUSIONS AND RELEVANCE Patients with Lewy body disease manifest a spectrum of tau pathology. Cortical aggregates of tau are common in patients with DLB and in PD-impaired patients, even in those without elevated amyloid levels. When present, tau deposition is associated with cognitive impairment. These findings support a role for tau copathology in the Lewy body diseases.
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Affiliation(s)
- Stephen N Gomperts
- MassGeneral Institute for Neurodegenerative Disease, Charlestown, Massachusetts2Alzheimer's Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown
| | - Joseph J Locascio
- Alzheimer's Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown
| | - Sara J Makaretz
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown
| | - Aaron Schultz
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown
| | - Christina Caso
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown
| | - Neil Vasdev
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Reisa Sperling
- Alzheimer's Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown4Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown5Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - John H Growdon
- Alzheimer's Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown
| | - Bradford C Dickerson
- Alzheimer's Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown3Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown4Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown
| | - Keith Johnson
- Alzheimer's Disease Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown4Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown5Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston
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van Steenoven I, Aarsland D, Weintraub D, Londos E, Blanc F, van der Flier WM, Teunissen CE, Mollenhauer B, Fladby T, Kramberger MG, Bonanni L, Lemstra AW. Cerebrospinal Fluid Alzheimer's Disease Biomarkers Across the Spectrum of Lewy Body Diseases: Results from a Large Multicenter Cohort. J Alzheimers Dis 2016; 54:287-95. [PMID: 27567832 PMCID: PMC5535729 DOI: 10.3233/jad-160322] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Concomitant Alzheimer's disease (AD) pathology is observed in Lewy body diseases (LBD), but the clinical impact is unknown. Only a few biomarker studies in LBD exist and have included small cohorts from single centers. OBJECTIVE We aimed to evaluate the prevalence of abnormal cerebrospinal fluid (CSF) AD biomarkers across the spectrum of LBD in a large multicenter cohort and to assess whether an AD biomarker profile was associated with demographic and clinical differences in dementia with Lewy bodies (DLB). METHODS We included 375 DLB patients, 164 Parkinson's disease (PD) patients without dementia, and 55 PD patients with dementia (PDD) from 10 centers. CSF amyloid-beta42 (Aβ42), total tau (t-tau), and phosphorylated tau (p-tau) values were dichotomized as abnormal or normal according to locally available cut-off values. A CSF AD profile was defined as abnormal Aβ42 combined with abnormal t-tau and/or p-tau. RESULTS A substantial proportion of DLB patients had abnormal values for CSF Aβ42, t-tau, and p-tau, while abnormal values were uncommon in PD without dementia. Patients with PDD had values in between. A CSF AD profile was observed in 25% of DLB patients, compared with only 9% of PDD and 3% of PD without dementia. Within DLB, patients with a CSF AD profile were older, more often female, performed worse on the Mini-Mental State Examination, and had shorter disease duration compared with patients with normal CSF. CONCLUSION A CSF AD profile is more common in DLB compared with PDD and PD, and is associated with more severe cognitive impairment in DLB.
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Affiliation(s)
- Inger van Steenoven
- Department of Neurology & Alzheimer Centre, VU University Medical Center, Amsterdam, The Netherlands
| | - Dag Aarsland
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
- Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Frédéric Blanc
- Neuropsychology Unit and Geriatric Day Hospital (Strasbourg Resource and Research Memory Centre, CMRR), University Hospital of Strasbourg and ICube Laboratory, FMTS, University of Strasbourg and CNRS, Strasbourg, France
| | - Wiesje M. van der Flier
- Department of Neurology & Alzheimer Centre and Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry Lab and Biobank, Department of Clinical Chemistry, VU University Medical Center Amsterdam, The Netherlands
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel and University Medical Center, Department of Neurosurgery and Institute of Neuropathology, Göttingen, Germany
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital and Faculty of Medicine, University of Oslo, Norway
| | | | - Laura Bonanni
- Department of Neuroscience and Imaging and Clinical Science, and Aging Research Centre, G. d’Annunzio University, Chieti, Italy
| | - Afina W. Lemstra
- Department of Neurology & Alzheimer Centre, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
Neurologic applications were at the forefront of PET imaging when the technique was developed in the mid-1970s. Although oncologic indications have become prominent in terms of number of studies performed worldwide, neurology remains a major field in which functional imaging provides unique information, both for clinical and research purposes. The evaluation of glucose metabolism using FDG remains the most frequent exploration, but in recent years, alternative radiotracers have been developed, including fluorinated amino acid analogues for primary brain tumor imaging and fluorinated compounds for assessing the amyloid deposits in patients with suspected Alzheimer disease. As the brain is enclosed in the skull, which presents fixed landmarks, it is relatively easy to coregister images obtained with various cross-sectional imaging methods, either functional or anatomical, with a relatively high accuracy and robustness. Nevertheless, PET in neurology has fully benefited from the advent of hybrid imaging. Attenuation and scatter correction is now much faster and equally accurate, using CT as compared with the traditional transmission scan using an external radioactive source. The perfect coregistration with the CT data, which is now systematically performed, also provides its own set of valuable information, for instance regarding cerebral atrophy. However, hybrid imaging in neurology comes with pitfalls and limitations, in addition to those that are well known, for example, blood glucose levels or psychotropic drugs that greatly affect the physiological FDG uptake. Movements of the patient's head, either during the PET acquisition or between the PET and the CT acquisitions will generate artifacts that may be very subtle yet lead to erroneous interpretation of the study. Similarly, quantitative analysis, such as voxel-based analyses, may prove very helpful in improving the diagnostic accuracy and the reproducibility of the reading, but a wide variety of artifacts may also be introduced, and should therefore be identified and corrected.
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Affiliation(s)
- Eric Salmon
- Division of Nuclear Medicine, Department of Medical Physics, Cyclotron Research Center, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Claire Bernard Ir
- Division of Nuclear Medicine, Department of Medical Physics, Cyclotron Research Center, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine, Department of Medical Physics, Cyclotron Research Center, University Hospital of Liège, University of Liège, Liège, Belgium.
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Boeve BF, Dickson DW, Duda JE, Ferman TJ, Galasko DR, Galvin JE, Goldman JG, Growdon JH, Hurtig HI, Kaufer DI, Kantarci K, Leverenz JB, Lippa CF, Lopez OL, McKeith IG, Singleton AB, Taylor A, Tsuang D, Weintraub D, Zabetian CP. Arguing against the proposed definition changes of PD. Mov Disord 2016; 31:1619-1622. [PMID: 27492190 PMCID: PMC5168716 DOI: 10.1002/mds.26721] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 05/31/2016] [Accepted: 06/03/2016] [Indexed: 11/25/2022] Open
Abstract
As members of the Lewy Body Dementia Association Scientific Advisory Council, we aim to address some of the issues raised in the article titled “Time to Redefine PD? Introductory Statement of the MDS Task Force on the Definition of Parkinson's Disease.” In particular, we suggest that the 1‐year rule distinguishing Parkinson's disease dementia from dementia with Lewy bodies is worth maintaining because it serves an important purpose in clinical practice and clinical and basic science research and when helping the lay community understand the complexity of these different clinical phenotypes. Furthermore, we believe that adding an additional diagnostic label, “PD (dementia with Lewy bodies subtype),” will confuse rather than clarify the distinction between dementia with Lewy bodies and PD or PD dementia, and will not improve management or expedite therapeutic development. We present arguments supporting our contentions. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Bradley F Boeve
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Dennis W Dickson
- Departments of Pathology and Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
| | - John E Duda
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
| | - Douglas R Galasko
- Department of Neurosciences, University of California, San Diego, California, USA
| | - James E Galvin
- Marcus Neuroscience Institute, Florida Atlantic University, Boca Raton, Florida, USA
| | - Jennifer G Goldman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - John H Growdon
- Department of Neurology, Harvard Medical School at Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Howard I Hurtig
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Daniel I Kaufer
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carol F Lippa
- Department of Neurology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ian G McKeith
- Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Angela Taylor
- Lewy Body Dementia Association, Lilburn, Georgia, USA
| | - Debby Tsuang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Daniel Weintraub
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cyrus P Zabetian
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
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Abdelnour C, van Steenoven I, Londos E, Blanc F, Auestad B, Kramberger MG, Zetterberg H, Mollenhauer B, Boada M, Aarsland D. Alzheimer's disease cerebrospinal fluid biomarkers predict cognitive decline in lewy body dementia. Mov Disord 2016; 31:1203-8. [DOI: 10.1002/mds.26668] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/11/2016] [Accepted: 04/13/2016] [Indexed: 01/13/2023] Open
Affiliation(s)
- Carla Abdelnour
- Fundació ACE, Alzheimer Research Center and Memory ClinicInstitut Català de Neurociències AplicadesBarcelona Spain
| | - Inger van Steenoven
- Alzheimer Center, Department of NeurologyVU Medical CenterAmsterdam The Netherlands
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical SciencesLund UniversityMalmö Sweden
| | - Frédéric Blanc
- Neuropsychology Unit and Geriatric Day Hospital (Strasbourg Resource and Research Memory Center, CMRR), University Hospital of Strasbourg and ICube laboratory, FMTSUniversity of Strasbourg and CNRSStrasbourg France
| | - Bjørn Auestad
- Research DepartmentStavanger University HospitalStavanger Norway
- Department of Mathematics and Natural SciencesUniversity of StavangerStavanger Norway
| | | | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistrythe Sahlgrenska Academy at the University of GothenburgMölndal Sweden
- Department of Molecular NeuroscienceUCL Institute of NeurologyLondon United Kingdom
| | - Brit Mollenhauer
- Paracelsus‐Elena‐Klinik, Kassel and University Medical Center, Department of Neurosurgery and Institute of NeuropathologyGöttingen Germany
| | - Mercè Boada
- Fundació ACE, Alzheimer Research Center and Memory ClinicInstitut Català de Neurociències AplicadesBarcelona Spain
| | - Dag Aarsland
- Research DepartmentStavanger University HospitalStavanger Norway
- Karolinska Institutet, Department of Neurobiology, Care sciences and Society (NVS)Center for Alzheimer Research Division for NeurogeriatricsStockholm Sweden
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Blennow K, Biscetti L, Eusebi P, Parnetti L. Cerebrospinal fluid biomarkers in Alzheimer's and Parkinson's diseases-From pathophysiology to clinical practice. Mov Disord 2016; 31:836-47. [DOI: 10.1002/mds.26656] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/22/2016] [Accepted: 03/25/2016] [Indexed: 01/05/2023] Open
Affiliation(s)
- Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg; Mölndal Campus Mölndal Sweden
| | - Leonardo Biscetti
- Section of Neurology, Department of Medicine, Center for Memory Disturbances, University of Perugia; Sant'Andrea delle Fratte Perugia Italy
| | - Paolo Eusebi
- Section of Neurology, Department of Medicine, Center for Memory Disturbances, University of Perugia; Sant'Andrea delle Fratte Perugia Italy
| | - Lucilla Parnetti
- Section of Neurology, Department of Medicine, Center for Memory Disturbances, University of Perugia; Sant'Andrea delle Fratte Perugia Italy
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Abstract
PURPOSE OF REVIEW This article provides an overview of the clinical features, neuropathologic findings, diagnostic criteria, and management of dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD), together known as the Lewy body dementias. RECENT FINDINGS DLB and PDD are common, clinically similar syndromes that share characteristic neuropathologic changes, including deposition of α-synuclein in Lewy bodies and neurites and loss of tegmental dopamine cell populations and basal forebrain cholinergic populations, often with a variable degree of coexisting Alzheimer pathology. The clinical constellations of DLB and PDD include progressive cognitive impairment associated with parkinsonism, visual hallucinations, and fluctuations of attention and wakefulness. Current clinical diagnostic criteria emphasize these features and also weigh evidence for dopamine cell loss measured with single-photon emission computed tomography (SPECT) imaging and for rapid eye movement (REM) sleep behavior disorder, a risk factor for the synucleinopathies. The timing of dementia relative to parkinsonism is the major clinical distinction between DLB and PDD, with dementia arising in the setting of well-established idiopathic Parkinson disease (after at least 1 year of motor symptoms) denoting PDD, while earlier cognitive impairment relative to parkinsonism denotes DLB. The distinction between these syndromes continues to be an active research question. Treatment for these illnesses remains symptomatic and relies on both pharmacologic and nonpharmacologic strategies. SUMMARY DLB and PDD are important and common dementia syndromes that overlap in their clinical features, neuropathology, and management. They are believed to exist on a spectrum of Lewy body disease, and some controversy persists in their differentiation. Given the need to optimize cognition, extrapyramidal function, and psychiatric health, management can be complex and should be systematic.
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Markers of cognitive decline in PD: The case for heterogeneity. Parkinsonism Relat Disord 2016; 24:8-14. [PMID: 26774536 DOI: 10.1016/j.parkreldis.2016.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 01/25/2023]
Abstract
Cognitive impairment is highly prevalent and has a severe negative effect on health related and perceived quality of life in Parkinson's disease (PD). It is now established that 20-40% of persons with PD will develop cognitive deficits early in the disease. Moreover, the risk of developing dementia is six times higher in PD patients than in age-matched controls and it is estimated that 80% of patients will develop dementia after 20 years of the disease. In order to address these symptoms properly it is crucial to identify very early in the disease the patients who are most likely to develop dementia rapidly. Persons who meet criteria for mild cognitive impairment (MCI) exhibit measurable cognitive deficits but those deficits are not severe enough to interfere significantly with daily life. While the presence of MCI in PD increases the chance of developing dementia, various studies suggest that PD-MCI might consist of distinct subtypes with different pathophysiologies and prognoses. In this paper we comment on various biomarkers associated with cognitive decline in PD, specifically clinical, neuropathological, genetic and neuroimaging ones. We also discuss disrupted functional connectivity in PD-MCI and reveal preliminary results from our own group. We propose that the current studies looking at different types of biomarkers provide support for different causes being associated with cognitive decline in PD. Large-scale multi-disciplinary and multi-modal longitudinal studies are required to identify more specifically the different phenotypes associated with different cognitive profiles and evolution in PD.
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Gomperts SN, Marquie M, Locascio JJ, Bayer S, Johnson KA, Growdon JH. PET Radioligands Reveal the Basis of Dementia in Parkinson's Disease and Dementia with Lewy Bodies. NEURODEGENER DIS 2015; 16:118-24. [PMID: 26655867 DOI: 10.1159/000441421] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/01/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Effective therapies for dementia with Lewy bodies (DLB) and Parkinson's disease (PD) dementia will require accurate diagnosis and an understanding of the contribution of distinct molecular pathologies to these diseases. We seek to use imaging biomarkers to improve diagnostic accuracy and to clarify the contribution of molecular species to cognitive impairment in DLB and PD. SUMMARY We have performed cross-sectional and prospective cohort studies in subjects with DLB, PD with normal cognition, PD with mild cognitive impairment and PD with dementia, contrasted with Alzheimer's disease (AD) and healthy control subjects (HCS). Subjects underwent formal neurological examination, detailed neuropsychological assessments, MRI and PET scans with the radioligands altropane (a dopamine transporter, DAT) and Pittsburgh compound B (PiB; β-amyloid). Putamen DAT concentrations were similar in DLB and PD and differentiated them from HCS and AD. Decreased caudate DAT concentration related to functional impairment in DLB but not PD. PiB uptake was greatest in DLB. However, cortical PiB retention was common in PD and predicted cognitive decline. PET imaging of tau aggregates holds promise both to clarify the contribution of tau to cognitive decline in these diseases and to differentiate DLB and PD from the parkinsonian tauopathies. KEY MESSAGES Together, DAT and amyloid PET imaging discriminate DLB from PD and from other disease groups and identify pathological processes that contribute to their course. Multimodal PET imaging has the potential to increase the diagnostic accuracy of DLB and PD in the clinic, improve cohort uniformity for clinical trials, and serve as biomarkers for targeted molecular therapies.
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Peraza LR, Colloby SJ, Firbank MJ, Greasy GS, McKeith IG, Kaiser M, O'Brien J, Taylor J. Resting state in Parkinson's disease dementia and dementia with Lewy bodies: commonalities and differences. Int J Geriatr Psychiatry 2015; 30:1135-46. [PMID: 26270627 PMCID: PMC4737212 DOI: 10.1002/gps.4342] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD) are two dementias with overlapping phenotypes. Clinically, these are differentiated by the one-year precedence rule between the onset of dementia with respect to Parkinsonism. In this report we aimed to find differences between DLB and PDD in functional connectivity (FC) using resting state functional magnetic resonance imaging, which we hypothesised would reflect the underlying pathological differences between DLB and PDD. METHODS The study cohort comprised of 18 patients with DLB, 12 with PDD and 17 healthy control (HC) groups. Eight cortical and four subcortical seeds were chosen, and time series extracted to estimate correlation maps. We also implemented a voxel-based morphometry (VBM) analysis to assess regional grey matter differences. FC analysis was corrected for age, sex and regional grey matter differences. RESULTS The FC analysis showed greater alterations in DLB than in PDD for seeds placed within the fronto-parietal network (FPN), whilst in contrast, for the supplementary motor area seed FC alterations were more apparent in PDD than in DLB. However, when comparing DLB and PDD, no significant differences were found. In addition, VBM analysis revealed greater atrophy in PDD than HC and DLB in the bilateral motor cortices and precuneus respectively. CONCLUSIONS PDD and DLB demonstrate similar FC alterations in the brain. However, attention- and motor-related seeds revealed subtle differences between both conditions when compared with HC, which may relate to the neuropathology and chronological precedence of core symptoms in the Lewy body dementias.
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Affiliation(s)
- Luis R. Peraza
- Institute of Neuroscience, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK,Institute of Ageing, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Sean J. Colloby
- Institute of Neuroscience, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Michael J. Firbank
- Institute of Neuroscience, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - G. Shirmin Greasy
- Institute of Neuroscience, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Ian G. McKeith
- Institute of Neuroscience, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
| | - Marcus Kaiser
- Institute of Neuroscience, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK,Interdisciplinary Computing and Complex BioSystems (ICOS) Research Group, School of Computing ScienceNewcastle UniversityNewcastle upon TyneUK
| | - John O'Brien
- Institute of Neuroscience, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK,Department of Psychiatry, Cambridge Biomedical CampusUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - John‐Paul Taylor
- Institute of Neuroscience, Campus for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
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Yoon JH, Kim M, Moon SY, Yong SW, Hong JM. Olfactory function and neuropsychological profile to differentiate dementia with Lewy bodies from Alzheimer's disease in patients with mild cognitive impairment: A 5-year follow-up study. J Neurol Sci 2015; 355:174-9. [PMID: 26076880 DOI: 10.1016/j.jns.2015.06.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a well-known precursor of Alzheimer's disease (AD) but often also precedes dementia with Lewy bodies (DLB). The early differentiation of DLB from AD is important to delay disease progression. Olfactory dysfunction is a well-known early sign of both AD and Lewy body disorders, including Parkinson's disease (PD) and DLB. Thus, the aim of the present study was to determine whether olfactory and neuropsychological tests can aid in the differentiation of DLB from AD at the MCI stage. METHODS The present study included 122 MCI patients who were monitored until they developed dementia or until their condition stabilized; the follow-up period averaged 4.9 years (range: 3.9-6.2 years). Baseline olfactory function as measured with the Cross-Cultural Smell Identification (CCSI) test and neuropsychological data were compared. RESULTS During the follow-up period, 32 subjects developed probable AD (MCI-AD), 18 had probable DLB (MCI-DLB), 45 did not convert to dementia (MCI-stable), and eight developed a non-AD/DLB dementia. The mean CCSI score (95% confidence interval [CI]) in patients with MCI-DLB (4.6; 95% CI: 4.0-5.3) was significantly lower than that of MCI-AD patients (6.4; 95% CI: 6.0-6.7, p<0.001) and MCI-stable patients (7.3; 95% CI: 6.9-7.8, p<0.001). The area under the curve of the receiver operating characteristic to discriminate MCI-DLB from MCI-AD using CCSI scores was (0.84; 95% CI: 0.72-0.97). Frontal-executive function and visuospatial ability was worse in patients with MCI-DLB, while verbal recognition memory impairment was greater in those with MCI-AD. CONCLUSION Olfactory and neuropsychological tests can help predict conversion to DLB or AD in patients with MCI.
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Affiliation(s)
- Jung Han Yoon
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea.
| | - Min Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - So Young Moon
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Seok Woo Yong
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
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32
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Vandenberghe R. The relationship between amyloid deposition, neurodegeneration, and cognitive decline in dementia. Curr Neurol Neurosci Rep 2015; 14:498. [PMID: 25224538 DOI: 10.1007/s11910-014-0498-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Amyloid imaging has been clinically approved for measuring β amyloid plaque load in patients being evaluated for Alzheimer's disease or other causes of cognitive decline. Here we explore a multidimensional approach to cognitive decline, where we situate amyloid plaque burden among a number of other relevant dimensions, such as aging, volume loss, other proteinopathies such as TDP43 and Lewy bodies, and functional reorganisation of cognitive brain systems. The multidimensional model incorporates a 'pure AD' trajectory, corresponding to e.g. monogenic Alzheimer's disease, but leaves room for other combinations of biomarker abnormalities (e.g. volume loss without amyloid positivity) and other trajectories. More tools will become available in the future that allow one to carve out a causal-mechanistic space for explaing cognitive decline in a personalized manner, enhancing progress towards more efficacious interventions.
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Affiliation(s)
- Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, University of Leuven, Leuven, Belgium,
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33
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Fujishiro H, Nakamura S, Sato K, Iseki E. Prodromal dementia with Lewy bodies. Geriatr Gerontol Int 2015; 15:817-26. [PMID: 25690399 DOI: 10.1111/ggi.12466] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 11/26/2022]
Abstract
Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementing disorder after Alzheimer's disease (AD), but there is limited information regarding the prodromal DLB state compared with that of AD. Parkinson's disease (PD) and DLB share common prodromal symptoms with Lewy body disease (LBD), allowing us to use a common strategy for identifying the individuals with an underlying pathophysiology of LBD. Dysautonomia, olfactory dysfunction, rapid eye movement sleep behavior disorder (RBD) and psychiatric symptoms antedate the onset of dementia by years or even decades in patients with DLB. Although RBD is the most potentially accurate prodromal predictor of DLB, disease progression before the onset of dementia could differ between the prodromal DLB state with and without RBD. Experts who specialize in idiopathic RBD and DLB might need communication in order to clarify the clinical relevance of RBD with the disease progression of DLB. The presence of prodromal LBD symptoms or findings of occipital hypoperfusion/hypometabolism helps us to predict the possible pathophysiological process of LBD in non-demented patients. This approach might provide the opportunity for additional neuroimaging, including cardiac (123) I-metaiodobenzylguanidine scintigraphy and dopamine transporter imaging. Although limited radiological findings in patients with prodromal DLB states have been reported, there is now a need for larger clinical multisite studies with pathological verification. The long prodromal phase of DLB provides a critical opportunity for potential intervention with disease-modifying therapy, but only if we are able to clearly identify the diversity in the clinical courses of DLB. In the present article, we reviewed the limited literature regarding the clinical profiles of prodromal DLB.
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Affiliation(s)
- Hiroshige Fujishiro
- Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Kiyoshi Sato
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto, Japan
| | - Eizo Iseki
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto, Japan
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