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Orlović I, Bartolović M, Marušić K, Vlahović D, Šiško Markoš I, Karlović D, Peitl V. THE ENIGMA OF LEWY BODY DEMENTIA: A CASE REPORT. Acta Clin Croat 2020; 59:771-776. [PMID: 34285451 PMCID: PMC8253061 DOI: 10.20471/acc.2020.59.04.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/12/2019] [Indexed: 11/24/2022] Open
Abstract
Lewy body dementia is a progressive neurodegenerative disease and is considered to be the second most common cause of dementia in the elderly. Because of the complexity of clinical presentation, it is often misdiagnosed and mistaken for other dementias, which may result in administering inappropriate therapy, and thus worsening of the patient condition. We reviewed a case of a 71-year-old patient whose clinical presentation gradually occurred with complex visual hallucinations, atypical extrapyramidal motor symptoms, fluctuating cognitive impairments with delirious episodes, and oscillating syncope. Depressive mood, impaired daily functioning and sensitivity to antipsychotics were also noted. Extensive diagnostic workup was performed with neuropsychological testing and use of single-photon emission computerized tomography. Considering the clinical presentation and diagnostic procedures performed, the diagnosis of Lewy body dementia was set and pharmacotherapy was revised. We discuss the importance of taking overall clinical presentation and diagnostic treatment in consideration and applying appropriate therapy to slow down the progression of the disease and exacerbation of the patient's psychological functions.
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Affiliation(s)
- Ivona Orlović
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Matija Bartolović
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Katarina Marušić
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Vlahović
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Ines Šiško Markoš
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Dalibor Karlović
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Vjekoslav Peitl
- 1Department of Psychiatry, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Catholic University of Croatia, Zagreb, Croatia; 4School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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Gupta S, Singhal NK, Ganesh S, Sandhir R. Extending Arms of Insulin Resistance from Diabetes to Alzheimer's Disease: Identification of Potential Therapeutic Targets. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2020; 18:172-184. [PMID: 30430949 DOI: 10.2174/1871527317666181114163515] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/08/2018] [Accepted: 11/08/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND & OBJECTIVE Type 3 diabetes (T3D) is chronic insulin resistant state of brain which shares pathology with sporadic Alzheimer's disease (sAD). Insulin signaling is a highly conserved pathway in the living systems that orchestrate cell growth, repair, maintenance, energy homeostasis and reproduction. Although insulin is primarily studied as a key molecule in diabetes mellitus, its role has recently been implicated in the development of Alzheimer's disease (AD). Severe complications in brain of diabetic patients and metabolically compromised status is evident in brain of AD patients. Underlying shared pathology of two disorders draws a trajectory from peripheral insulin resistance to insulin unresponsiveness in the central nervous system (CNS). As insulin has a pivotal role in AD, it is not an overreach to address diabetic condition in AD brain as T3D. Insulin signaling is indispensable to nervous system and it is vital for neuronal growth, repair, and maintenance of chemical milieu at synapses. Downstream mediators of insulin signaling pathway work as a regulatory hub for aggregation and clearance of unfolded proteins like Aβ and tau. CONCLUSION In this review, we discuss the regulatory roles of insulin as a pivotal molecule in brain with the understanding of defective insulin signaling as a key pathological mechanism in sAD. This article also highlights ongoing trials of targeting insulin signaling as a therapeutic manifestation to treat diabetic condition in brain.
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Affiliation(s)
- Smriti Gupta
- Department of Biochemistry, Basic Medical Science Block II, Sector 25, Panjab University, Chandigarh 160014, India
| | - Nitin Kumar Singhal
- National Agri-Food Biotechnology Institute, Sector 81, S.A.S. Nagar, Mohali, Punjab 140306, India
| | - Subramaniam Ganesh
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology, Kanpur 208016, India
| | - Rajat Sandhir
- Department of Biochemistry, Basic Medical Science Block II, Sector 25, Panjab University, Chandigarh 160014, India
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Sakamoto F, Shiraishi S, Tsuda N, Hashimoto M, Tomiguchi S, Ikeda M, Yamashita Y. Diagnosis of dementia with Lewy bodies: can 123I-IMP and 123I-MIBG scintigraphy yield new core features? Br J Radiol 2016; 90:20160156. [PMID: 27897064 DOI: 10.1259/bjr.20160156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Since the clinical symptoms of different types of dementia frequently overlap, especially in the earlier stages at onset, it is difficult to distinguish dementia with Lewy bodies (DLB) from other neurodegenerative dementias based on their clinical manifestations alone. Nuclear medicine imaging has been reported as a high-value index for the objective evaluation and diagnosis of DLB. The aim of this study was to evaluate whether nuclear medicine imaging findings may yield core features to be added to the diagnosis of DLB. METHODS We enrolled 332 patients with suspected DLB. All were evaluated by both 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy and 123I-labelled N-isopropyl-p-iodoamphetamine (123I-IMP). brain perfusion single-photon emission CT. The final clinical diagnosis indicated probable DLB in 92 patients (40 males, 52 females; mean age ± standard deviation, 77.4 ± 6.4 years; range, 56-89 years); 240 patients (98 males, 142 females; mean age, 75.5 ± 9.0 years; range, 70-87 years) were recorded as being without DLB. The accepted core features used for clinical evaluations were fluctuating cognition, visual hallucinations and Parkinsonism. The nuclear medicine evaluation indices were the severity score of cerebral blood flow on 123I-IMP scintigraphs of the posterior cingulate and praecuneus and a reduction in the blood flow in the occipital lobe. For 123I-MIBG evaluation, we recorded the early and delayed heart-to-mediastinum (H/M) ratios and the washout rate. RESULTS Univariate and multivariate analyses of fluctuating cognition, visual hallucinations, Parkinsonism and early H/M ratio in patients with probable and without DLB revealed significant differences. Parameters based on 123I-IMP studies did not show any significant differences by multivariate analysis. The area under the curve for the early H/M ratio was 0.918; for fluctuating cognition, visual hallucinations and Parkinsonism, it was 0.693, 0.760 and 0.611, respectively, by receiver-operating characteristic analysis. The early H/M ratio of <2.0 on 123I-MIBG scintigraphs was of the highest diagnostic accuracy. The sensitivity, specificity and accuracy for the diagnosis of probable DLB were 82.4%, 96.3% and 92.5%, respectively. CONCLUSION The early H/M ratio obtained by 123I-MIBG myocardial scintigraphy can serve as a reliable diagnostic index for the core clinical features of DLB. It can be used for the early diagnosis and treatment of DLB. Advances in knowledge: 123I-MIBG myocardial scintigraphy performed at the initial clinical examination can facilitate the early identification or exclusion of DLB and the early H/M ratio may be a diagnostic biomarker for DLB.
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Affiliation(s)
- Fumi Sakamoto
- 1 Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinya Shiraishi
- 1 Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Noriko Tsuda
- 1 Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Mamoru Hashimoto
- 2 Department of Neuropsychiatry, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Seiji Tomiguchi
- 3 Department of Diagnostic Medical Imaging, School of Health Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Manabu Ikeda
- 2 Department of Neuropsychiatry, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- 1 Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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Moguel-Cobos G, Maroney Z, Erickson JM, Tröster AI, Quinn DK. Psychogenic Movement Disorders and Dopamine Transporter Scans: Still a Clinical Diagnosis? PSYCHOSOMATICS 2016; 58:83-89. [PMID: 27889083 DOI: 10.1016/j.psym.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Guillermo Moguel-Cobos
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
| | - Zane Maroney
- University of New Mexico School of Medicine, Albuquerque, NM
| | | | - Alexander I Tröster
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ; Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico Psychiatric Center, Albuquerque, NM
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Abstract
Dementia, whether secondary to Alzheimer disease or another process, is a significant cause of morbidity and mortality worldwide. Although dementia remains a clinical diagnosis, for many years imaging has served as a key component in the assessment of patients with cognitive impairment. There have been tremendous advancements in the neuroimaging of dementia over the past decade, moving the field past the rule-out dogma toward ruling in specific pathophysiologic processes. This article is written for the practicing clinician, to provide a review of neuroimaging findings associated with selected degenerative and nondegenerative forms of dementia.
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Sakakibara R, Tateno F, Kishi M, Tsuyusaki Y, Terada H, Inaoka T. MIBG myocardial scintigraphy in pre-motor Parkinson's disease: A review. Parkinsonism Relat Disord 2014; 20:267-73. [DOI: 10.1016/j.parkreldis.2013.11.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 11/01/2013] [Accepted: 11/04/2013] [Indexed: 01/02/2023]
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Han D, Wang Q, Gao Z, Chen T, Wang Z. Clinical features of dementia with lewy bodies in 35 Chinese patients. Transl Neurodegener 2014; 3:1. [PMID: 24398160 PMCID: PMC3896842 DOI: 10.1186/2047-9158-3-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 01/04/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the clinical features of dementia with Lewy bodies (DLB) in a Chinese population. METHODS Computer-based online searches through China Biology Medicine disc and China National Knowledge Infrastructure were performed to collect case reports of DLB published between 1980 and 2012. Clinical characteristics were analyzed. RESULTS A total of 18 studies comprising 35 patients (26 males and 9 females) were included. The mean age at onset was 67.2 ± 9.8 years. Onset was characterized by memory impairment and accounted for 58.8% of all cases, followed by parkinsonism (11.8%), visual hallucinations (8.8%), and compulsive personality disorder (2.9%). The other patients (17.6%) presented two of the three core features of DLB at onset. With disease progression, parkinsonism was reported in 100% of cases, followed by visual hallucinations (97.1%), psychiatric symptoms (85.7%), severe neuroleptic sensitivity (81.8%), fluctuating cognition (68.6%), repeated falls (40.0%), sleep disorders (22.9%), and transient loss of consciousness (17.1%). 26 patients who were subjected to Mini-Mental State Examination scored ≤ 24. 10 patients presented relative preservation of hippocampus and medial temporal lobe structures on CT/MRI scan. Occipital hypometabolism occurred in 2 of 3 patients who underwent SPECT/PET perfusion scan. 12 patients showed an increasing of slow frequency activity on EEG, prominently in frontal and temporal lobes. CONCLUSIONS DLB often strikes elderly individuals. Its clinical core features are dementia, fluctuating cognition, recurrent visual hallucinations and spontaneous features of parkinsonism. Neuropsychological, neuroimaging and EEG examinations may improve the diagnostic accuracy and discriminate DLB from other dementias.
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Affiliation(s)
- Ding Han
- Department of Neurology, South Building, General Hospital of Chinese PLA, Beijing 100853, China
| | - Qiong Wang
- Department of Neurology, South Building, General Hospital of Chinese PLA, Beijing 100853, China
| | - Zhongbao Gao
- Department of Neurology, South Building, General Hospital of Chinese PLA, Beijing 100853, China
| | - Tong Chen
- Department of Neurology, South Building, General Hospital of Chinese PLA, Beijing 100853, China
| | - Zhenfu Wang
- Department of Neurology, South Building, General Hospital of Chinese PLA, Beijing 100853, China
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Abstract
Neurodegenerative disorders leading to dementia are common diseases that affect many older and some young adults. Neuroimaging methods are important tools for assessing and monitoring pathological brain changes associated with progressive neurodegenerative conditions. In this review, the authors describe key findings from neuroimaging studies (magnetic resonance imaging and radionucleotide imaging) in neurodegenerative disorders, including Alzheimer's disease (AD) and prodromal stages, familial and atypical AD syndromes, frontotemporal dementia, amyotrophic lateral sclerosis with and without dementia, Parkinson's disease with and without dementia, dementia with Lewy bodies, Huntington's disease, multiple sclerosis, HIV-associated neurocognitive disorder, and prion protein associated diseases (i.e., Creutzfeldt-Jakob disease). The authors focus on neuroimaging findings of in vivo pathology in these disorders, as well as the potential for neuroimaging to provide useful information for differential diagnosis of neurodegenerative disorders.
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Affiliation(s)
- Shannon L. Risacher
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, and Indiana Alzheimer Disease Center Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew J. Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, and Indiana Alzheimer Disease Center Indiana University School of Medicine, Indianapolis, Indiana
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Utilidad de la imagen precoz de la gammagrafía de inervación miocárdica en el diagnóstico de la demencia con cuerpos de Lewy. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remn.2012.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Camacho V, Estorch M, Marquié M, Domènech A, Flotats A, Fernández A, Duch J, Geraldo L, Deportos J, Artigas C, Lleó A, Carrió I. Utility of early imaging of myocardial innervation scintigraphy in the diagnosis of Lewy body dementia. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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The diagnosis and evaluation of dementia and mild cognitive impairment with emphasis on SPECT perfusion neuroimaging. CNS Spectr 2012; 17:176-206. [PMID: 22929226 DOI: 10.1017/s1092852912000636] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As the world population ages, the incidence of dementing illnesses will dramatically increase. The number of people afflicted with dementia is expected to quadruple in the next 50 years. Since the neuropathology of the dementias precedes clinical symptoms often by several years, earlier detection and intervention could be key steps to mitigating the progression and burden of these diseases. This review will explore methods of evaluating, differentiating, and diagnosing the multiple forms of dementia. Particular emphasis will be placed on the diagnosis of mild cognitive impairment-the precursor to dementia. Anatomical imaging; cerebrospinal fluid markers; functional neuroimaging, such as positron emission tomography and single photon emission tomography; and molecular imaging, such as amyloid marker imaging, will be assessed in terms of sensitivity and specificity. Cost will also be a consideration, as the growing population afflicted with dementia represents an increasingly large financial encumbrance to the healthcare systems of every nation. In the face of expensive new markers and limited availability of cyclotrons, single photon emission computer tomography (SPECT) provides relatively high sensitivity and specificity at a comparatively low overall cost.
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Treglia G, Cason E, Cortelli P, Gabellini A, Liguori R, Bagnato A, Giordano A, Fagioli G. Iodine-123 metaiodobenzylguanidine scintigraphy and iodine-123 ioflupane single photon emission computed tomography in Lewy body diseases: complementary or alternative techniques? J Neuroimaging 2012; 24:149-54. [PMID: 23163913 DOI: 10.1111/j.1552-6569.2012.00774.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 07/24/2012] [Accepted: 08/05/2012] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare myocardial sympathetic imaging using (123)I-Metaiodobenzylguanidine (MIBG) scintigraphy and striatal dopaminergic imaging using (123)I-Ioflupane (FP-CIT) single photon emission computed tomography (SPECT) in patients with suspected Lewy body diseases (LBD). METHODS Ninety-nine patients who performed both methods within 2 months for differential diagnosis between Parkinson's disease (PD) and other parkinsonism (n = 68) or between dementia with Lewy bodies (DLB) and other dementia (n = 31) were enrolled. Sensitivity, specificity, accuracy, positive and negative predictive values of both methods were calculated. RESULTS For (123) I-MIBG scintigraphy, the overall sensitivity, specificity, accuracy, positive and negative predictive values in LBD were 83%, 79%, 82%, 86%, and 76%, respectively. For (123)I-FP-CIT SPECT, the overall sensitivity, specificity, accuracy, positive and negative predictive values in LBD were 93%, 41%, 73%, 71%, and 80%, respectively. There was a statistically significant difference between these two methods in patients without LBD, but not in patients with LBD. CONCLUSIONS LBD usually present both myocardial sympathetic and striatal dopaminergic impairments. (123)I-FP-CIT SPECT presents high sensitivity in the diagnosis of LBD; (123)I-MIBG scintigraphy may have a complementary role in differential diagnosis between PD and other parkinsonism. These scintigraphic methods showed similar diagnostic accuracy in differential diagnosis between DLB and other dementia.
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Affiliation(s)
- Giorgio Treglia
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
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Franciotti R, Falasca NW, Bonanni L, Anzellotti F, Maruotti V, Comani S, Thomas A, Tartaro A, Taylor JP, Onofrj M. Default network is not hypoactive in dementia with fluctuating cognition: an Alzheimer disease/dementia with Lewy bodies comparison. Neurobiol Aging 2012; 34:1148-58. [PMID: 23063646 DOI: 10.1016/j.neurobiolaging.2012.09.015] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 09/04/2012] [Accepted: 09/12/2012] [Indexed: 12/21/2022]
Abstract
Default mode network resting state activity in posterior cingulate cortex is abnormally reduced in Alzheimer disease (AD) patients. Fluctuating cognition and electroencephalogram abnormalities are established core and supportive elements respectively for the diagnosis of dementia with Lewy bodies (DLB). Our aim was to assess whether patients with DLB with both of these features have different default mode network patterns during resting state functional magnetic resonance imaging compared with AD. Eighteen patients with DLB, 18 AD patients without fluctuating cognition, and 15 control subjects were selected after appropriate matching and followed for 2-5 years to confirm diagnosis. Independent component analysis with functional connectivity (FC) and Granger causality approaches were applied to isolate and characterize resting state networks. FC was reduced in AD and DLB patients compared with control subjects. Posterior cingulate cortex activity was lower in AD than in control subjects and DLB patients (p < 0.05). Right hemisphere FC was reduced in DLB patients in comparison with control subjects but not in patients with AD, and was correlated with severity of fluctuations (ρ = -0.69; p < 0.01). Causal flow analysis showed differences between patients with DLB and AD and control subjects.
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Sakakibara R, Ogata T, Haruta M, Kishi M, Tsuyusaki Y, Tateno A, Tateno F, Mouri T. Amnestic mild cognitive impairment with low myocardial metaiodobenzylguanidine uptake. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2012; 1:146-151. [PMID: 23383388 PMCID: PMC3560457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 06/21/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES We reported cases of amnestic mild cognitive impairment (MCI) without the core clinical features of dementia with Lewy bodies (DLB) (dementia and spontaneous parkinsonism) with low uptake in (123)I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. METHODS During a 3-year period at a university clinic, we had 254 patients with memory complaints; 106 men, 148 women; mean age 72.5 years (48-95 years). In all patients we performed neurologic examination; memory tests including the MMSE, ADAScog, FAB and additional WMS-R; and imaging tests including brain MRI, SPECT and MIBG scintigraphy. RESULTS The criteria of amnestic MCI were fulfilled in 44 patients; and 13 of them (30%) showed low MIBG uptake. They had the following: uniformly elderly, with an equal sex ratio, have relatively slow progression, preserved general cognitive function (MMSE 24.8/30). In addition to memory impairment, they commonly showed low frontal function by FAB (12.5/18) and some had mild visual hallucination (5). Other than memory disorder, they had autonomic disorder (nocturia in 7, constipation in 2, postural hypotension in one), REM sleep behavioral disorder (in 3) and occipital hypoperfusion by SPECT (in 5). CONCLUSION This cohort of multidomain amnestic MCI cases may present with early stage DLB because of the presence of low MIBG uptake. Clinically, they commonly have low FAB, and may have visual hallucination, autonomic and sleep disorders.
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Affiliation(s)
- Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho UniversitySakura, Japan
| | - Takeshi Ogata
- Neurology, Internal Medicine, Sakura Medical Center, Toho UniversitySakura, Japan
| | - Masayuki Haruta
- Neurology, Internal Medicine, Sakura Medical Center, Toho UniversitySakura, Japan
| | - Masahiko Kishi
- Neurology, Internal Medicine, Sakura Medical Center, Toho UniversitySakura, Japan
| | - Yohei Tsuyusaki
- Neurology, Internal Medicine, Sakura Medical Center, Toho UniversitySakura, Japan
| | - Akihiko Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho UniversitySakura, Japan
| | - Fuyuki Tateno
- Neurology, Internal Medicine, Sakura Medical Center, Toho UniversitySakura, Japan
| | - Takayuki Mouri
- Information Technology System, Sakura Medical Center, Toho UniversitySakura, Japan
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Treglia G, Cason E, Giordano A, Fagioli G. Abnormal striatal dopaminergic and cardiac sympathetic imaging in dementia with Lewy bodies: two sides of the same coin. Parkinsonism Relat Disord 2012; 18:707-8; author reply 709. [PMID: 22425545 DOI: 10.1016/j.parkreldis.2012.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
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Umemura A, Oka Y, Okita K, Matsukawa N, Yamada K. Subthalamic nucleus stimulation for Parkinson disease with severe medication-induced hallucinations or delusions. J Neurosurg 2011; 114:1701-5. [DOI: 10.3171/2011.2.jns101261] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Subthalamic nucleus deep brain stimulation (STN DBS) improves cardinal motor symptoms of Parkinson disease (PD) and reduces antiparkinsonian medication. Therefore, STN DBS seems to be well indicated for patients suffering from medication-induced psychotic symptoms. However, there are few available data dealing with the effect of STN DBS in this kind of patient. The authors studied the effect of STN DBS in patients with PD and severe medication-induced hallucinations or delusions.
Methods
The authors retrospectively reviewed the clinical course of 10 patients who suffered from severe medication-induced hallucinations or delusions and underwent bilateral STN DBS. Patients whose preoperative thought disorder score (Unified Parkinson's Disease Rating Scale Part I, item 2) was 3 or more were enrolled in this study. All patients underwent cognitive function examination and brain perfusion SPECT preoperatively to exclude dementia with Lewy bodies.
Results
Subthalamic nucleus DBS yielded significant improvement of motor function in all patients. In 8 patients, psychotic symptoms completely disappeared with significant reduction of dopaminergic medication. In 2 patients, hallucinations and delusions deteriorated immediately after surgery despite complete withdrawal of antiparkinsonian medication. However, these psychotic symptoms completely disappeared after a few months with administration of antipsychotics, and no recurrence was observed afterward in either patient.
Conclusions
Subthalamic nucleus DBS is a good treatment option for patients with PD who are suffering severe medication-induced hallucinations or delusion. However, vigilance is needed, because temporary deterioration of psychotic symptoms may occur after surgery.
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Affiliation(s)
| | | | - Kenji Okita
- 2Neurology, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Matsukawa
- 2Neurology, Nagoya City University Graduate School of Medicine, Nagoya, Japan
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Apolipoprotein E4 frequencies in a Japanese population with Alzheimer's disease and dementia with Lewy bodies. PLoS One 2011; 6:e18569. [PMID: 21552550 PMCID: PMC3084234 DOI: 10.1371/journal.pone.0018569] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 03/04/2011] [Indexed: 12/21/2022] Open
Abstract
Background The apolipoprotein E (APOE) ε4 allele has been reported to be a risk factor for Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). Previous neuropathological studies have demonstrated similar frequencies of the APOE ε4 allele in AD and DLB. However, the few ante-mortem studies on APOE allele frequencies in DLB have shown lower frequencies than post-mortem studies. One reason for this may be inaccuracy of diagnosis. We examined APOE genotypes in subjects with AD, DLB, and a control group using the latest diagnostic criteria and MRI, SPECT, and MIBG myocardial scintigraphy. Methods The subjects of this study consisted of 145 patients with probable AD, 50 subjects with probable DLB, and a control group. AD subjects were divided into two groups based on age of onset: early onset AD (EOAD) and late onset AD (LOAD). All subjects had characteristic features on MRI, SPECT, and/or myocardial scintigraphy. Results The rate of APOE4 carrier status was 18.3% and the frequency of the ε4 allele was 9.7% in controls. The rate of APOE4 carrier status and the frequency of the ε4 allele were 47% and 27% for LOAD, 50% and 31% for EOAD, and 42% and 31% for DLB, respectively. Conclusion The APOE4 genotypes in this study are consistent with previous neuropathological studies suggesting accurate diagnosis of AD and DLB. APOE4 genotypes were similar in AD and DLB, giving further evidence that the ε4 allele is a risk factor for both disorders.
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Galvin JE, Price JL, Yan Z, Morris JC, Sheline YI. Resting bold fMRI differentiates dementia with Lewy bodies vs Alzheimer disease. Neurology 2011; 76:1797-803. [PMID: 21525427 DOI: 10.1212/wnl.0b013e31821ccc83] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Clinicopathologic phenotypes of dementia with Lewy bodies (DLB) and Alzheimer disease (AD) often overlap, making discrimination difficult. We performed resting state blood oxygen level-dependent (BOLD) functional connectivity MRI (fcMRI) to determine whether there were differences between AD and DLB. METHODS Participants (n = 88) enrolled in a longitudinal study of memory and aging underwent 3-T fcMRI. Clinical diagnoses of probable DLB (n = 15) were made according to published criteria. Cognitively normal control participants (n = 38) were selected for the absence of cerebral amyloid burden as imaged with Pittsburgh compound B (PiB). Probable AD cases (n = 35) met published criteria and had appreciable amyloid deposits with PiB imaging. Functional images were collected using a gradient spin-echo sequence sensitive to BOLD contrast (T2* weighting). Correlation maps selected a seed region in the combined bilateral precuneus. RESULTS Participants with DLB had a functional connectivity pattern for the precuneus seed region that was distinct from AD; both the DLB and AD groups had functional connectivity patterns that differed from the cognitively normal group. In the DLB group, we found increased connectivity between the precuneus and regions in the dorsal attention network and the putamen. In contrast, we found decreased connectivity between the precuneus and other task-negative default regions and visual cortices. There was also a reversal of connectivity in the right hippocampus. CONCLUSIONS Changes in functional connectivity in DLB indicate patterns of activation that are distinct from those seen in AD and may improve discrimination of DLB from AD and cognitively normal individuals. Since patterns of connectivity differ between AD and DLB groups, measurements of BOLD functional connectivity can shed further light on neuroanatomic connections that distinguish DLB from AD.
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Affiliation(s)
- J E Galvin
- Center of Excellence on Brain Aging, New York University Langone School of Medicine, 145 East 32nd St, Second Floor, New York, NY 10016, USA.
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Treglia G, Cason E. Diagnostic performance of myocardial innervation imaging using MIBG scintigraphy in differential diagnosis between dementia with lewy bodies and other dementias: a systematic review and a meta-analysis. J Neuroimaging 2010; 22:111-7. [PMID: 21091814 DOI: 10.1111/j.1552-6569.2010.00532.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE This study was designed to review the diagnostic performance of myocardial innervation imaging using iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy in differential diagnosis between dementia with Lewy bodies (DLB) and other dementias. METHODS A comprehensive computer literature search of studies published through May 2010 regarding MIBG scintigraphy in patients with DLB was performed in PubMed/MEDLINE and Embase databases. Only studies in which MIBG scintigraphy was performed for differential diagnosis between DLB and other dementias were selected. Pooled sensitivity and specificity of MIBG scintigraphy were presented with a 95% confidence interval (CI). The area under the ROC curve was calculated to measure the accuracy of MIBG scintigraphy in differential diagnosis between Lewy body diseases and other dementias. RESULTS Ultimately, we identified 8 studies comprising a total of 346 patients with dementia (152 patients with DLB and 194 patients with other dementias). The pooled sensitivity of MIBG scintigraphy in detection of DLB was 98% (95% CI, 94-100%); the pooled specificity of MIBG scintigraphy in differential diagnosis between DLB and other dementias was 94% (95% CI, 90-97%). The area under the ROC curve was .99. CONCLUSIONS Myocardial innervation imaging with MIBG scintigraphy demonstrated high pooled sensitivity and specificity in patients with suspected DLB. MIBG scintigraphy is an accurate test for differential diagnosis between DLB and other dementias.
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Affiliation(s)
- Giorgio Treglia
- Institute of Nuclear Medicine, Policlinico Gemellli, Catholic University of the Sacred Heart, Rome, Italy.
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