Diagnostic accuracy of dopaminergic imaging in prodromal dementia with Lewy bodies

Int J Geriat Psychiatry

Barnett

et al. 2019

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Introduction Lewy body disease is postulated, by the Braak model, to originate in the enteric nervous system, before spreading to the central nervous system. Therefore, a high prevalence of gastroparesis symptoms would be expected in prodromal dementia with Lewy bodies (DLB) and be highest in those with a dopaminergic deficit on imaging. The aim of this study was to explore whether gastroparesis symptoms are an early diagnostic marker of prodromal DLB and explore the relationship between symptoms and dopaminergic imaging findings on FP‐CIT SPECT. Methods We recruited 75 patients over 60 with mild cognitive impairment (MCI), 48 with MCI with suspected Lewy body disease (MCI‐LB) and 27 with MCI with suspected Alzheimer's disease (MCI‐AD). All patients completed the Gastroparesis Cardinal Symptom Index (GSCI) questionnaire and also underwent FP‐CIT [123I‐N‐fluoropropyl‐2β‐carbomethoxy‐3β‐(4‐iodophenyl)] dopaminergic imaging. Results At least one symptom suggestive of gastroparesis was reported in 48% (n = 23) MCI‐LB vs 37% MCI‐AD (n = 10) (P = 0.36). Rates of definite symptoms of gastroparesis, as defined by a GCSI total score ≥ 1.90, were rare and rates in MCI‐LB were not different from MCI‐AD (6% vs 0%, p = 0.55). After adjusting for gender differences between groups, no difference in gastroparesis symptom prevalence (2.27 vs 0.81 P = 0.05) or severity score (0.62 vs 0.28, p = 0.28) was noted between normally and abnormally visually rated FP‐CIT SPECT scans. Conclusion The GCSI is not a useful tool for differentiating MCI‐LB from MCI‐AD. A low rate of definite gastroparesis was detected in prodromal DLB. No association was found between gastroparesis symptoms and FP‐CIT SPECT findings.

Section: Diagnosismentioning

confidence: 76%

Section: Clinical Assessmentmentioning

confidence: 99%

mentioning

confidence: 99%

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Prevalence and severity of symptoms suggestive of gastroparesis in prodromal dementia with Lewy bodies

Durcan

Int J Geriat Psychiatry

Barnett

et al. 2019

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“…In a study by Thomas et al, examining the diagnostic accuracy of 123 I‐FP‐CIT SPECT in prodromal DLB, 75 patients with MCI and over the age of 60 years were recruited and underwent 123 I‐FP‐CIT SPECT, alongside detailed clinical, neurological, and neuropsychological assessments . A diagnostic panel further classified the MCI patients, based on the presence or absence of core Lewy body symptoms; two or more LB symptoms (probable MCI‐LB, n = 33), one LB symptom (possible MCI‐LB, n = 15), no LB symptoms (MCI‐AD, n = 27).…”

Section: Functional Radiotracer Imaging In Prodromal Dlbmentioning

confidence: 99%

“…Additionally, at least one biomarker supportive of Lewy body disease is required, alongside the clinical prodromal DLB subtype. In our recent work, we used similar criteria that extended the 2017 consensus dementia criteria to the earlier MCI phase by requiring subjects with MCI‐LB to meet NIA‐AA criteria and have one (possible MCI‐LB) or two (probable MCI‐LB) of the core clinical or indicative biomarkers …”

Section: Introductionmentioning

confidence: 99%

Imaging in prodromal dementia with Lewy bodies: Where do we stand?

Durcan

Int J Geriat Psychiatry

Osborne

et al. 2019

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Objectives The aim of this review was to provide an overview of the literature on imaging in prodromal dementia with Lewy bodies (DLB). Design Systematic PubMed search and literature review. Results Diagnostic classification of the prodromal DLB stage remains to be established but is likely to require imaging biomarkers to improve diagnostic accuracy. In subjects with mild cognitive impairment with Lewy body disease (MCI‐LB) (here synonymous with prodromal DLB) and REM sleep behaviour disorder, a high risk condition for future conversion to a synucleinopathy, imaging modalities have assessed early structural brain changes, striatal dopaminergic integrity, metabolic brain, and cerebral perfusion alterations. It remains uncertain whether structural brain imaging can differentiate MCI‐LB from mild cognitive impairment with Alzheimer disease (MCI‐AD), but early right anterior insula thinning has been reported to occur in MCI‐LB compared with MCI‐AD. Dopaminergic deficits have been observed in a substantial proportion of MCI‐LB subjects and have a high specificity for Lewy body disease at the pre‐dementia stage. Cardiac sympathetic denervation, occipital hypometabolism, or hypoperfusion is less studied as this pre‐dementia stage and it remains to be determined whether any imaging abnormalities antedate DLB. Conclusion Imaging studies in prodromal DLB are still in their infancy but offer great potential to study early in vivo structural and functional biological alterations. Future work should focus on longitudinal multimodal imaging studies with postmortem validation of diagnosis in order to develop and then validate criteria for prodromal DLB.

Research diagnostic criteria for mild cognitive impairment with Lewy bodies: A systematic review and meta‐analysis

Carrarini

Ferreira

et al. 2023

Alzheimer's & Dementia

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Introduction Operationalized research criteria for mild cognitive impairment with Lewy bodies (MCI‐LB) were published in 2020. The aim of this systematic review and meta‐analysis was to review the evidence for the diagnostic clinical features and biomarkers in MCI‐LB set out in the criteria. Methods MEDLINE, PubMed, and Embase were searched on 9/28/22 for relevant articles. Articles were included if they presented original data reporting the rates of diagnostic features in MCI‐LB. Results Fifty‐seven articles were included. The meta‐analysis supported the inclusion of the current clinical features in the diagnostic criteria. Evidence for striatal dopaminergic imaging and meta‐iodobenzylguanidine cardiac scintigraphy, though limited, supports their inclusion. Quantitative electroencephalogram (EEG) and fluorodeoxyglucose positron emission tomography (PET) show promise as diagnostic biomarkers. Discussion The available evidence largely supports the current diagnostic criteria for MCI‐LB. Further evidence will help refine the diagnostic criteria and understand how best to apply them in clinical practice and research. Highlights A meta‐analysis of the diagnostic features of MCI‐LB was carried out. The four core clinical features were more common in MCI‐LB than MCI‐AD/stable MCI. Neuropsychiatric and autonomic features were also more common in MCI‐LB. More evidence is needed for the proposed biomarkers. FDG‐PET and quantitative EEG show promise as diagnostic biomarkers in MCI‐LB.