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Juengling F, Wuest F, Schirrmacher R, Abele J, Thiel A, Soucy JP, Camicioli R, Garibotto V. PET Imaging in Dementia: Mini-Review and Canadian Perspective for Clinical Use. Can J Neurol Sci 2024:1-13. [PMID: 38433571 DOI: 10.1017/cjn.2024.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
PET imaging is increasingly recognized as an important diagnostic tool to investigate patients with cognitive disturbances of possible neurodegenerative origin. PET with 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG), assessing glucose metabolism, provides a measure of neurodegeneration and allows a precise differential diagnosis among the most common neurodegenerative diseases, such as Alzheimer's disease, frontotemporal dementia or dementia with Lewy bodies. PET tracers specific for the pathological deposits characteristic of different neurodegenerative processes, namely amyloid and tau deposits typical of Alzheimer's Disease, allow the visualization of these aggregates in vivo. [18F]FDG and amyloid PET imaging have reached a high level of clinical validity and are since 2022 investigations that can be offered to patients in standard clinical care in most of Canada.This article will briefly review and summarize the current knowledge on these diagnostic tools, their integration into diagnostic algorithms as well as perspectives for future developments.
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Affiliation(s)
- Freimut Juengling
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Division of Oncologic Imaging and Radionuclide Therapy, Cross Cancer Institute, Edmonton, AB, Canada
- Medical Faculty, University of Bern, Bern, Switzerland
| | - Frank Wuest
- Division of Oncologic Imaging and Radionuclide Therapy, Cross Cancer Institute, Edmonton, AB, Canada
| | - Ralf Schirrmacher
- Division of Oncologic Imaging and Radionuclide Therapy, Cross Cancer Institute, Edmonton, AB, Canada
- Medical Isotope and Cyclotron Facility, University of Alberta, Edmonton, AB, Canada
| | - Jonathan Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Alexander Thiel
- Department of Neurology and Neurosurgery, Lady Davis Institute for Medical Research, McGill University, Montréal, QC, Canada
| | - Jean-Paul Soucy
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Valentina Garibotto
- Diagnostic Department, Nuclear Medicine and Molecular Imaging Division, University Hospitals of Geneva, Geneva, Switzerland
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Lee YG, Jeon S, Baik K, Kang SW, Ye BS. Substantia nigral dopamine transporter uptake in dementia with Lewy bodies. NPJ Parkinsons Dis 2023; 9:88. [PMID: 37296236 PMCID: PMC10256694 DOI: 10.1038/s41531-023-00534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Nigrostriatal dopaminergic degeneration is a pathological hallmark of dementia with Lewy bodies (DLB). To identify the subregional dopamine transporter (DAT) uptake patterns that improve the diagnostic accuracy of DLB, we analyzed N-(3-[18F] fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl)-nortropane (FP-CIT) PET in 51 patients with DLB, in 36 patients with mild cognitive impairment with Lewy body (MCI-LB), and in 40 healthy controls (HCs). In addition to a high affinity for DAT, FP-CIT show a modest affinity to serotonin or norepinephrine transporters. Specific binding ratios (SBRs) of the nigrostriatal subregions were transformed to age-adjusted z-scores (zSBR) based on HCs. The diagnostic accuracy of subregional zSBRs were tested using receiver operating characteristic (ROC) curve analyses separately for MCI-LB and DLB versus HCs. Then, the effect of subregional zSBRs on the presence of clinical features and gray matter (GM) density were evaluated in all patients with MCI-LB or DLB as a group. ROC curve analyses showed that the diagnostic accuracy of DLB based on the zSBR of substantia nigra (area under the curve [AUC], 0.90) or those for MCI-LB (AUC, 0.87) were significantly higher than that based on the zSBR of posterior putamen for DLB (AUC, 0.72) or MCI-LB (AUC, 0.65). Lower zSBRs in nigrostriatal regions were associated with visual hallucination, severe parkinsonism, and cognitive dysfunction, while lower zSBR of substantia nigra was associated with widespread GM atrophy in DLB and MCI-LB patients. Taken together, our results suggest that evaluation of nigral DAT uptake may increase the diagnostic accuracy of DLB and MCI-LB than other striatal regions.
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Affiliation(s)
- Young-Gun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Seun Jeon
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Woo Kang
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
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Jreige M, Kurian GK, Perriraz J, Potheegadoo J, Bernasconi F, Stampacchia S, Blanke O, Alessandra G, Lejay N, Chiabotti PS, Rouaud O, Nicod Lalonde M, Schaefer N, Treglia G, Allali G, Prior JO. The diagnostic performance of functional dopaminergic scintigraphic imaging in the diagnosis of dementia with Lewy bodies: an updated systematic review. Eur J Nucl Med Mol Imaging 2023; 50:1988-2035. [PMID: 36920494 PMCID: PMC10199865 DOI: 10.1007/s00259-023-06154-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/13/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Dopaminergic scintigraphic imaging is a cornerstone to support the diagnosis in dementia with Lewy bodies. To clarify the current state of knowledge on this imaging modality and its impact on clinical diagnosis, we performed an updated systematic review of the literature. METHODS This systematic review was carried out according to PRISMA guidelines. A comprehensive computer literature search of PubMed/MEDLINE, EMBASE, and Cochrane Library databases for studies published through June 2022 was performed using the following search algorithm: (a) "Lewy body" [TI] OR "Lewy bodies" [TI] and (b) ("DaTscan" OR "ioflupane" OR "123ip" OR "123?ip" OR "123 ip" OR "123i-FP-CIT" OR "FPCIT" OR "FP-CIT" OR "beta?CIT" OR "beta CIT" OR "CIT?SPECT" OR "CIT SPECT" OR "Dat?scan*" OR "dat scan*" OR "dat?spect*" OR "SPECT"). Risk of bias and applicability concerns of the studies were evaluated using the QUADAS-2 tool. RESULTS We performed a qualitative analysis of 59 studies. Of the 59 studies, 19 (32%) addressed the diagnostic performance of dopamine transporter imaging, 15 (25%) assessed the identification of dementia with Lewy bodies in the spectrum of Lewy body disease and 18 (31%) investigated the role of functional dopaminergic imaging in distinguishing dementia with Lewy bodies from other dementias. Dopamine transporter loss was correlated with clinical outcomes in 19 studies (32%) and with other functional imaging modalities in 15 studies (25%). Heterogeneous technical aspects were found among the studies through the use of various radioligands, the more prevalent being the [123I]N‑ω‑fluoropropyl‑2β‑carbomethoxy‑3β‑(4‑iodophenyl) nortropane (123I-FP-CIT) in 54 studies (91.5%). Image analysis used visual analysis (9 studies, 15%), semi-quantitative analysis (29 studies, 49%), or a combination of both (16 studies, 27%). CONCLUSION Our systematic review confirms the major role of dopaminergic scintigraphic imaging in the assessment of dementia with Lewy bodies. Early diagnosis could be facilitated by identifying the prodromes of dementia with Lewy bodies using dopaminergic scintigraphic imaging coupled with emphasis on clinical neuropsychiatric symptoms. Most published studies use a semi-quantitative analytical assessment of tracer uptake, while there are no studies using quantitative analytical methods to measure dopamine transporter loss. The superiority of a purely quantitative approach to assess dopaminergic transmission more accurately needs to be further clarified.
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Affiliation(s)
- Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - George K Kurian
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Jérémy Perriraz
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jevita Potheegadoo
- Laboratory of Cognitive Neuroscience, Neuro-X Institute & Brain Mind Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Fosco Bernasconi
- Laboratory of Cognitive Neuroscience, Neuro-X Institute & Brain Mind Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Sara Stampacchia
- Laboratory of Cognitive Neuroscience, Neuro-X Institute & Brain Mind Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Neuro-X Institute & Brain Mind Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Griffa Alessandra
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Noemie Lejay
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Paolo Salvioni Chiabotti
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Rouaud
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Nicod Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Giorgio Treglia
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Gilles Allali
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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Sensi SL, Russo M, Tiraboschi P. Biomarkers of diagnosis, prognosis, pathogenesis, response to therapy: Convergence or divergence? Lessons from Alzheimer's disease and synucleinopathies. HANDBOOK OF CLINICAL NEUROLOGY 2023; 192:187-218. [PMID: 36796942 DOI: 10.1016/b978-0-323-85538-9.00015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Alzheimer's disease (AD) is the most common disorder associated with cognitive impairment. Recent observations emphasize the pathogenic role of multiple factors inside and outside the central nervous system, supporting the notion that AD is a syndrome of many etiologies rather than a "heterogeneous" but ultimately unifying disease entity. Moreover, the defining pathology of amyloid and tau coexists with many others, such as α-synuclein, TDP-43, and others, as a rule, not an exception. Thus, an effort to shift our AD paradigm as an amyloidopathy must be reconsidered. Along with amyloid accumulation in its insoluble state, β-amyloid is becoming depleted in its soluble, normal states, as a result of biological, toxic, and infectious triggers, requiring a shift from convergence to divergence in our approach to neurodegeneration. These aspects are reflected-in vivo-by biomarkers, which have become increasingly strategic in dementia. Similarly, synucleinopathies are primarily characterized by abnormal deposition of misfolded α-synuclein in neurons and glial cells and, in the process, depleting the levels of the normal, soluble α-synuclein that the brain needs for many physiological functions. The soluble to insoluble conversion also affects other normal brain proteins, such as TDP-43 and tau, accumulating in their insoluble states in both AD and dementia with Lewy bodies (DLB). The two diseases have been distinguished by the differential burden and distribution of insoluble proteins, with neocortical phosphorylated tau deposition more typical of AD and neocortical α-synuclein deposition peculiar to DLB. We propose a reappraisal of the diagnostic approach to cognitive impairment from convergence (based on clinicopathologic criteria) to divergence (based on what differs across individuals affected) as a necessary step for the launch of precision medicine.
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Affiliation(s)
- Stefano L Sensi
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology Unit, Center for Advanced Studies and Technology-CAST and ITAB Institute for Advanced Biotechnology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Mirella Russo
- Department of Neuroscience, Imaging, and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Molecular Neurology Unit, Center for Advanced Studies and Technology-CAST and ITAB Institute for Advanced Biotechnology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Pietro Tiraboschi
- Division of Neurology V-Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Nicastro N, Nencha U, Burkhard PR, Garibotto V. Dopaminergic imaging in degenerative parkinsonisms, an established clinical diagnostic tool. J Neurochem 2023; 164:346-363. [PMID: 34935143 DOI: 10.1111/jnc.15561] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
Parkinson's disease (PD) and other neurodegenerative parkinsonisms are characterised by loss of striatal dopaminergic neurons. Dopamine functional deficits can be measured in vivo using positron emission tomography (PET) and single-photon emission computed tomography (SPECT) ligands assessing either presynaptic (e.g. dopamine synthesis and storage, transporter density) or postsynaptic terminals (i.e. D2 receptors availability). Nuclear medicine imaging thus helps the clinician to separate degenerative forms of parkinsonism with other neurological conditions, e.g. essential tremor or drug-induced parkinsonism. With the present study, we aimed at summarizing the current evidence about dopaminergic molecular imaging in the diagnostic evaluation of PD, atypical parkinsonian syndromes and dementia with Lewy bodies (DLB), as well as its potential to distinguish these conditions and to estimate disease progression. In fact, PET/SPECT methods are clinically validated and have been increasingly integrated into diagnostic guidelines (e.g. for PD and DLB). In addition, there is novel evidence on the classification properties of extrastriatal signal. Finally, dopamine imaging has an outstanding potential to detect neurodegeneration at the premotor stage, including REM-sleep behavior disorder and olfactory loss. Therefore, inclusion of subjects at an early stage for clinical trials can largely benefit from a validated in vivo biomarker such as presynaptic dopamine pathways PET/SPECT assessment.
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Affiliation(s)
- Nicolas Nicastro
- Division of Neurorehabilitation, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Umberto Nencha
- Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre R Burkhard
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Valentina Garibotto
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
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Thomas AJ, Hamilton CA, Heslegrave A, Barker S, Durcan R, Lawley S, Barnett N, Lett D, Firbank M, Roberts G, Taylor JP, Donaghy PC, Zetterberg H, O'Brien J. A Longitudinal Study of Plasma pTau181 in Mild Cognitive Impairment with Lewy Bodies and Alzheimer's Disease. Mov Disord 2022; 37:1495-1504. [PMID: 35318733 PMCID: PMC9540809 DOI: 10.1002/mds.28994] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) co-pathology is common in dementia with Lewy bodies and is associated with increased decline. Plasma pTau181 is a blood-based biomarker that can detect AD co-pathology. OBJECTIVES We investigated whether pTau181 was associated with cognitive decline in mild cognitive impairment with Lewy bodies (MCI-LB) and MCI with AD (MCI-AD). METHODS We assessed plasma pTau181 using a single-molecule array (Simoa) immunoassay at baseline and follow-up in a longitudinal cohort of MCI-LB, MCI-AD, and controls. RESULTS One hundred forty-six subjects (56 probable MCI-LB, 22 possible MCI-LB, 44 MCI-AD, and 24 controls) were reviewed for up to 5.7 years. Probable MCI-LB had significantly higher pTau181 (22.2% mean increase) compared with controls and significantly lower (24.4% mean decrease) levels compared with MCI-AD. Receiver operating characteristic analyses of pTau181 in discriminating probable MCI-LB from controls showed an area under the curve (AUC) of 0.68 (83% specificity, 57% sensitivity); for discriminating MCI-AD from healthy controls, AUC was 0.8 (83.3% specificity, 72.7% sensitivity). pTau181 concentration was less useful in discriminating between probable MCI-LB and MCI-AD: AUC of 0.64 (71.4% specificity, 52.3% sensitivity). There was an association between pTau181 and cognitive decline in MCI-AD but not in MCI-LB. In a subset with repeat samples there was a nonsignificant 3% increase per follow-up year in plasma pTau181. The rate of change in pTau181 was not significantly different in different diagnostic subgroups. CONCLUSIONS pTau181 was not associated with an increased decline assessed using either baseline or repeat pTau181. pTau181 partially discriminated probable MCI-LB from controls and MCI-AD from controls but was not useful in distinguishing probable MCI-LB from MCI-AD.
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Affiliation(s)
- Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amanda Heslegrave
- UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah Lawley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Debbie Lett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Palermo G, Giannoni S, Bellini G, Siciliano G, Ceravolo R. Dopamine Transporter Imaging, Current Status of a Potential Biomarker: A Comprehensive Review. Int J Mol Sci 2021; 22:11234. [PMID: 34681899 PMCID: PMC8538800 DOI: 10.3390/ijms222011234] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022] Open
Abstract
A major goal of current clinical research in Parkinson's disease (PD) is the validation and standardization of biomarkers enabling early diagnosis, predicting outcomes, understanding PD pathophysiology, and demonstrating target engagement in clinical trials. Molecular imaging with specific dopamine-related tracers offers a practical indirect imaging biomarker of PD, serving as a powerful tool to assess the status of presynaptic nigrostriatal terminals. In this review we provide an update on the dopamine transporter (DAT) imaging in PD and translate recent findings to potentially valuable clinical practice applications. The role of DAT imaging as diagnostic, preclinical and predictive biomarker is discussed, especially in view of recent evidence questioning the incontrovertible correlation between striatal DAT binding and nigral cell or axon counts.
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Affiliation(s)
- Giovanni Palermo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (G.P.); (S.G.); (G.B.); (G.S.)
| | - Sara Giannoni
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (G.P.); (S.G.); (G.B.); (G.S.)
- Unit of Neurology, San Giuseppe Hospital, 50053 Empoli, Italy
| | - Gabriele Bellini
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (G.P.); (S.G.); (G.B.); (G.S.)
| | - Gabriele Siciliano
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (G.P.); (S.G.); (G.B.); (G.S.)
| | - Roberto Ceravolo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (G.P.); (S.G.); (G.B.); (G.S.)
- Center for Neurodegenerative Diseases, Unit of Neurology, Parkinson’s Disease and Movement Disorders, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Olivieri P, Lebouvier T, Hardouin JB, Courtemanche H, Le Dily S, Barbin L, Pallardy A, Derkinderen P, Boutoleau-Bretonnière C. LeSCoD: a new clinical scale for the detection of Lewy body disease in neurocognitive disorders. J Neurol 2021; 268:3886-3896. [PMID: 33830336 DOI: 10.1007/s00415-021-10539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dementia with Lewy bodies remains underdiagnosed in clinical practice mainly because of the low sensitivity of existing diagnostic criteria and a strong overlap with Alzheimer's pathology that can mask the Lewy phenotype. OBJECTIVE The objective of this study was therefore to develop and validate a new clinical scale designed to detect signs of Lewy body disease, called LeSCoD for Lewy body Screening scale in Cognitive Disorders. METHODS 128 patients who fulfilled the clinical criteria of dementia with Lewy bodies (DLB; n = 32), Alzheimer's disease (AD; n = 77) or both (n = 19) was prospectively enrolled. 18F-DOPA PET imaging and/or CSF biomarkers were available in some patients. LeSCoD scale was systematically administered and the potential correlation with 18F-DOPA PET imaging was evaluated in a subgroup of patients. RESULTS LeSCoD scale showed robust internal and external validity. We determined a cut-off of 10 above which the sensitivity and specificity for Lewy body disease diagnosis were 86% and 95%, respectively. The LeSCoD scale correlated with striatal dopamine uptake in 18F-DOPA PET. CONCLUSION LeSCoD scale is a simple and reliable tool for the evaluation of Lewy body disease in routine clinical practice, with a higher sensitivity and specificity than the existing criteria. It might be an alternative to the use of dopamine-specific imaging.
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Affiliation(s)
- Pauline Olivieri
- Department of Neurology of Memory and Language, GHU Paris Psychiatry and Neurosciences, Hôpital Sainte Anne, 75014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Thibaud Lebouvier
- University of Lille, Inserm U1172, CHU Lille, DISTALZ, Lille, France
| | - Jean-Benoît Hardouin
- UMR INSERM 1246-SPHERE "Methods in Patient-Centered Outcomes and Health Research", Université de Nantes, Université de Tours, Tours, France.,Unit of Methodology and Biostatistics, Université de Nantes, Nantes, France
| | - Hélène Courtemanche
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France.,INSERM CIC 04, Nantes, France
| | | | | | | | | | - Claire Boutoleau-Bretonnière
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France. .,INSERM CIC 04, Nantes, France. .,Claire Boutoleau-Bretonnière, Centre Mémoire Ressource et Recherche (CMRR), Centre Hospitalier Universitaire de Nantes Hôpital Laennec, Boulevard Jacques Monod, 44000, Nantes, France.
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Saeed U, Lang AE, Masellis M. Neuroimaging Advances in Parkinson's Disease and Atypical Parkinsonian Syndromes. Front Neurol 2020; 11:572976. [PMID: 33178113 PMCID: PMC7593544 DOI: 10.3389/fneur.2020.572976] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson's disease (PD) and atypical Parkinsonian syndromes are progressive heterogeneous neurodegenerative diseases that share clinical characteristic of parkinsonism as a common feature, but are considered distinct clinicopathological disorders. Based on the predominant protein aggregates observed within the brain, these disorders are categorized as, (1) α-synucleinopathies, which include PD and other Lewy body spectrum disorders as well as multiple system atrophy, and (2) tauopathies, which comprise progressive supranuclear palsy and corticobasal degeneration. Although, great strides have been made in neurodegenerative disease research since the first medical description of PD in 1817 by James Parkinson, these disorders remain a major diagnostic and treatment challenge. A valid diagnosis at early disease stages is of paramount importance, as it can help accommodate differential prognostic and disease management approaches, enable the elucidation of reliable clinicopathological relationships ideally at prodromal stages, as well as facilitate the evaluation of novel therapeutics in clinical trials. However, the pursuit for early diagnosis in PD and atypical Parkinsonian syndromes is hindered by substantial clinical and pathological heterogeneity, which can influence disease presentation and progression. Therefore, reliable neuroimaging biomarkers are required in order to enhance diagnostic certainty and ensure more informed diagnostic decisions. In this article, an updated presentation of well-established and emerging neuroimaging biomarkers are reviewed from the following modalities: (1) structural magnetic resonance imaging (MRI), (2) diffusion-weighted and diffusion tensor MRI, (3) resting-state and task-based functional MRI, (4) proton magnetic resonance spectroscopy, (5) transcranial B-mode sonography for measuring substantia nigra and lentiform nucleus echogenicity, (6) single photon emission computed tomography for assessing the dopaminergic system and cerebral perfusion, and (7) positron emission tomography for quantifying nigrostriatal functions, glucose metabolism, amyloid, tau and α-synuclein molecular imaging, as well as neuroinflammation. Multiple biomarkers obtained from different neuroimaging modalities can provide distinct yet corroborative information on the underlying neurodegenerative processes. This integrative "multimodal approach" may prove superior to single modality-based methods. Indeed, owing to the international, multi-centered, collaborative research initiatives as well as refinements in neuroimaging technology that are currently underway, the upcoming decades will mark a pivotal and exciting era of further advancements in this field of neuroscience.
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Affiliation(s)
- Usman Saeed
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Center, Toronto, ON, Canada.,Cognitive and Movement Disorders Clinic, Sunnybrook Health Sciences Center, Toronto, ON, Canada
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Sasikumar S, Strafella AP. Imaging Mild Cognitive Impairment and Dementia in Parkinson's Disease. Front Neurol 2020; 11:47. [PMID: 32082250 PMCID: PMC7005138 DOI: 10.3389/fneur.2020.00047] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/14/2020] [Indexed: 12/11/2022] Open
Abstract
Cognitive dysfunction is a significant non-motor feature of Parkinson's disease, with the risk of dementia increasing with prolonged disease duration. Multiple cognitive domains are affected, and the pathophysiology cannot be explained by dopaminergic loss alone. Sophisticated neuroimaging techniques can detect the nature and extent of extra-nigral involvement by targeting neurotransmitters, abnormal protein aggregates and tissue metabolism. This review identifies the functional and anatomical imaging characteristics that predict cognitive impairment in PD, the limitations that challenge this process, and the avenues of potential research.
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Affiliation(s)
| | - Antonio P Strafella
- Division of Neurology, University of Toronto, Toronto, ON, Canada.,Morton and Gloria Shulman Movement Disorder Unit & E. J. Safra Parkinson Disease Program, Neurology Division, Department of Medicine, Toronto Western Hospital, UHN, University of Toronto, Toronto, ON, Canada.,Research Imaging Centre, Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, University of Toronto, Toronto, ON, Canada.,Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, UHN, University of Toronto, Toronto, ON, Canada
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11
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Mavroudis I, Petridis F, Kazis D. Cerebrospinal Fluid, Imaging, and Physiological Biomarkers in Dementia With Lewy Bodies. Am J Alzheimers Dis Other Demen 2019; 34:421-432. [PMID: 31422676 PMCID: PMC10653361 DOI: 10.1177/1533317519869700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Dementia with Lewy bodies is a progressive neurodegenerative disorder, clinically characterized by gradual cognitive impairment and fluctuating cognition, behavioral changes and recurrent visual hallucinations, and autonomic function and movement symptoms in the type of parkinsonism. It is the second most common type of dementia in the Western world after Alzheimer disease. Over the last 20 years, many neurophysiological, neuroimaging, and cerebrospinal fluid (CSF) biomarkers have been described toward a better discrimination between dementia with Lewy bodies, Alzheimer disease, and other neurodegenerative conditions.In the present review, we aim to describe the neurophysiological, imaging, and CSF biomarkers in dementia with Lewy bodies and to question whether they could be reliable tools for the clinical practice.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neurology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Kazis
- Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Nihashi T, Ito K, Terasawa T. Diagnostic accuracy of DAT-SPECT and MIBG scintigraphy for dementia with Lewy bodies: an updated systematic review and Bayesian latent class model meta-analysis. Eur J Nucl Med Mol Imaging 2019; 47:1984-1997. [PMID: 31423561 DOI: 10.1007/s00259-019-04480-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/07/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Imperfect clinical reference standards can preclude accurately estimating the diagnostic accuracy of DAT-SPECT and MIBG myocardial scintigraphy for diagnosing DLB. To investigate the validity of unadjusted accuracy, we updated our previous meta-analysis. METHODS Literature search was updated to March 18, 2018. We also examined published systematic review reports. Two investigators extracted data and rated study validity using the QUADAS-2 tool. We performed a Bayesian latent class model meta-analysis accounting for imperfect reference standards. RESULTS We evaluated 27 studies including 2236 patients. With the exception of two DAT-SPECT studies that involved postmortem neuropathological verification, studies were susceptible to bias from imperfect reference standards. Compared with the unadjusted accuracy estimates, the adjusted sensitivity values were similar, whereas the adjusted specificity values were generally lower for detecting α-synuclein pathology in the brain. The adjusted summary sensitivity and specificity were 0.86 (95% credible interval [CrI], 0.76-0.95) and 0.81 (CrI, 0.70-0.92), and 0.93 (CrI, 0.74-1.00) and 0.75 (CI, 0.47-0.94) for visual and semi-quantitative assessments of DAT-SPECT, respectively; 0.92 (CrI, 0.81-0.99) and 0.80 (CrI, 0.67-0.93), and 0.87 (CrI, 0.74-0.98) and 0.80 (CrI, 0.69-0.93), for delayed- and early-phase scans of MIBG scintigraphy, respectively. When diagnosing the typical clinical syndrome, the adjusted accuracy values were similar to the unadjusted estimates. The adjusted sensitivity and specificity were 0.89 (CrI, 0.75-0.98) and 0.87 (CrI, 0.72-0.97), and 0.97 (CrI, 0.78-1.0) and 0.70 (CrI, 0.43-0.92) for visual and semi-quantitative assessments of DAT-SPECT, respectively; and 0.93 (CrI, 0.81-0.98) and 0.90 (CrI, 0.73-0.97), and 0.85 (CrI, 0.66-0.96) and 0.96 (95% CI, 0.83-1.0) for delayed- and early-phase scans of MIBG scintigraphy, respectively. CONCLUSIONS In our adjusted analyses, both imaging biomarkers had high diagnostic accuracy for detecting the hallmark pathology in the brain and for diagnosing the typical clinical syndrome.
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Affiliation(s)
- Takashi Nihashi
- Department of Radiology, Komaki City Hospital, Komaki, Japan.,Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kengo Ito
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Teruhiko Terasawa
- Section of General Internal Medicine, Department of Emergency and General Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan. .,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
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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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14
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Peripheral inflammation in mild cognitive impairment with possible and probable Lewy body disease and Alzheimer's disease. Int Psychogeriatr 2019; 31:551-560. [PMID: 30854988 DOI: 10.1017/s1041610218001126] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED ABSTRACTObjectives and design:To Investigate the peripheral inflammatory profile in patients with mild cognitive impairment (MCI) from three subgroups - probable Lewy body disease (probable MCI-LB), possible Lewy body disease, and probable Alzheimer's disease (probable MCI-AD) - as well as associations with clinical features. SETTING Memory clinics and dementia services. PARTICIPANTS Patients were classified based on clinical symptoms as probable MCI-LB (n = 38), possible MCI-LB (n = 18), and probable MCI-AD (n = 21). Healthy comparison subjects were recruited (n = 20). MEASUREMENTS Ten cytokines were analyzed from plasma samples: interferon (IFN)-gamma, interleukin (IL)-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, and tumor necrosis factor (TNF)-alpha. C-reactive protein levels were investigated. RESULTS There was a higher level of IL-10, IL-1beta, IL-2, and IL-4 in MCI groups compared to the healthy comparison group (p < 0.0085). In exploratory analyses to understand these findings, the MC-AD group lower IL-1beta (p = 0.04), IL-2 (p = 0.009), and IL-4 (p = 0.012) were associated with increasing duration of memory symptoms, and in the probable MCI-LB group, lower levels of IL-1beta were associated with worsening motor severity (p = 0.002). In the possible MCI-LB, longer duration of memory symptoms was associated with lower levels of IL-1beta (p = 0.003) and IL-4 (p = 0.026). CONCLUSION There is increased peripheral inflammation in patients with MCI compared to healthy comparison subjects regardless of the MCI subtype. These possible associations with clinical features are consistent with other work showing that inflammation is increased in early disease but require replication. Such findings have importance for timing of putative therapeutic strategies aimed at lowering inflammation.
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Thomas AJ, Donaghy P, Roberts G, Colloby SJ, Barnett NA, Petrides G, Lloyd J, Olsen K, Taylor JP, McKeith I, O'Brien JT. Diagnostic accuracy of dopaminergic imaging in prodromal dementia with Lewy bodies. Psychol Med 2019; 49:396-402. [PMID: 29692275 PMCID: PMC6331684 DOI: 10.1017/s0033291718000995] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Dopaminergic imaging has high diagnostic accuracy for dementia with Lewy bodies (DLB) at the dementia stage. We report the first investigation of dopaminergic imaging at the prodromal stage. METHODS We recruited 75 patients over 60 with mild cognitive impairment (MCI), 33 with probable MCI with Lewy body disease (MCI-LB), 15 with possible MCI-LB and 27 with MCI with Alzheimer's disease. All underwent detailed clinical, neurological and neuropsychological assessments and FP-CIT [123I-N-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)] dopaminergic imaging. FP-CIT scans were blindly rated by a consensus panel and classified as normal or abnormal. RESULTS The sensitivity of visually rated FP-CIT imaging to detect combined possible or probable MCI-LB was 54.2% [95% confidence interval (CI) 39.2-68.6], with a specificity of 89.0% (95% CI 70.8-97.6) and a likelihood ratio for MCI-LB of 4.9, indicating that FP-CIT may be a clinically important test in MCI where any characteristic symptoms of Lewy body (LB) disease are present. The sensitivity in probable MCI-LB was 61.0% (95% CI 42.5-77.4) and in possible MCI-LB was 40.0% (95% CI 16.4-67.7). CONCLUSIONS Dopaminergic imaging had high specificity at the pre-dementia stage and gave a clinically important increase in diagnostic confidence and so should be considered in all patients with MCI who have any of the diagnostic symptoms of DLB. As expected, the sensitivity was lower in MCI-LB than in established DLB, although over 50% still had an abnormal scan. Accurate diagnosis of LB disease is important to enable early optimal treatment for LB symptoms.
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Affiliation(s)
- Alan J. Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Paul Donaghy
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Gemma Roberts
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP, UK
| | - Sean J. Colloby
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Nicky A. Barnett
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - George Petrides
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne NE1 4LP, UK
| | - Kirsty Olsen
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - John T. O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
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17
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Komatsu J, Samuraki M, Nakajima K, Arai H, Arai H, Arai T, Asada T, Fujishiro H, Hanyu H, Iizuka O, Iseki E, Kashihara K, Kosaka K, Maruno H, Mizukami K, Mizuno Y, Mori E, Nakamura H, Nakano S, Nakashima K, Nishio Y, Orimo S, Takahashi A, Taki J, Tokuda T, Urakami K, Utsumi K, Wada K, Washimi Y, Yamashina S, Yamasaki J, Yoshita M, Yamada M. 123I-MIBG myocardial scintigraphy for the diagnosis of DLB: a multicentre 3-year follow-up study. J Neurol Neurosurg Psychiatry 2018; 89:1167-1173. [PMID: 29853532 DOI: 10.1136/jnnp-2017-317398] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/26/2018] [Accepted: 05/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE We previously reported the usefulness of iodine-123 metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy for differentiation of dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) in a cross-sectional multicentre study. The aim of this study was, by using reassessed diagnosis after 3-year follow-up, to evaluate the diagnostic accuracy of 123I-MIBG scintigraphy in differentiation of probable DLB from probable AD. METHODS We undertook 3-year follow-up of 133 patients with probable or possible DLB or probable AD who had undergone 123I-MIBG myocardial scintigraphy at baseline. An independent consensus panel made final diagnosis at 3-year follow-up. Based on the final diagnosis, we re-evaluated the diagnostic accuracy of 123I-MIBG scintigraphy performed at baseline. RESULTS Sixty-five patients completed 3-year follow-up assessment. The final diagnoses were probable DLB (n=30), possible DLB (n=3) and probably AD (n=31), and depression (n=1). With a receiver operating characteristic curve analysis of heart-to-mediastinum (H/M) ratios for differentiating probable DLB from probable AD, the sensitivity/specificity were 0.77/0.94 for early images using 2.51 as the threshold of early H/M ratio, and 0.77/0.97 for delayed images using 2.20 as the threshold of delayed H/M ratio. Five of six patients who were diagnosed with possible DLB at baseline and with probable DLB at follow-up had low H/M ratio at baseline. CONCLUSIONS Our follow-up study confirmed high correlation between abnormal cardiac sympathetic activity evaluated with 123I-MIBG myocardial scintigraphy at baseline and the clinical diagnosis of probable DLB at 3-year follow-up. Its diagnostic usefulness in early stage of DLB was suggested. TRIAL REGISTRATION NUMBER UMIN00003419.
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Affiliation(s)
- Junji Komatsu
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Miharu Samuraki
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Heii Arai
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Arai
- Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tetsuaki Arai
- Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Asada
- Department of Neuropsychiatry, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshige Fujishiro
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Haruo Hanyu
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Osamu Iizuka
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eizo Iseki
- PET/CT Dementia Research Center, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Kenji Kosaka
- Department of Neurology, Medical Care Court Clinic, Yokohama, Japan
| | | | - Katsuyoshi Mizukami
- Faculty of Health and Sport Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yoshikuni Mizuno
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Seigo Nakano
- Center for Treatment, Care and Research of Dementia, Medical Co. LTA, Tokyo, Japan
| | - Kenji Nakashima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yoshiyuki Nishio
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | | | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Takahiko Tokuda
- Department of Molecular Pathobiology of Brain Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuya Urakami
- Department of Biological Regulation, Faculty of Medicine, School of Health Science, Tottori University, Tottori, Japan
| | - Kumiko Utsumi
- Department of Neuropsychiatry, Sunagawa City Medical Center, Sunagawa, Japan
| | - Kenji Wada
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yukihiko Washimi
- Department for Cognitive Disorders, Hospital of National Center for Geriatrics and Gerontology, Toyota, Japan
| | - Shouhei Yamashina
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Toho University School of Medicine, Tokyo, Japan
| | - Junichi Yamasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohmori Hospital, Toho University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Yoshita
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.,Department of Neurology, Hokuriku National Hospital, Toyama, Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Abstract
Lewy body dementia (DLB) is a common form of cognitive impairment, accounting for 30% of dementia cases in ages over 65 years. Early diagnosis of DLB has been challenging; particularly in the context of differentiation with Parkinson’s disease dementia and other forms of dementias, such as Alzheimer’s disease and rapidly progressive dementias. Current practice involves the use of [123I]FP-CIT-SPECT, [18F]FDG PET and [123I]MIBG molecular imaging to support diagnostic procedures. Structural imaging techniques have an essential role for excluding structural causes, which could lead to a DLB-like phenotype, as well as aiding differential diagnosis through illustrating disease-specific patterns of atrophy. Novel PET molecular imaging modalities, such as amyloid and tau imaging, may provide further insights into DLB pathophysiology and may aid in early diagnosis. A multimodal approach, through combining various established techniques and possibly using novel radioligands, might further aid towards an in-depth understanding of this highly disabling disease. In this review, we will provide an overview of neuroimaging applications in patients with DLB.
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Koenig AM, Nobuhara CK, Williams VJ, Arnold SE. Biomarkers in Alzheimer's, Frontotemporal, Lewy Body, and Vascular Dementias. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:164-172. [PMID: 31975911 DOI: 10.1176/appi.focus.20170048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article reviews the current evidence base for biomarkers of the most common causes of dementia in later life: Alzheimer's disease (AD), frontotemporal lobar degenerations, Lewy body dementias, and vascular cognitive impairment and dementia. Biomarkers are objectively measurable indicators of normal physiology, pathological processes, or response to an intervention. Ideally, they are sensitive, specific, easy to obtain, and closely reflect the underlying biological processes of interest. While such markers are well established and in broad clinical use for common disorders in general medicine (e.g., thallium stress tests for coronary artery disease or serum blood urea nitrogen and creatinine for renal failure), analogous, validated markers for AD or other common dementias are limited, although biomarkers in research settings and specialty dementia clinics are progressing toward clinical use. By way of introducing current and future biomarkers for dementias of later life, this article will benefit the practicing clinician by increasing awareness of the availability and utility of current and emerging biomarkers in dementia diagnosis and prognosis and for monitoring new disease-modifying therapeutics that arrive in the clinic over the coming decade.
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Affiliation(s)
- Aaron M Koenig
- All authors are with the MassGeneral Institute for Neurodegenerative Disease (MIND), Department of Neurology, Massachusetts General Hospital, Boston
| | - Chloe K Nobuhara
- All authors are with the MassGeneral Institute for Neurodegenerative Disease (MIND), Department of Neurology, Massachusetts General Hospital, Boston
| | - Victoria J Williams
- All authors are with the MassGeneral Institute for Neurodegenerative Disease (MIND), Department of Neurology, Massachusetts General Hospital, Boston
| | - Steven E Arnold
- All authors are with the MassGeneral Institute for Neurodegenerative Disease (MIND), Department of Neurology, Massachusetts General Hospital, Boston
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20
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Park KW, Hong YJ, Park JH, Park H, Cheon SM, Kim JW, Kim BC, Jeong YJ, Yoon HJ, Kang DY. Pattern of cerebral hypoperfusion according to the clinical staging in dementia with Lewy bodies. Neurocase 2018; 24:83-89. [PMID: 29508646 DOI: 10.1080/13554794.2018.1447133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study aimed to detect different patterns of cerebral hypoperfusion in DLB according to clinical staging. Thirty-three patients with DLB were recruited by clinical dementia rating (CDR) stage. Compared with control, cerebral hypoperfusion was mainly observed in the lingual gyrus, the cuneus, the occipital gyrus in CDR 0.5 group; the fusiform gyrus, the middle temporal gyrus, and the posterior cingulate in CDR 1; and the lingual gyrus, the cuneus, the hippocampus, the fusiform gyrus, and the inferior frontal gyrus in CDR 2. Our findings suggest that cerebral hypoperfusion spreads to the frontal cortex and temporal lobes as disease progresses.
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Affiliation(s)
- Kyung Won Park
- a Department of Neurology, Cognitive Disorders and Dementia Center, College of Medicine , Dong-A University , Busan , Korea.,b Institute of Convergence Bio-Health , Dong-A University , Busan , Korea
| | - Yun Jeong Hong
- a Department of Neurology, Cognitive Disorders and Dementia Center, College of Medicine , Dong-A University , Busan , Korea.,c Biomedical Research Institute , Pusan National University Hospital , Busan , Korea
| | - Jong Hwan Park
- b Institute of Convergence Bio-Health , Dong-A University , Busan , Korea
| | - Hyuntae Park
- b Institute of Convergence Bio-Health , Dong-A University , Busan , Korea.,d Department of Health Care Science , Dong-A University , Busan , Korea
| | - Sang Myung Cheon
- a Department of Neurology, Cognitive Disorders and Dementia Center, College of Medicine , Dong-A University , Busan , Korea
| | - Jae Woo Kim
- a Department of Neurology, Cognitive Disorders and Dementia Center, College of Medicine , Dong-A University , Busan , Korea
| | - Byeong C Kim
- e Department of Neurology , Chonnam National University Medical School , Gwangju , Korea
| | - Young Jin Jeong
- f Department of Nuclear Medicine, College of Medicine , Dong-A University , Busan , Korea
| | - Hyun Jin Yoon
- f Department of Nuclear Medicine, College of Medicine , Dong-A University , Busan , Korea
| | - Do-Young Kang
- b Institute of Convergence Bio-Health , Dong-A University , Busan , Korea.,f Department of Nuclear Medicine, College of Medicine , Dong-A University , Busan , Korea
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Electroencephalographic derived network differences in Lewy body dementia compared to Alzheimer's disease patients. Sci Rep 2018; 8:4637. [PMID: 29545639 PMCID: PMC5854590 DOI: 10.1038/s41598-018-22984-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/05/2018] [Indexed: 01/10/2023] Open
Abstract
Dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD) require differential management despite presenting with symptomatic overlap. Currently, there is a need of inexpensive DLB biomarkers which can be fulfilled by electroencephalography (EEG). In this regard, an established electrophysiological difference in DLB is a decrease of dominant frequency (DF)—the frequency with the highest signal power between 4 and 15 Hz. Here, we investigated network connectivity in EEG signals acquired from DLB patients, and whether these networks were able to differentiate DLB from healthy controls (HCs) and associated dementias. We analysed EEG recordings from old adults: HCs, AD, DLB and Parkinson’s disease dementia (PDD) patients. Brain networks were assessed with the minimum spanning tree (MST) within six EEG bands: delta, theta, high-theta, alpha, beta and DF. Patients showed lower alpha band connectivity and lower DF than HCs. DLB and PDD showed a randomised MST compared with HCs and AD in high-theta and alpha but not in DF. The MST randomisation in DLB and PDD reflects decreased brain efficiency as well as impaired neural synchronisation. However, the lack of network topology differences at the DF between all dementia groups and HCs may indicate a compensatory response of the brain to the neuropathology.
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Firbank MJ, O'Brien JT, Taylor JP. Long reaction times are associated with delayed brain activity in lewy body dementia. Hum Brain Mapp 2017; 39:633-643. [PMID: 29094778 PMCID: PMC5813138 DOI: 10.1002/hbm.23866] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/13/2017] [Accepted: 10/18/2017] [Indexed: 12/22/2022] Open
Abstract
A significant symptom of Lewy body dementia (LBD) is slow cognitive processing or bradyphrenia. In a previous fMRI task‐based study, we found slower responses in LBD, accompanied by greater deactivation in the default mode network. In this study, we investigated the timing and magnitude of the activations and deactivations with respect to reaction time to determine whether the slower responses in LBD were associated with delayed neuronal activity. Using fMRI, we examined the magnitude and latency of activations and deactivations during an event‐related attention task in 32 patients with LBD and 23 healthy controls using predefined regions of interest. Default mode network deactivations did not significantly differ in their timing between groups or task conditions, while the task‐related activations in the parietal, occipital, frontal, and motor cortex were all significantly later in the LBD group. Repeating the analysis with reaction time as a parametric modulator of activation magnitude produced similar findings, with the reaction time modulator being significant in a number of regions including the default mode network, suggesting that the increased deactivation in LBD is partly explained by slower task completion. Our data suggest that the default mode network deactivation is initiated at the start of the task, and remains deactivated until its end, with the increased magnitude of deactivation in LBD reflecting the more prolonged cognitive processing in these patients. These data add substantially to our understanding of the neural origins of bradyphrenia, which will be essential for determining optimum therapeutic strategies for cognitive impairment in LBD. Hum Brain Mapp 39:633–643, 2018. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Michael J Firbank
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - John Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom
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Sheikh-Bahaei N, Sajjadi SA, Manavaki R, Gillard JH. Imaging Biomarkers in Alzheimer's Disease: A Practical Guide for Clinicians. J Alzheimers Dis Rep 2017; 1:71-88. [PMID: 30480230 PMCID: PMC6159632 DOI: 10.3233/adr-170013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Although recent developments in imaging biomarkers have revolutionized the diagnosis of Alzheimer’s disease at early stages, the utility of most of these techniques in clinical setting remains unclear. The aim of this review is to provide a clear stepwise algorithm on using multitier imaging biomarkers for the diagnosis of Alzheimer’s disease to be used by clinicians and radiologists for day-to-day practice. We summarized the role of most common imaging techniques and their appropriate clinical use based on current consensus guidelines and recommendations with brief sections on acquisition and analysis techniques for each imaging modality. Structural imaging, preferably MRI or alternatively high resolution CT, is the essential first tier of imaging. It improves the accuracy of clinical diagnosis and excludes other potential pathologies. When the results of clinical examination and structural imaging, assessed by dementia expert, are still inconclusive, functional imaging can be used as a more advanced option. PET with ligands such as amyloid tracers and 18F-fluorodeoxyglucose can improve the sensitivity and specificity of diagnosis particularly at the early stages of the disease. There are, however, limitations in using these techniques in wider community due to a combination of lack of facilities and expertise to interpret the findings. The role of some of the more recent imaging techniques including tau imaging, functional MRI, or diffusion tensor imaging in clinical practice, remains to be established in the ongoing and future studies.
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Affiliation(s)
- Nasim Sheikh-Bahaei
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Roido Manavaki
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Sonni I, Ratib O, Boccardi M, Picco A, Herholz K, Nobili F, Varrone A. Clinical validity of presynaptic dopaminergic imaging with 123I-ioflupane and noradrenergic imaging with 123I-MIBG in the differential diagnosis between Alzheimer's disease and dementia with Lewy bodies in the context of a structured 5-phase development framework. Neurobiol Aging 2017; 52:228-242. [DOI: 10.1016/j.neurobiolaging.2016.04.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/23/2016] [Accepted: 04/21/2016] [Indexed: 11/27/2022]
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Saeed U, Compagnone J, Aviv RI, Strafella AP, Black SE, Lang AE, Masellis M. Imaging biomarkers in Parkinson's disease and Parkinsonian syndromes: current and emerging concepts. Transl Neurodegener 2017; 6:8. [PMID: 28360997 PMCID: PMC5370489 DOI: 10.1186/s40035-017-0076-6] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/28/2017] [Indexed: 12/24/2022] Open
Abstract
Two centuries ago in 1817, James Parkinson provided the first medical description of Parkinson’s disease, later refined by Jean-Martin Charcot in the mid-to-late 19th century to include the atypical parkinsonian variants (also termed, Parkinson-plus syndromes). Today, Parkinson’s disease represents the second most common neurodegenerative disorder with an estimated global prevalence of over 10 million. Conversely, atypical parkinsonian syndromes encompass a group of relatively heterogeneous disorders that may share some clinical features with Parkinson’s disease, but are uncommon distinct clinicopathological diseases. Decades of scientific advancements have vastly improved our understanding of these disorders, including improvements in in vivo imaging for biomarker identification. Multimodal imaging for the visualization of structural and functional brain changes is especially important, as it allows a ‘window’ into the underlying pathophysiological abnormalities. In this article, we first present an overview of the cardinal clinical and neuropathological features of, 1) synucleinopathies: Parkinson’s disease and other Lewy body spectrum disorders, as well as multiple system atrophy, and 2) tauopathies: progressive supranuclear palsy, and corticobasal degeneration. A comprehensive presentation of well-established and emerging imaging biomarkers for each disorder are then discussed. Biomarkers for the following imaging modalities are reviewed: 1) structural magnetic resonance imaging (MRI) using T1, T2, and susceptibility-weighted sequences for volumetric and voxel-based morphometric analyses, as well as MRI derived visual signatures, 2) diffusion tensor MRI for the assessment of white matter tract injury and microstructural integrity, 3) proton magnetic resonance spectroscopy for quantifying proton-containing brain metabolites, 4) single photon emission computed tomography for the evaluation of nigrostriatal integrity (as assessed by presynaptic dopamine transporters and postsynaptic dopamine D2 receptors), and cerebral perfusion, 5) positron emission tomography for gauging nigrostriatal functions, glucose metabolism, amyloid and tau molecular imaging, as well as neuroinflammation, 6) myocardial scintigraphy for dysautonomia, and 7) transcranial sonography for measuring substantia nigra and lentiform nucleus echogenicity. Imaging biomarkers, using the ‘multimodal approach’, may aid in making early, accurate and objective diagnostic decisions, highlight neuroanatomical and pathophysiological mechanisms, as well as assist in evaluating disease progression and therapeutic responses to drugs in clinical trials.
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Affiliation(s)
- Usman Saeed
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, Toronto, Canada
| | - Jordana Compagnone
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, Toronto, Canada
| | - Richard I Aviv
- Department of Medical Imaging, University of Toronto and Division of Neuroradiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Antonio P Strafella
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Division of Brain, Imaging & Behaviour - Systems Neuroscience, Toronto Western Hospital, Toronto, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, Toronto, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Movement Disorders Centre, Toronto Western Hospital, Toronto, Canada.,Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Canada
| | - Mario Masellis
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, Toronto, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room A4-55, Toronto, Ontario M4N 3 M5 Canada
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Added Value of Combined Semi-Quantitative and Visual [123I]FP-CIT SPECT Analyses for the Diagnosis of Dementia With Lewy Bodies. Clin Nucl Med 2017; 42:e96-e102. [DOI: 10.1097/rlu.0000000000001477] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bonanni L, Cagnin A, Agosta F, Babiloni C, Borroni B, Bozzali M, Bruni AC, Filippi M, Galimberti D, Monastero R, Muscio C, Parnetti L, Perani D, Serra L, Silani V, Tiraboschi P, Padovani A. The Italian dementia with Lewy bodies study group (DLB-SINdem): toward a standardization of clinical procedures and multicenter cohort studies design. Neurol Sci 2016; 38:83-91. [DOI: 10.1007/s10072-016-2713-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 09/08/2016] [Indexed: 01/23/2023]
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Brooks DJ. Molecular imaging of dopamine transporters. Ageing Res Rev 2016; 30:114-21. [PMID: 26802555 DOI: 10.1016/j.arr.2015.12.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/26/2015] [Accepted: 12/29/2015] [Indexed: 12/31/2022]
Abstract
The dopamine transporter (DAT) is responsible for clearance of dopamine from the synaptic cleft after its release. Imaging DAT availability provides a measure of dopamine terminal function and a method for detecting the striatal dopamine terminal dysfunction present in idiopathic Parkinson's disease (PD) and atypical neurodegenerative parkinsonian disorders such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). DAT imaging with positron emission tomography (PET) or single photon emission computed tomography (SPECT) can be used to support or refute a diagnosis of dopamine deficient parkinsonism in cases where this is unclear and rationalise a trial of dopamine replacement agents as therapy. It can also detect subclinical dopaminergic dysfunction when present in subjects at risk for PD such as relatives of patients, susceptibility gene mutation carriers, and subjects with late onset hyposmia or sleep disorders. The presence of normal DAT availability on imaging can help categorise "subjects without evidence of dopamine deficiency" (SWEDDs) who on occasion mimic PD and include dystonic tremors, drug-induced and psychogenic parkinsonism in their ranks. Reduced levels of baseline striatal DAT availability on PET or SPECT scanning, however, should be regarded as supportive rather than diagnostic of dopamine deficient parkinsonism.
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Walker Z, Moreno E, Thomas A, Inglis F, Tabet N, Stevens T, Whitfield T, Aarsland D, Rainer M, Padovani A. Evolution of clinical features in possible DLB depending on FP-CIT SPECT result. Neurology 2016; 87:1045-51. [PMID: 27511183 PMCID: PMC5027811 DOI: 10.1212/wnl.0000000000003076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
Objective: To test the hypothesis that core and suggestive features in possible dementia with Lewy bodies (DLB) would vary in their ability to predict an abnormal dopamine transporter scan and therefore a follow-up diagnosis of probable DLB. A further objective was to assess the evolution of core and suggestive features in patients with possible DLB over time depending on the 123I-FP-CIT SPECT scan result. Methods: A total of 187 patients with possible DLB (dementia plus one core or one suggestive feature) were randomized to have dopamine transporter imaging or to follow-up without scan. DLB features were compared at baseline and at 6-month follow-up according to imaging results and follow-up diagnosis. Results: For the whole cohort, the baseline frequency of parkinsonism was 30%, fluctuations 29%, visual hallucinations 24%, and REM sleep behavior disorder 17%. Clinician-rated presence of parkinsonism at baseline was significantly (p = 0.001) more frequent and Unified Parkinson’s Disease Rating Scale (UPDRS) score at baseline was significantly higher (p = 0.02) in patients with abnormal imaging. There was a significant increase in UPDRS score in the abnormal scan group over time (p < 0.01). There was relatively little evolution of the rest of the DLB features regardless of the imaging result. Conclusions: In patients with possible DLB, apart from UPDRS score, there was no difference in the evolution of DLB clinical features over 6 months between cases with normal and abnormal imaging. Only parkinsonism and dopamine transporter imaging helped to differentiate DLB from non-DLB dementia.
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Affiliation(s)
- Zuzana Walker
- From University College London (Z.W.); North Essex Partnership University NHS Foundation Trust (Z.W., T.S., T.W.), Braintree; GE Healthcare (E.M.), Buckinghamshire; Newcastle University (A.T.), Newcastle upon Tyne; Glasgow Memory Clinic Ltd. (F.I.); Brighton and Sussex Medical School (N.T.), Brighton, UK; Centre for Age-Related Diseases (D.A.), Stavanger University Hospital; Department of Geriatric Psychiatry (D.A.), Akershus University Hospital, Oslo, Norway; Department of Neurobiology, (D.A.) Care Sciences and Society Division of Alzheimer's Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner Institut für Gedächtnis und Alzheimerforschung Wien (M.R.), Austria; and University of Brescia (A.P.), Italy.
| | - Emilio Moreno
- From University College London (Z.W.); North Essex Partnership University NHS Foundation Trust (Z.W., T.S., T.W.), Braintree; GE Healthcare (E.M.), Buckinghamshire; Newcastle University (A.T.), Newcastle upon Tyne; Glasgow Memory Clinic Ltd. (F.I.); Brighton and Sussex Medical School (N.T.), Brighton, UK; Centre for Age-Related Diseases (D.A.), Stavanger University Hospital; Department of Geriatric Psychiatry (D.A.), Akershus University Hospital, Oslo, Norway; Department of Neurobiology, (D.A.) Care Sciences and Society Division of Alzheimer's Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner Institut für Gedächtnis und Alzheimerforschung Wien (M.R.), Austria; and University of Brescia (A.P.), Italy
| | - Alan Thomas
- From University College London (Z.W.); North Essex Partnership University NHS Foundation Trust (Z.W., T.S., T.W.), Braintree; GE Healthcare (E.M.), Buckinghamshire; Newcastle University (A.T.), Newcastle upon Tyne; Glasgow Memory Clinic Ltd. (F.I.); Brighton and Sussex Medical School (N.T.), Brighton, UK; Centre for Age-Related Diseases (D.A.), Stavanger University Hospital; Department of Geriatric Psychiatry (D.A.), Akershus University Hospital, Oslo, Norway; Department of Neurobiology, (D.A.) Care Sciences and Society Division of Alzheimer's Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner Institut für Gedächtnis und Alzheimerforschung Wien (M.R.), Austria; and University of Brescia (A.P.), Italy
| | - Fraser Inglis
- From University College London (Z.W.); North Essex Partnership University NHS Foundation Trust (Z.W., T.S., T.W.), Braintree; GE Healthcare (E.M.), Buckinghamshire; Newcastle University (A.T.), Newcastle upon Tyne; Glasgow Memory Clinic Ltd. (F.I.); Brighton and Sussex Medical School (N.T.), Brighton, UK; Centre for Age-Related Diseases (D.A.), Stavanger University Hospital; Department of Geriatric Psychiatry (D.A.), Akershus University Hospital, Oslo, Norway; Department of Neurobiology, (D.A.) Care Sciences and Society Division of Alzheimer's Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner Institut für Gedächtnis und Alzheimerforschung Wien (M.R.), Austria; and University of Brescia (A.P.), Italy
| | - Naji Tabet
- From University College London (Z.W.); North Essex Partnership University NHS Foundation Trust (Z.W., T.S., T.W.), Braintree; GE Healthcare (E.M.), Buckinghamshire; Newcastle University (A.T.), Newcastle upon Tyne; Glasgow Memory Clinic Ltd. (F.I.); Brighton and Sussex Medical School (N.T.), Brighton, UK; Centre for Age-Related Diseases (D.A.), Stavanger University Hospital; Department of Geriatric Psychiatry (D.A.), Akershus University Hospital, Oslo, Norway; Department of Neurobiology, (D.A.) Care Sciences and Society Division of Alzheimer's Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner Institut für Gedächtnis und Alzheimerforschung Wien (M.R.), Austria; and University of Brescia (A.P.), Italy
| | - Tim Stevens
- From University College London (Z.W.); North Essex Partnership University NHS Foundation Trust (Z.W., T.S., T.W.), Braintree; GE Healthcare (E.M.), Buckinghamshire; Newcastle University (A.T.), Newcastle upon Tyne; Glasgow Memory Clinic Ltd. (F.I.); Brighton and Sussex Medical School (N.T.), Brighton, UK; Centre for Age-Related Diseases (D.A.), Stavanger University Hospital; Department of Geriatric Psychiatry (D.A.), Akershus University Hospital, Oslo, Norway; Department of Neurobiology, (D.A.) Care Sciences and Society Division of Alzheimer's Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner Institut für Gedächtnis und Alzheimerforschung Wien (M.R.), Austria; and University of Brescia (A.P.), Italy
| | - Tim Whitfield
- From University College London (Z.W.); North Essex Partnership University NHS Foundation Trust (Z.W., T.S., T.W.), Braintree; GE Healthcare (E.M.), Buckinghamshire; Newcastle University (A.T.), Newcastle upon Tyne; Glasgow Memory Clinic Ltd. (F.I.); Brighton and Sussex Medical School (N.T.), Brighton, UK; Centre for Age-Related Diseases (D.A.), Stavanger University Hospital; Department of Geriatric Psychiatry (D.A.), Akershus University Hospital, Oslo, Norway; Department of Neurobiology, (D.A.) Care Sciences and Society Division of Alzheimer's Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner Institut für Gedächtnis und Alzheimerforschung Wien (M.R.), Austria; and University of Brescia (A.P.), Italy
| | - Dag Aarsland
- From University College London (Z.W.); North Essex Partnership University NHS Foundation Trust (Z.W., T.S., T.W.), Braintree; GE Healthcare (E.M.), Buckinghamshire; Newcastle University (A.T.), Newcastle upon Tyne; Glasgow Memory Clinic Ltd. (F.I.); Brighton and Sussex Medical School (N.T.), Brighton, UK; Centre for Age-Related Diseases (D.A.), Stavanger University Hospital; Department of Geriatric Psychiatry (D.A.), Akershus University Hospital, Oslo, Norway; Department of Neurobiology, (D.A.) Care Sciences and Society Division of Alzheimer's Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner Institut für Gedächtnis und Alzheimerforschung Wien (M.R.), Austria; and University of Brescia (A.P.), Italy
| | - Michael Rainer
- From University College London (Z.W.); North Essex Partnership University NHS Foundation Trust (Z.W., T.S., T.W.), Braintree; GE Healthcare (E.M.), Buckinghamshire; Newcastle University (A.T.), Newcastle upon Tyne; Glasgow Memory Clinic Ltd. (F.I.); Brighton and Sussex Medical School (N.T.), Brighton, UK; Centre for Age-Related Diseases (D.A.), Stavanger University Hospital; Department of Geriatric Psychiatry (D.A.), Akershus University Hospital, Oslo, Norway; Department of Neurobiology, (D.A.) Care Sciences and Society Division of Alzheimer's Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner Institut für Gedächtnis und Alzheimerforschung Wien (M.R.), Austria; and University of Brescia (A.P.), Italy
| | - Alessandro Padovani
- From University College London (Z.W.); North Essex Partnership University NHS Foundation Trust (Z.W., T.S., T.W.), Braintree; GE Healthcare (E.M.), Buckinghamshire; Newcastle University (A.T.), Newcastle upon Tyne; Glasgow Memory Clinic Ltd. (F.I.); Brighton and Sussex Medical School (N.T.), Brighton, UK; Centre for Age-Related Diseases (D.A.), Stavanger University Hospital; Department of Geriatric Psychiatry (D.A.), Akershus University Hospital, Oslo, Norway; Department of Neurobiology, (D.A.) Care Sciences and Society Division of Alzheimer's Disease Research Centre, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner Institut für Gedächtnis und Alzheimerforschung Wien (M.R.), Austria; and University of Brescia (A.P.), Italy
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Salas-Gonzalez D, Górriz JM, Ramírez J, Illán IA, Padilla P, Martínez-Murcia FJ, Lang EW. Building a FP-CIT SPECT Brain Template Using a Posterization Approach. Neuroinformatics 2016; 13:391-402. [PMID: 25749984 DOI: 10.1007/s12021-015-9262-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Spatial affine registration of brain images to a common template is usually performed as a preprocessing step in intersubject and intrasubject comparison studies, computer-aided diagnosis, region of interest selection and brain segmentation in tomography. Nevertheless, it is not straightforward to build a template of [123I]FP-CIT SPECT brain images because they exhibit very low intensity values outside the striatum. In this work, we present a procedure to automatically build a [123I]FP-CIT SPECT template in the standard Montreal Neurological Institute (MNI) space. The proposed methodology consists of a head voxel selection using the Otsu's method, followed by a posterization of the source images to three different levels: background, head, and striatum. Analogously, we also design a posterized version of a brain image in the MNI space; subsequently, we perform a spatial affine registration of the posterized source images to this image. The intensity of the transformed images is normalized linearly, assuming that the histogram of the intensity values follows an alpha-stable distribution. Lastly, we build the [123I]FP-CIT SPECT template by means of the transformed and normalized images. The proposed methodology is a fully automatic procedure that has been shown to work accurately even when a high-resolution magnetic resonance image for each subject is not available.
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Affiliation(s)
- D Salas-Gonzalez
- Computational Intelligence and Machine Learning Group, University of Regensburg, 93040, Regensburg, Germany.
| | - Juan M Górriz
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain
| | - Javier Ramírez
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain
| | - Ignacio A Illán
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain
| | - Pablo Padilla
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain
| | | | - Elmar W Lang
- Computational Intelligence and Machine Learning Group, University of Regensburg, 93040, Regensburg, Germany
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Atri A. Imaging of neurodegenerative cognitive and behavioral disorders: practical considerations for dementia clinical practice. HANDBOOK OF CLINICAL NEUROLOGY 2016; 136:971-984. [PMID: 27430453 DOI: 10.1016/b978-0-444-53486-6.00050-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This chapter reviews clinical applications and imaging findings useful in medical practice relating to neurodegenerative cognitive/dementing disorders. The preponderance of evidence and consensus guidelines support an essential role of multitiered neuroimaging in the evaluation and management of neurodegenerative cognitive/dementia syndrome that range in severity from mild impairments to frank dementia. Additionally, imaging features are incorporated in updated clinical and research diagnostic criteria for most dementias, including Alzheimer's disease (AD), Dementia with Lewy bodies (DLB), Frontotemporal Lobar Degenerations/Frontotemporal Dementia (FTD), and Vascular Cognitive Impairment (VCI). Best clinical practices dictate that structural imaging, preferably with magnetic resonance imaging (MRI) when possible and computed tomography when not, be obtained as a first-tier approach during the course of a thorough clinical evaluation to improve diagnostic confidence and assess for nonneurodegenerative treatable conditions that may cause or substantially contribute to cognitive/behavioral symptoms or which may dictate a substantial change in management. These conditions include less common structural (e.g., mass lesions such as tumors and hematomas; normal-pressure hydrocephalus), inflammatory, autoimmune and infectious conditions, and more common comorbid contributing conditions (e.g., vascular cerebral injury causing leukoaraiosis, infarcts, or microhemorrhages) that can produce a mixed dementia syndrome. When, after appropriate clinical, cognitive/neuropsychologic, and structural neuroimaging assessment, a dementia specialist remains in doubt regarding etiology and appropriate management, second-tier imaging with molecular methods, preferably with fluorodexoyglucose positron emission tomography (PET) (or single-photon emission computed tomography if PET is unavailable) can provide more diagnostic specificity (e.g., help differentiate between atypical AD and FTD as the etiology for a frontal/dysexecutive syndrome). The potential clinical utility of other promising methods, whether already approved for use (e.g., amyloid PET) or as yet only used in research (e.g., tau PET, functional MRI, diffusor tensor imaging), remains to be proven for widespread use in community practice. However, these constitute unreimbursed third-tier options that merit further study for clinical and cost-effective utility. In the future, combination use of imaging methods will likely improve diagnostic accuracy.
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Affiliation(s)
- Alireza Atri
- Ray Dolby Brain Health Center, California Pacific Medical Center Research Institute, Sutter Health, San Francisco, CA, USA.
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Brigo F, Turri G, Tinazzi M. 123I-FP-CIT SPECT in the differential diagnosis between dementia with Lewy bodies and other dementias. J Neurol Sci 2015; 359:161-71. [PMID: 26671107 DOI: 10.1016/j.jns.2015.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/20/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
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Mishima A, Nihashi T, Ando Y, Kawai H, Kato T, Ito K, Terasawa T. Biomarkers Differentiating Dementia with Lewy Bodies from Other Dementias: A Meta-Analysis. J Alzheimers Dis 2015; 50:161-74. [DOI: 10.3233/jad-150675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Aki Mishima
- Section of General Internal Medicine, Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takashi Nihashi
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshio Ando
- Department of Radiology, Toyota Memorial Hospital, Toyota, Aichi, Japan
| | - Hisashi Kawai
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Kato
- Department of Radiology, Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Kengo Ito
- Department of Radiology, Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Teruhiko Terasawa
- Section of General Internal Medicine, Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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Abstract
The broad importance of dementia is undisputed, with Alzheimer's disease justifiably getting the most attention. However, dementia with Lewy bodies and Parkinson's disease dementia, now called Lewy body dementias, are the second most common type of degenerative dementia in patients older than 65 years. Despite this, Lewy body dementias receive little attention and patients are often misdiagnosed, leading to less than ideal management. Over the past 10 years, considerable effort has gone into improving diagnostic accuracy by refining diagnostic criteria and using imaging and other biomarkers. Dementia with Lewy bodies and Parkinson's disease dementia share the same pathophysiology, and effective treatments will depend not only on successful treatment of symptoms but also on targeting the pathological mechanisms of disease, ideally before symptoms and clinical signs develop. We summarise the most pertinent progress from the past 10 years, outlining some of the challenges for the future, which will require refinement of diagnosis and clarification of the pathogenesis, leading to disease-modifying treatments.
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Affiliation(s)
- Zuzana Walker
- Division of Psychiatry, University College London, London, UK; North Essex Partnership University NHS Foundation Trust, Epping, UK.
| | - Katherine L Possin
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Bradley F Boeve
- Division of Behavioral Neurology, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Division of Movement Disorders, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Dag Aarsland
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway; Department of Geriatric Psychiatry, Akershus University Hospital, Oslo, Norway; Department of Neurobiology, Care Sciences and Society, Division of Alzheimer's Disease Research Centre, Karolinska Institute, Stockholm, Sweden
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Correlation between 123I-FP-CIT brain SPECT and parkinsonism in dementia with Lewy bodies: caveat for clinical use. Clin Nucl Med 2015; 40:32-5. [PMID: 25290294 DOI: 10.1097/rlu.0000000000000602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although parkinsonism is considered a core feature of dementia with Lewy bodies (DLB), it is occasionally mild or even absent. I-FP-CIT SPECT has been accepted as a diagnostic support tool in this context, given that low striatal uptake is associated with neuronal loss. The aim of this retrospective study was to look for correlations between I-FP-CIT uptake in the striatum and clinical extrapyramidal signs (EPSs) in patients with a diagnosis of probable DLB to clarify the extent to which the supporting role of I-FP-CIT is related to motor impairment. METHODS Semiquantitative I-FP-CIT uptake was analyzed and correlated with Unified Parkinson Disease Rating Scale Part III scores in a sample of 22 patients with a diagnosis of probable DLB and a wide range of EPSs. RESULTS A significant negative linear correlation between I-FP-CIT uptake and Unified Parkinson Disease Rating Scale Part III score was found both in the caudate and the putamen (r = -0.69 and -0.72, respectively, P < 0.001). Striatal uptake in patients with no or questionable EPS was comparable to that recorded in normal age-matched subjects (99% [22%] in the putamen) but significantly reduced in those with mild and severe EPS (43% [35%] and 30% [17%], respectively, P < 0.0001, but P = nonsignificant between mild and severe EPS). CONCLUSIONS SPECT may be redundant when there are no doubts about the parkinsonism (ie, when it is absent or unequivocally present), but it may be helpful in identifying presynaptic nigrostriatal degeneration in patients with mild EPSs.
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Utility of the combination of DAT SPECT and MIBG myocardial scintigraphy in differentiating dementia with Lewy bodies from Alzheimer's disease. Eur J Nucl Med Mol Imaging 2015; 43:184-192. [PMID: 26233438 PMCID: PMC4679785 DOI: 10.1007/s00259-015-3146-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/14/2015] [Indexed: 11/28/2022]
Abstract
Purpose 123I-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT SPECT) and 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy can be used to assist in the diagnosis of patients with dementia with Lewy bodies (DLB). We compared the diagnostic value of these two methods in differentiating DLB from Alzheimer’s disease (AD). Furthermore, we evaluated whether a combination of DAT SPECT and MIBG myocardial scintigraphy would provide a more useful means of differentiating between DLB and AD. Methods Patients with AD (n = 57) and patients with DLB (n = 76) who underwent both DAT SPECT and MIBG myocardial scintigraphy were enrolled. The sensitivity, specificity, and accuracy of both methods as well as their combination for differentiating DLB from AD were calculated. Moreover, we examined whether symptoms of the patients with DLB were associated with the patterns of the abnormalities displayed on DAT SPECT and MIBG myocardial scintigraphy. Results The sensitivity and specificity of differentiating DLB from AD were 72.4 and 94.4 % by the heart to mediastinum ratio of MIBG uptake, 88.2 and 88.9 % by the specific binding ratio on DAT SPECT, and 96.1 and 90.7 % by their combination, respectively. The combined use of DAT SPECT and MIBG myocardial scintigraphy enabled more accurate differentiation between DLB and AD compared with either DAT SPECT or MIBG myocardial scintigraphy alone. There was a significantly higher frequency of parkinsonism in the abnormal DAT SPECT group than the normal DAT SPECT group. On the other hand, there was a higher frequency of the appearance of rapid eye movement (REM) sleep behavior disorder in the abnormal MIBG uptake group than the normal MIBG uptake group. Conclusion These results suggested that using a combination of these scintigraphic methods is a useful and practical approach to differentiate DLB from AD.
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Garriga M, Milà M, Mir M, Al-Baradie R, Huertas S, Castejon C, Casas L, Badenes D, Giménez N, Font MA, Gonzalez JM, Ysamat M, Aguilar M, Slevin M, Krupinski J. (123)I-FP-CIT SPECT imaging in early diagnosis of dementia in patients with and without a vascular component. Front Syst Neurosci 2015; 9:99. [PMID: 26190980 PMCID: PMC4486766 DOI: 10.3389/fnsys.2015.00099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/15/2015] [Indexed: 01/18/2023] Open
Abstract
Alzheimer’s disease (AD) and vascular dementia (VaD) are the most common cause of dementia. Cerebral ischemia is a major risk factor for development of dementia. 123I-FP-CIT SPECT (DaTScan) is a complementary tool in the differential diagnoses of patients with incomplete or uncertain Parkinsonism. Additional application of DaTScan enables the categorization of Parkinsonian disease with dementia (PDD), and its differentiation from pure AD, and may further contribute to change the therapeutic decision. The aim of this study was to analyze the vascular contribution towards dementia and mild cognitive impairment (MCI). We evaluated the utility of DaTScan for the early diagnosis of dementia in patients with and without a clinical vascular component, and the association between neuropsychological function, vascular component and dopaminergic function on DaTScan. One-hundred and five patients with MCI or the initial phases of dementia were studied prospectively. We developed an initial assessment using neurologic examination, blood tests, cognitive function tests, structural neuroimaging and DaTScan. The vascular component was later quantified in two ways: clinically, according to the Framingham Risk Score (FRS) and by structural neuroimaging using Wahlund Scale Total Score (WSTS). Early diagnosis of dementia was associated with an abnormal DaTScan. A significant association was found between a high WSTS and an abnormal DaTScan (p < 0.01). Mixed AD was the group with the highest vascular component, followed by the VaD group, while MCI and pure AD showed similar WSTS. No significant associations were found between neuropsychological impairment and DaTScan independently of associated vascular component. DaTScan seems to be a good tool to discriminate, in a first clinical assessment, patients with MCI from those with established dementia. There was bigger general vascular affectation observable in MRI or CT in patients with abnormal dopaminergic uptake seen on DaTScan.
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Affiliation(s)
- Marina Garriga
- Neurology Unit, Hospital Universitari Mútua Terrassa Terrassa, Spain ; Psychiatric Unit, Hospital Universitari Mútua Terrassa Terrassa, Spain
| | - Marta Milà
- Neurology Unit, Hospital Universitari Mútua Terrassa Terrassa, Spain
| | - Manzoor Mir
- College of Applied Medical Sciences, Majmaah University Almajmaah Al Majmaah, Saudi Arabia
| | - Raid Al-Baradie
- College of Applied Medical Sciences, Majmaah University Almajmaah Al Majmaah, Saudi Arabia
| | - Sonia Huertas
- Neurology Unit, Hospital Universitari Mútua Terrassa Terrassa, Spain
| | - Cesar Castejon
- Neurology Unit, Hospital Universitari Mútua Terrassa Terrassa, Spain
| | - Laura Casas
- Neurology Unit, Hospital Universitari Mútua Terrassa Terrassa, Spain
| | - Dolors Badenes
- Neurology Unit, Hospital Universitari Mútua Terrassa Terrassa, Spain
| | - Nuria Giménez
- Research Unit, Research Foundation Mútua Terrassa, Universitat de Barcelona Barcelona, Spain
| | - M Angels Font
- Research Unit, Research Foundation Mútua Terrassa, Universitat de Barcelona Barcelona, Spain
| | - Jose M Gonzalez
- Cetir-Grup Medic, CTD, Hospital Universitari Mútua de Terrassa Terrassa, Spain
| | - Maria Ysamat
- Cetir-Grup Medic, CTD, Hospital Universitari Mútua de Terrassa Terrassa, Spain
| | - Miguel Aguilar
- Neurology Unit, Hospital Universitari Mútua Terrassa Terrassa, Spain
| | - Mark Slevin
- School of Healthcare Science, Manchester Metropolitan University Manchester, UK
| | - Jerzy Krupinski
- Neurology Unit, Hospital Universitari Mútua Terrassa Terrassa, Spain ; School of Healthcare Science, Manchester Metropolitan University Manchester, UK
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McConathy J, Sheline YI. Imaging biomarkers associated with cognitive decline: a review. Biol Psychiatry 2015; 77:685-92. [PMID: 25442005 PMCID: PMC4362908 DOI: 10.1016/j.biopsych.2014.08.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/30/2014] [Accepted: 08/27/2014] [Indexed: 01/18/2023]
Abstract
In evaluating disease changes, it is critical to have measurements that are sensitive, specific, and reliable. Cognitive decline, particularly in the context of Alzheimer's disease, is an area that has attracted numerous recent studies, and the proposed biomarkers used in these investigations need to be validated. In this review, we highlight studies with important implications about the role of imaging biomarkers in cognitive decline and dementia as well as in distinguishing preclinical dementia before evidence of cognitive decline. Structural changes determined on cross-sectional and longitudinal magnetic resonance imaging provide early prediction of dementia, particularly when combined with other measures. Molecular imaging using positron emission tomography and single photon emission computed tomography tracers quantify the presence or activity of receptors, transporters, enzymes, metabolic pathways, and proteins. The newest developments in molecular imaging are described, and methods are compared. Distinguishing features of imaging biomarkers among dementias and the spectrum of preclinical Alzheimer's disease, mild cognitive impairment, and Alzheimer's disease are described. Appropriate use criteria for positron emission tomography with amyloid tracers are delineated. Although these efforts are still in the early phase of development, there is great promise for further development in structural magnetic resonance imaging and positron emission tomography technologies.
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Affiliation(s)
- Jonathan McConathy
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| | - Yvette I Sheline
- Departments of Psychiatry, Radiology, and Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
BACKGROUND Dementia with Lewy body (DLB) is considered to be the second most common form of neurodegenerative disorders after Alzheimer's disease (AD), affecting as many as 100,000 people in the UK and up to 1.3 million in the USA. However, nearly half of patients with DLB remain undiagnosed thus depriving many of them from an early and adequate treatment of their distressing symptoms. Accurate and early diagnosis of DLB is important for both patients and their caregivers, since the neuropsychiatric symptoms require specific management. METHODS In the current study, we review the most recent developments in the field of molecular nuclear imaging to diagnose DLB. RESULTS The review addresses, the neurotransmitter based (dopaminergic, cholinergic, and glutamatergic) nuclear imaging techniques, role of the autonomic dysfunction and its visualization in DLB with myocardial sympathetic imaging and vesicular catecholamine uptake, as well as the use of amyloid polypeptides and glial markers as molecular imaging probes in the clinical diagnosis of DLB. CONCLUSIONS Most of the above nuclear imaging methods are restricted to highly specialized clinical centers, and thus not applicable to a large number of patients requiring dementia (e.g. DLB) diagnosis in routine clinical setting. Validating them against more readily accessible peripheral biomarkers, e.g. CSF and blood biomarkers linked to the DLB process, may facilitate their use in wider clinical settings.
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Walker Z, Moreno E, Thomas A, Inglis F, Tabet N, Rainer M, Pizzolato G, Padovani A. Clinical usefulness of dopamine transporter SPECT imaging with 123I-FP-CIT in patients with possible dementia with Lewy bodies: randomised study. Br J Psychiatry 2015; 206:145-52. [PMID: 25431431 DOI: 10.1192/bjp.bp.114.148643] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) is underrecognised in clinical settings. AIMS To investigate whether performing a (123)I-ioflupane injection ((123)I-FP-CIT also called DaTSCAN™) single photon emission computed tomography (SPECT) scan in patients with possible DLB would lead to a more certain diagnosis (probable DLB or non-DLB dementia). METHOD We randomised 187 patients with possible DLB 2:1 to have a scan or not (control group). The outcome measure was a change in diagnosis to probable DLB or non-DLB. RESULTS There were 56 controls and 114 scanned patients, of whom 43% had an abnormal scan. More patients in the imaging group had a change in diagnosis compared with controls at 8 and 24 weeks (61% (n = 70) v. 4% (n = 2) and 71% (n = 77) v. 16% (n = 9); both P<0.0001). Clinicians were more likely to change the diagnosis if the scan was abnormal (82%) than if it was normal (46%). CONCLUSIONS Imaging significantly contributed to a more certain diagnosis, proving to be a useful adjunct in the work-up of patients with possible DLB.
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Affiliation(s)
- Zuzana Walker
- Zuzana Walker, MD, FRCPsych, Division of Psychiatry, University College London, London, and North Essex Partnership University NHS Foundation Trust, Essex, UK; Emilio Moreno, MD, PhD, GE Healthcare, Amersham, UK; Alan Thomas, PhD, FRCPsych, Biological Research Building, Newcastle University, Newcastle, UK; Fraser Inglis, FRCP, Glasgow Memory Clinic, Glasgow, UK; Naji Tabet, MD, MRCPsych, Postgraduate Medicine, Brighton and Sussex Medical School, Brighton, UK; Michael Rainer, MD, Karl Landsteiner Institut für Gedächtnis- und Alzheimerforschung, Vienna, Austria; Gilberto Pizzolato (deceased), MD, previously at Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Alessandro Padovani, MD, PhD, Scienze Cliniche e Sperimentali, University of Brescia, Brescia, Italy
| | - Emilio Moreno
- Zuzana Walker, MD, FRCPsych, Division of Psychiatry, University College London, London, and North Essex Partnership University NHS Foundation Trust, Essex, UK; Emilio Moreno, MD, PhD, GE Healthcare, Amersham, UK; Alan Thomas, PhD, FRCPsych, Biological Research Building, Newcastle University, Newcastle, UK; Fraser Inglis, FRCP, Glasgow Memory Clinic, Glasgow, UK; Naji Tabet, MD, MRCPsych, Postgraduate Medicine, Brighton and Sussex Medical School, Brighton, UK; Michael Rainer, MD, Karl Landsteiner Institut für Gedächtnis- und Alzheimerforschung, Vienna, Austria; Gilberto Pizzolato (deceased), MD, previously at Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Alessandro Padovani, MD, PhD, Scienze Cliniche e Sperimentali, University of Brescia, Brescia, Italy
| | - Alan Thomas
- Zuzana Walker, MD, FRCPsych, Division of Psychiatry, University College London, London, and North Essex Partnership University NHS Foundation Trust, Essex, UK; Emilio Moreno, MD, PhD, GE Healthcare, Amersham, UK; Alan Thomas, PhD, FRCPsych, Biological Research Building, Newcastle University, Newcastle, UK; Fraser Inglis, FRCP, Glasgow Memory Clinic, Glasgow, UK; Naji Tabet, MD, MRCPsych, Postgraduate Medicine, Brighton and Sussex Medical School, Brighton, UK; Michael Rainer, MD, Karl Landsteiner Institut für Gedächtnis- und Alzheimerforschung, Vienna, Austria; Gilberto Pizzolato (deceased), MD, previously at Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Alessandro Padovani, MD, PhD, Scienze Cliniche e Sperimentali, University of Brescia, Brescia, Italy
| | - Fraser Inglis
- Zuzana Walker, MD, FRCPsych, Division of Psychiatry, University College London, London, and North Essex Partnership University NHS Foundation Trust, Essex, UK; Emilio Moreno, MD, PhD, GE Healthcare, Amersham, UK; Alan Thomas, PhD, FRCPsych, Biological Research Building, Newcastle University, Newcastle, UK; Fraser Inglis, FRCP, Glasgow Memory Clinic, Glasgow, UK; Naji Tabet, MD, MRCPsych, Postgraduate Medicine, Brighton and Sussex Medical School, Brighton, UK; Michael Rainer, MD, Karl Landsteiner Institut für Gedächtnis- und Alzheimerforschung, Vienna, Austria; Gilberto Pizzolato (deceased), MD, previously at Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Alessandro Padovani, MD, PhD, Scienze Cliniche e Sperimentali, University of Brescia, Brescia, Italy
| | - Naji Tabet
- Zuzana Walker, MD, FRCPsych, Division of Psychiatry, University College London, London, and North Essex Partnership University NHS Foundation Trust, Essex, UK; Emilio Moreno, MD, PhD, GE Healthcare, Amersham, UK; Alan Thomas, PhD, FRCPsych, Biological Research Building, Newcastle University, Newcastle, UK; Fraser Inglis, FRCP, Glasgow Memory Clinic, Glasgow, UK; Naji Tabet, MD, MRCPsych, Postgraduate Medicine, Brighton and Sussex Medical School, Brighton, UK; Michael Rainer, MD, Karl Landsteiner Institut für Gedächtnis- und Alzheimerforschung, Vienna, Austria; Gilberto Pizzolato (deceased), MD, previously at Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Alessandro Padovani, MD, PhD, Scienze Cliniche e Sperimentali, University of Brescia, Brescia, Italy
| | - Michael Rainer
- Zuzana Walker, MD, FRCPsych, Division of Psychiatry, University College London, London, and North Essex Partnership University NHS Foundation Trust, Essex, UK; Emilio Moreno, MD, PhD, GE Healthcare, Amersham, UK; Alan Thomas, PhD, FRCPsych, Biological Research Building, Newcastle University, Newcastle, UK; Fraser Inglis, FRCP, Glasgow Memory Clinic, Glasgow, UK; Naji Tabet, MD, MRCPsych, Postgraduate Medicine, Brighton and Sussex Medical School, Brighton, UK; Michael Rainer, MD, Karl Landsteiner Institut für Gedächtnis- und Alzheimerforschung, Vienna, Austria; Gilberto Pizzolato (deceased), MD, previously at Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Alessandro Padovani, MD, PhD, Scienze Cliniche e Sperimentali, University of Brescia, Brescia, Italy
| | - Gilberto Pizzolato
- Zuzana Walker, MD, FRCPsych, Division of Psychiatry, University College London, London, and North Essex Partnership University NHS Foundation Trust, Essex, UK; Emilio Moreno, MD, PhD, GE Healthcare, Amersham, UK; Alan Thomas, PhD, FRCPsych, Biological Research Building, Newcastle University, Newcastle, UK; Fraser Inglis, FRCP, Glasgow Memory Clinic, Glasgow, UK; Naji Tabet, MD, MRCPsych, Postgraduate Medicine, Brighton and Sussex Medical School, Brighton, UK; Michael Rainer, MD, Karl Landsteiner Institut für Gedächtnis- und Alzheimerforschung, Vienna, Austria; Gilberto Pizzolato (deceased), MD, previously at Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Alessandro Padovani, MD, PhD, Scienze Cliniche e Sperimentali, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Zuzana Walker, MD, FRCPsych, Division of Psychiatry, University College London, London, and North Essex Partnership University NHS Foundation Trust, Essex, UK; Emilio Moreno, MD, PhD, GE Healthcare, Amersham, UK; Alan Thomas, PhD, FRCPsych, Biological Research Building, Newcastle University, Newcastle, UK; Fraser Inglis, FRCP, Glasgow Memory Clinic, Glasgow, UK; Naji Tabet, MD, MRCPsych, Postgraduate Medicine, Brighton and Sussex Medical School, Brighton, UK; Michael Rainer, MD, Karl Landsteiner Institut für Gedächtnis- und Alzheimerforschung, Vienna, Austria; Gilberto Pizzolato (deceased), MD, previously at Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Alessandro Padovani, MD, PhD, Scienze Cliniche e Sperimentali, University of Brescia, Brescia, Italy
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Gore RL, Vardy ERLC, O'Brien JT. Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum? J Neurol Neurosurg Psychiatry 2015; 86:50-9. [PMID: 24860139 DOI: 10.1136/jnnp-2013-306389] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Dementia with Lewy bodies (DLB) is recognised as the second most common form of dementia in older people. Delirium is a condition of acute brain dysfunction for which a pre-existing diagnosis of dementia is a risk factor. Conversely delirium is associated with an increased risk of developing dementia. The reasons for this bidirectional relationship are not well understood. Our aim was to review possible similarities in the clinical presentation and pathophysiology between delirium and DLB, and explore possible links between these diagnoses. A systematic search using Medline, Embase and Psychinfo was performed. References were scanned for relevant articles, supplemented by articles identified from reference lists and those known to the authors. 94 articles were selected for inclusion in the review. Delirium and DLB share a number of clinical similarities, including global impairment of cognition, fluctuations in attention and perceptual abnormalities. Delirium is a frequent presenting feature of DLB. In terms of pathophysiological mechanisms, cholinergic dysfunction and genetics may provide a common link. Neuroimaging studies suggest a brain vulnerability in delirium which may also occur in dementia. The basal ganglia, which play a key role in DLB, have also been implicated in delirium. The role of Cerebrospinal fluid (CSF) and serum biomarkers for both diagnoses is an interesting area although some results are conflicting and further work in this area is needed. Delirium and DLB share a number of features and we hypothesise that delirium may, in some cases, represent early or 'prodromal' DLB. Further research is needed to test the novel hypothesis that delirium may be an early marker for future DLB, which would aid early diagnosis of DLB and identify those at high risk.
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Affiliation(s)
- Rachel L Gore
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK Department of Old Age Psychiatry, Northumberland Tyne and Wear NHS Trust, Morpeth, Northumberland, UK
| | - Emma R L C Vardy
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK Department of Older Peoples Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - John T O'Brien
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK Department of Psychiatry, University of Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Level E4 Cambridge Biomedical Campus, Cambridge, UK
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Bajaj N, Hauser RA, Seibyl J, Kupsch A, Plotkin M, Chen C, Grachev ID. Association between Hoehn and Yahr, Mini-Mental State Examination, age, and clinical syndrome predominance and diagnostic effectiveness of ioflupane I 123 injection (DaTSCAN™) in subjects with clinically uncertain parkinsonian syndromes. ALZHEIMERS RESEARCH & THERAPY 2014; 6:67. [PMID: 25478029 PMCID: PMC4255542 DOI: 10.1186/s13195-014-0067-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/09/2014] [Indexed: 01/05/2023]
Abstract
Introduction Diagnostic effectiveness of Ioflupane I 123 injection (DaTSCAN™, DaTscan™, or [123I]FP-CIT or ioflupane [123I]) SPECT imaging, was assessed in patients with clinically uncertain parkinsonian syndrome (CUPS). Methods We investigated the association between subject’s Hoehn & Yahr (H&Y) stage, Mini-Mental State Examination (MMSE), age, and motor symptom subgroups and diagnostic performance of ioflupane [123I] imaging. Phase 4 study data were used to calculate sensitivity, specificity, positive and negative predictive value, and accuracy in 92 CUPS subjects, using 1-year clinical diagnosis after ioflupane [123I] imaging as reference standard. Results Diagnostic effectiveness of ioflupane [123I] imaging was high in all subgroups: 91% to 100% for H&Y low (<2) and high (≥2) stage subjects; 93% to 96% for MMSE low (<29) or high (≥29) scores; 91% to100% in both age subgroups (younger [<68] and older [≥68]); and 92% to 100% in subjects with both tremor dominant and balanced motor signs. Specificity of ioflupane [123I] imaging for bradykinetic rigid or posturally (BRP) unstable motor subtype was lower, but better than for baseline clinical diagnosis. Conclusions Strongest diagnostic performance of ioflupane [123I] imaging for clinical diagnosis of Parkinson’s syndrome (PS) or non-PS was associated with tremor and balanced motor dominance rather than with BRP dominance. High diagnostic effectiveness of ioflupane [123I] imaging and favourable performance relative to final clinical diagnosis at 1 year post-scan in subjects with CUPS was demonstrated. This study suggests that the diagnostic performance of ioflupane [123I] imaging in CUPS remains high at all stages of disease, including early stage, and across both age groups and cognitive state (MMSE).
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Affiliation(s)
- Nin Bajaj
- National Parkinson's Foundation of Excellence, Nottingham University Hospitals NHS Trust and University of Nottingham, Derby Road, Nottingham NG7 2UH, UK
| | - Robert A Hauser
- USF Parkinson's Disease and Movement Disorders Center, National Parkinson Foundation Center of Excellence, USF Health - Byrd Institute, 4001 E. Fletcher Ave, 6th Floor, Tampa 33613, FL, USA
| | - John Seibyl
- The Institute for Neurodegenerative Disorders, 60 Temple St, New Haven 06510, CT, USA
| | - Andreas Kupsch
- Otto-von-Guericke-University, Leipziger Strasse 44, Magdeburg, 39120, Germany
| | - Michail Plotkin
- Leiter des Vivantes Instituts für Nuklearmedizin Mitte/Nord, Landsberger Allee 49, Berlin, 10249, Germany
| | - Chris Chen
- H2O Clinical LLC, 200 International Circle, Suite 5888, Cockeysville 21030, MD, USA
| | - Igor D Grachev
- Medical Affairs, GE Healthcare - Life Sciences, 101 Carnegie Center, Princeton NJ 08540, New Jersey, USA ; Presently: Novartis Consumer Health, Parsippany, New Jersey, USA ; Presently: Genpact Pharmalink, Short Hills, New Jersey, USA
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Seppälä TT, Louhija UM, Appelberg B, Herukka SK, Juva K. Comparison between clinical diagnosis and CSF biomarkers of Alzheimer disease in elderly patients with late onset psychosis: Helsinki Old Age Psychosis Study (HOPS). Am J Geriatr Psychiatry 2014; 22:908-16. [PMID: 23597931 DOI: 10.1016/j.jagp.2012.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 07/02/2012] [Accepted: 08/01/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the proportion of elderly people with a first psychotic episode actually suffering from dementia, especially Alzheimer disease (AD), by using cerebrospinal fluid (CSF) biomarkers. DESIGN Prospective case-control study. SETTING AND PARTICIPANTS Sixty-six patients age 65 years and older with recent psychotic symptoms and 12 comparison subjects with chronic schizophrenia over 10 years that were referred to acute old age psychiatry, in-ward treatment. MEASUREMENTS Concentration levels of CSF Aβ42, tau and p-tau-181 measured by ELISA compared to clinical diagnosis made by a multiprofessional team of one neurologist and several psychiatrists. RESULTS The CSF specimen was obtained from 51 (65.4%) of the patients. In five subjects out of 13 with a clinical diagnosis of AD, all the CSF biomarkers (Aβ42, tau and p-tau) were normal. Only one patient out of 25 with a psychiatric diagnosis and none out of the comparison group with schizophrenia showed a CSF profile typical of AD. Three patients with an AD diagnosis, four patients with a psychiatric diagnosis and one patient with schizophrenia had a low Aβ42 concentration with normal levels of tau or p-tau. The patients with AD had lower CSF Aβ42 levels than other patients. CONCLUSIONS The CSF biomarkers are important and useful as part of the diagnostic procedure for detecting AD and other dementia in elderly patients displaying psychotic symptoms. The accuracy of AD diagnosis encounters problems due to atypical behavioural symptoms in psychiatric settings and thus the differential diagnostics can be improved by using CSF biomarkers of AD more frequently.
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Affiliation(s)
- Toni T Seppälä
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Ulla-Marja Louhija
- Unit of Psychogeriatrics, Division of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Björn Appelberg
- Unit of Psychogeriatrics, Division of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Sanna-Kaisa Herukka
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Kati Juva
- Unit of Psychogeriatrics, Division of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
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Hall H, Reyes S, Landeck N, Bye C, Leanza G, Double K, Thompson L, Halliday G, Kirik D. Hippocampal Lewy pathology and cholinergic dysfunction are associated with dementia in Parkinson’s disease. Brain 2014; 137:2493-508. [DOI: 10.1093/brain/awu193] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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O'Brien JT, Oertel WH, McKeith IG, Grosset DG, Walker Z, Tatsch K, Tolosa E, Sherwin PF, Grachev ID. Is ioflupane I123 injection diagnostically effective in patients with movement disorders and dementia? Pooled analysis of four clinical trials. BMJ Open 2014; 4:e005122. [PMID: 24993764 PMCID: PMC4091455 DOI: 10.1136/bmjopen-2014-005122] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To pool clinical trials of similar design to assess overall sensitivity and specificity of ioflupane I123 injection (DaTSCAN or ioflupane ((123)I)) to detect or exclude a striatal dopaminergic deficit disorder (SDDD), such as parkinsonian syndrome and dementia with Lewy bodies. DESIGN Pooled analysis of three phase 3 and one phase 4 clinical trials. These four trials were selected because they were the four studies used for the US new drug application to the Food and Drug Administration (FDA). SETTING Multicentre, open-label, non-randomised. PARTICIPANTS Patients with either a movement disorder or dementia, and healthy volunteers. INTERVENTIONS Ioflupane ((123)I) was administered. OUTCOME MEASURES Images were assessed by panels of 3-5 blinded experts and/or on-site nuclear medicine physicians, classified as normal or abnormal and compared with clinical diagnosis (reference standard) to determine sensitivity and specificity. RESULTS Pooling the four studies, 928 participants were enrolled, 849 were dosed and 764 completed their study. Across all studies, when images were assessed by on-site readers, ioflupane ((123)I) diagnostic effectiveness had an overall (95% CI) sensitivity of 91.9% (88.7% to 94.5%) and specificity of 83.6% (78.7% to 87.9%). When reads were conducted blindly by a panel of independent experts, the overall sensitivity was 88.7% (86.8% to 90.4%) and specificity was 91.2% (89.0% to 93.0%). CONCLUSIONS In this pooled analysis, the visual assessment of ioflupane ((123)I) images provided high levels of sensitivity and specificity in detecting the presence/absence of an SDDD. Ioflupane ((123)I) imaging has the potential to improve diagnostic accuracy in patients with signs and symptoms of a movement disorder and/or dementia. TRIAL REGISTRATION NUMBER NCT00209456.
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Affiliation(s)
- John T O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, and Cambridgeshire and Peterborough Foundation NHS Trust, Cambridge, UK
| | - Wolfgang H Oertel
- Department of Neurology, Philipps-University of Marburg, Marburg, Germany
| | - Ian G McKeith
- Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Donald G Grosset
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, and University of Glasgow, Glasgow, Scotland, UK
| | - Zuzana Walker
- Mental Health Sciences Unit, University College London, London, UK
- North Essex Partnership University NHS Foundation Trust, Essex, UK
| | - Klaus Tatsch
- Department of Nuclear Medicine, Municipal Hospital Karlsruhe, Inc., Karlsruhe, Germany
| | - Eduardo Tolosa
- Neurology Service, Hospital Clínic, University of Barcelona, Institut d'investigacions Biomédiques August Pi i Sunyer (IDIBAPS),Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Catalonia, Spain
| | - Paul F Sherwin
- Clinical Development, Life Sciences, GE Healthcare, Princeton, New Jersey, USA
| | - Igor D Grachev
- Global Head of Neurology/DaTscan, Medical Affairs, Life Sciences, GE Healthcare, Princeton, New Jersey, USA
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Seibyl JP, Kupsch A, Booij J, Grosset DG, Costa DC, Hauser RA, Darcourt J, Bajaj N, Walker Z, Marek K, McKeith I, O’Brien JT, Tatsch K, Tolosa E, Dierckx RA, Grachev ID. Individual-Reader Diagnostic Performance and Between-Reader Agreement in Assessment of Subjects with Parkinsonian Syndrome or Dementia Using 123I-Ioflupane Injection (DaTscan) Imaging. J Nucl Med 2014; 55:1288-96. [DOI: 10.2967/jnumed.114.140228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 04/28/2014] [Indexed: 11/16/2022] Open
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Grachev ID. Age, Gender, and Diagnostic Performance of Ioflupane I123 Injection (DaTscan™) Brain Imaging in Patients with Movement Disorders and/or Dementia. ACTA ACUST UNITED AC 2014. [DOI: 10.15406/jnsk.2014.01.00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mak E, Su L, Williams GB, O'Brien JT. Neuroimaging characteristics of dementia with Lewy bodies. ALZHEIMERS RESEARCH & THERAPY 2014; 6:18. [PMID: 25031634 PMCID: PMC4055038 DOI: 10.1186/alzrt248] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This review summarises the findings and applications from neuroimaging studies in dementia with Lewy bodies (DLB), highlighting key differences between DLB and other subtypes of dementia. We also discuss the increasingly important role of imaging biomarkers in differential diagnosis and outline promising areas for future research in DLB. DLB shares common clinical, neuropsychological and pathological features with Parkinson’s disease dementia and other dementia subtypes, such as Alzheimer’s disease. Despite the development of consensus diagnostic criteria, the sensitivity for differential diagnosis of DLB in clinical practice remains low and many DLB patients will be misdiagnosed. The importance of developing accurate imaging markers in dementia is highlighted by the potential for treatments targeting specific molecular abnormalities as well as the responsiveness to cholinesterase inhibitors and marked neuroleptic sensitivity of DLB. We review various brain imaging techniques that have been applied to investigate DLB, including the characteristic nigrostriatal degeneration in DLB using positron emission tomography (PET) and single-photon emission computed tomography (SPECT) tracers. Dopamine transporter loss has proven to reliably differentiate DLB from other dementias and has been incorporated into the revised clinical diagnostic criteria for DLB. To date, this remains the 'gold standard' for diagnostic imaging of DLB. Regional cerebral blood flow, 18 F-fluorodeoxygluclose-PET and SPECT have also identified marked deficits in the occipital regions with relative sparing of the medial temporal lobe when compared to Alzheimer’s disease. In addition, structural, diffusion, and functional magnetic resonance imaging techniques have shown alterations in structure, white matter integrity, and functional activity in DLB. We argue that the multimodal identification of DLB-specific biomarkers has the potential to improve ante-mortem diagnosis and contribute to our understanding of the pathological background of DLB and its progression.
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Affiliation(s)
- Elijah Mak
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | - Li Su
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
| | | | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge CB2 0SP, UK
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Rongve A, Vossius C, Nore S, Testad I, Aarsland D. Time until nursing home admission in people with mild dementia: comparison of dementia with Lewy bodies and Alzheimer's dementia. Int J Geriatr Psychiatry 2014; 29:392-8. [PMID: 23943275 DOI: 10.1002/gps.4015] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 07/03/2013] [Accepted: 07/17/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We studied time until nursing home admission (NHA) in mild dementia and predictors for NHA in people with Dementia with Lewy bodies (DLB) and how it compares to Alzheimer's dementia (AD). METHODS Kaplan-Meier survival analysis and Cox proportional hazards were applied. RESULTS Median time until NHA was 1114 days (95% confidence interval [CI] [932, 1296]). In DLB median time until NHA was 663 days [472, 998]) as compared with 1336 days (1068, 1606) in AD, p < 0.0005. Predictors of shorter time to NHA in the DLB and AD groups in unadjusted analyses were a DLB diagnosis, the use of antipsychotic medication, more advanced age, longer duration of dementia symptoms prior to diagnosis, living alone, higher reported caregiver distress, and more neuropsychiatric symptoms. The use of cholinesterase inhibitors was associated with halved risk of NHA in the combined DLB/AD group in the unadjusted Cox regression. In adjusted Cox regression in the DLB group, we found the use of cholinesterase inhibitors to be associated with reduced risk of NHA (HR = 0.24) and the use of antipsychotic medication to be associated with increased risk of NHA (HR = 37) during the study period. CONCLUSION Patients diagnosed with DLB had nearly 2 years shorter time to NHA than those diagnosed with AD. In the DLB group, the use of cholinesterase inhibitors was associated with reduced and the use of antipsychotics with increased risk of NHA. Future studies should explore whether better identification and management of the variety of clinical problems in patients diagnosed with DLB can delay NHA.
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Affiliation(s)
- Arvid Rongve
- Department of Psychiatry, Haugesund Hospital, Haugesund, Norway
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