Characteristics of Cortical Atrophy and White Matter Lesions Between Dementia With Lewy Bodies and Alzheimer's Disease: A Case-Control Study

Abstract

Introduction: Currently, there is still clinical overlap between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) patients, which may affect the accuracy of the early diagnosis of DLB. For better diagnosis and prognosis, further exploration of local cortical atrophy patterns and white matter lesions is needed.Methods: We reviewed the outpatient medical records of 97 DLB patients and 173 AD patients from January 2018 to September 2020 along with 30 matched outpatient clinic normal elderly people. MRI visual rating scales, including medial temporal lobe atrophy (MTA), global cortical atrophy-frontal subscale (GCA-F), posterior atrophy (PA), Fazekas scale, Evans Index and cerebral microbleeds were evaluated and analyzed in DLB and AD patients with different severities and normal controls.Results: Overall, patients with DLB had higher scores on all visual rating scales than the normal controls. Meanwhile, compared with AD, DLB had lower MTA scores in the mild to moderate groups (both p ≤ 0.001), but the GCA-F and PA scores were similar (all p > 0.05). The Fazekas scores in the moderate to severe DLB group were lower than those in the AD group (p = 0.024 and p = 0.027, respectively). In addition, the diagnostic performance and sensitivity of multiple imaging indicators for DLB were better than that of MTA alone (the combination of MTA, GCA-F, PA, Fazekas visual rating scales, AUC = 0.756, 95%CI: 0.700–0.813, sensitivity = 0.647, specificity = 0.804 and MTA visual rating scale, AUC = 0.726, 95%CI: 0.667–0.785, sensitivity = 0.497, specificity = 0.876, respectively).Conclusion: The medial temporal lobe of DLB patients was relatively preserved, the frontal and parietal lobes were similarly atrophied to AD patients, and the white matter hyperintensity was lighter than that in AD patients. Combined multiple visual rating scales may provide a novel idea for the diagnosis of early DLB.

Brain morphometry and its relevance in cerebral small vessel disease

“…A marginally hyperintense rim seen with FLAIR is suggestive of a lacune instead of enlarged PVS. The typical anatomical location of enlarged PVS may be the best differentiating feature [21]. Total CSVD burden assessed by simple validate method, if there were one or more lacunes, one point was added, one point was added when the deep WMH Fazekas score reached 2 or periventricular WMH Fazekas score reached 3, if the number of EPVS at the basal ganglia or centrum semiovale level reached >10, one point was added [8].…”

“…There are several types of brain atrophy, such as global cortical atrophy, deep atrophy, total atrophy, mediotemporal hippocampal atrophy, precuneus atrophy etc. [21], which helps better classified brain changes for diagnostics, treatments and prognostics purposes. Therefore, more precise and thorough measurement of the brain morphology can shed light on underlying pathology and give clues for better prevention strategies.…”

Visual atrophy rating scales and amyloid PET status in an Alzheimer's disease clinical cohort

“…Despite representing a major source of heterogeneity, the cut-off issue seems to be incompletely acknowledged in the literature, to the point that some studies on VRS diagnostic accuracy have not reported the scores used to determine abnormality. 16,17 Evidence that 20-30% of AD patients, especially those with early onset (EOAD), show parietal-dominant patterns of atrophy 18,19 led to the development of the posterior atrophy (PA) scale. 20 In Table S2, we have reviewed the data extracted from 14 peer-reviewed research articles found using PubMed as the main database (in July 2022).…”

“…Moreover, studies have differed in the way they analyzed the left and right hemisphere scores, with some using the sum, others the highest score, while the majority incorporated the mean of both sides (see Table S2). Despite representing a major source of heterogeneity, the cut‐off issue seems to be incompletely acknowledged in the literature, to the point that some studies on VRS diagnostic accuracy have not reported the scores used to determine abnormality 16,17 …”

“…Despite representing a major source of heterogeneity, the cut‐off issue seems to be incompletely acknowledged in the literature, to the point that some studies on VRS diagnostic accuracy have not reported the scores used to determine abnormality. 16 , 17 …”