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

Durcan, Rory; Donaghy, Paul C.; Osborne, Curtis; Taylor, John‐Paul; Thomas, Alan

doi:10.1002/gps.5071

Cited by 11 publications

(10 citation statements)

References 48 publications

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“…This finding supports the use of this ratio (or a visual rating scale assessment [26]) to identify those with more typical LB features. However, a recent review in MCI-LB [5] suggested that reduced posterior cingulate metabolism can occur in those who progress to DLB, and further work is needed to validate the use of posterior cingulate preservation as a predictor of LB disease.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging of brain metabolism, either through FDG-PET, perfusion SPECT or arterial spin labelled MRI (ASL) [2][3][4] is often done as part of the investigation in dementia patients. Studies with FDG-PET in MCI-LB have found a hypometabolic pattern similar to that seen in dementia with Lewy bodies (DLB) [5], with parieto-occipital hypometabolism [6], and relative preservation of posterior cingulate (cingulate island sign) [7]. Compared with FDG-PET, ASL has the advantage of being cheaper, non-radioactive, and can be done alongside other MR imaging; Dolui [8] compared ASL and FDG in MCI-AD and age matched controls and found similarities between the two techniques, with the hypometabolism patterns in MCI-AD similar to those seen in AD dementia.…”

Section: Introductionmentioning

confidence: 90%

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Mild cognitive impairment with Lewy bodies: blood perfusion with arterial spin labelling

et al. 2020

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Objective To use arterial spin labelling to investigate differences in perfusion in mild cognitive impairment with Lewy bodies (MCI-LB) compared to Alzheimer type MCI (MCI-AD) and healthy controls. Methods We obtained perfusion images on 32 MCI-LB, 30 MCI-AD and 28 healthy subjects of similar age. Perfusion relative to cerebellum was calculated, and we aimed to examine differences in relative perfusion between MCI-LB and the other groups. This included whole brain voxelwise comparisons, as well as using predefined region-of-interest ratios of medial occipital to medial temporal, and posterior cingulate to precuneus. Differences in occipital perfusion in eyes open vs eyes closed conditions were also examined. Results Compared to controls, the MCI-LB showed reduced perfusion in the precuneus, parietal, occipital and fusiform gyrus regions. In our predefined regions, the ratio of perfusion in occipital/medial temporal was significantly lower, and the posterior cingulate/precuneus ratio was significantly higher in MCI-LB compared to controls. Overall, the occipital perfusion was greater in the eyes open vs closed condition, but this did not differ between groups. Conclusion We found patterns of altered perfusion in MCI-LB which are similar to those seen in dementia with Lewy bodies, with reduction in posterior parietal and occipital regions, but relatively preserved posterior cingulate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

Mild cognitive impairment with Lewy bodies: blood perfusion with arterial spin labelling

et al. 2020

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“…Another limitation is that a definite diagnosis based on a pathological evaluation is lacking. Further research with the addition of more cases and involving comparisons with other modalities, such as 123 I‐meta‐iodobenzylguanidine (MIBG) myocardial scintigraphy or 123 I‐Ioflupane SPECT is needed, particularly for an early diagnosis in the analysis of MCI patients …”

Section: Discussionmentioning

confidence: 99%

The Cingulate Island Sign on FDG‐PET vs. IMP‐SPECT to Assess Mild Cognitive Impairment in Alzheimer's Disease vs. Dementia with Lewy Bodies

Chiba

Fujishiro

Iseki

et al. 2019

Journal of Neuroimaging

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BACKGROUND AND PURPOSE: The cingulate island sign (CIS) on 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET); ie, the relative preservation of mid-posterior cingulate cortex metabolism, is a supportive biomarker in the diagnostic criteria for dementia with Lewy bodies (DLB). However, limited information is currently available on the diagnostic value of the CIS on FDG-PET or 123 I-iodoamphetamine single-photon emission computed tomography (IMP-SPECT) for differentiating between mild cognitive impairment (MCI) due to Alzheimer's disease (AD) (MCI-AD) and MCI due to DLB (MCI-DLB). METHODS: We examined the CIS ratio in 9 AD patients, 9 DLB patients, 8 patients with MCI-AD, and 9 patients with MCI-DLB using FDG-PET and IMP-SPECT. The CIS ratio was calculated using NEUROSTAT software. RESULTS: In the dementia groups, a receiver operating characteristic analysis of the CIS ratio showed significant accuracy for differentiating between AD and DLB on FDG-PET and IMP-SPECT. In the MCI groups, only the FDG-PET derived CIS ratio displayed significant accuracy for differentiating between AD and DLB. CONCLUSIONS: The FDG-PET and IMP-SPECT derived CIS ratios are both useful for differentiating between AD and DLB. The FDG-PET derived CIS ratio is more valuable than the IMP-SPECT derived CIS ratio for differential diagnosis in patients with MCI. A larger study is needed to confirm these results.

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“…Various clinical symptoms, including olfactory dysfunction, dysautonomia, depression, and RBD, occur in patients with the prodromal state of DLB (before or at the onset of memory loss) (5)(6)(7)(8). Moreover, recent evidence suggests the existence of prodromal DLB characterized by PPA (9-11).…”

Section: Discussionmentioning

confidence: 99%

“…The core clinical features of DLB include visual hallucinations, fluctuating cognition, rapid eye movement sleep behavior disorders (RBD), and motor symptoms of parkinsonism, as well as cognitive impairment characterized by deficits of attention, executive function, and visual perception (4). Various clinical symptoms, including olfactory dysfunction, dysautonomia, depression, and RBD, are observed in patients with the prodromal state of DLB (before or at the onset of memory loss) (5)(6)(7)(8). Moreover, recent evidence suggests the occurrence of PPA in patients with prodromal DLB (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Primary Progressive Aphasia as a Prodromal State of Dementia With Lewy Bodies: A Case Report

2020

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Dementia with Lewy bodies (DLB) is the second most common form of dementia in the elderly, and various clinical symptoms, including olfactory dysfunction, dysautonomia, depression, and rapid eye movement sleep behavior disorders (RBD), occur in patients with the prodromal state of DLB. We herein describe a case of a 72-years-old right-handed woman who exhibited primary progressive aphasia (PPA) as a prodromal state of DLB and took cholinesterase inhibitors (donepezil). At 4.5 years after aphasia onset, she exhibited all the core clinical features of DLB, including visual hallucinations, fluctuating cognition, RBD, and Parkinsonism, as well as progressive language impairment. She showed reduced dopamine transporter (DAT) uptake (assessed by DAT single-photon emission computed tomography imaging) in the striatum and decreased cardiac uptake (determined by 123 I-metaiodobenzylguanidine myocardial scintigraphy), which are indicative biomarkers of DLB. Thus, this patient met all the criteria for probable DLB. Notably, the unique feature of this case was the presentation of PPA, which is seldom observed in typical DLB. Moreover, cholinergic enhancement (donepezil, 5 mg daily) improved her language function and global cognitive function, although mild aphasia remained. The findings provide valuable insights into the spectrum of the prodromal state of DLB and shed light on the development of the medication for PPA caused by cholinergic insufficiency.

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

Cited by 11 publications

References 48 publications

Mild cognitive impairment with Lewy bodies: blood perfusion with arterial spin labelling

Mild cognitive impairment with Lewy bodies: blood perfusion with arterial spin labelling

The Cingulate Island Sign on FDG‐PET vs. IMP‐SPECT to Assess Mild Cognitive Impairment in Alzheimer's Disease vs. Dementia with Lewy Bodies

Primary Progressive Aphasia as a Prodromal State of Dementia With Lewy Bodies: A Case Report

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