Dementia with Lewy Bodies

1999 ◽  
Vol 33 (6) ◽  
pp. 800-808 ◽  
Author(s):  
Ian McKeith ◽  
John O'Brien
Keyword(s):  
Cognitive Impairment ◽  
Dementia With Lewy Bodies ◽  
Single Photon ◽  
Photon Emission ◽  
Lewy Bodies ◽  
High Specificity ◽  
The Elderly ◽  
Diagnostic Methods ◽  
Visual Hallucinations ◽  
Clinical Criteria

Objective: The aim of this paper is to summarise recent clinical and research findings with regard to dementia with Lewy bodies (DLB). Method: A literature review (Medline) was carried out, as well as a review of reports of recent DLB symposia of international meetings and of other relevant papers and data known to the authors. Results: Dementia with Lewy bodies, as the disorder should be known, is the second commonest form of degenerative dementia, accounting for up to 20% cases in the elderly. It is characterised by fluctuating cognitive impairment, spontaneous parkinsonism and recurrent visual hallucinations. Consensus clinical and neuro-pathological criteria have been published. The clinical criteria have been shown to have high specificity, but may still lack sensitivity. Recognition of DLB is clinically important in view of the high incidence (60%) of adverse and life-threatening reaction to antipsychotics, the difference in prognosis and, possibly, the differential treatment response to cholinergic therapy. Neuroimaging changes have not been well described in DLB but some show promise as potential markers to differentiate DLB from AD. These include relative preservation of temporal lobe structures on magnetic resonance imaging and loss of pre- and postsynaptic dopaminergic markers on single photon emission tomography. Conclusions: Dementia with Lewy bodies is a common cause of cognitive impairment in late life which appears to be clinically and neuropathologically distinct from AD. All clinicians should be aware of the typical triad of clinical features (fluctuating cognitive impairment, visual hallucinations and parkinsonism) which characterise the disorder and either avoid antipsychotics or prescribe them with extreme caution in such patients. Further research is likely to result in advances in diagnostic methods and therapeutics in the near future.

scholarly journals Clinical usefulness of dopamine transporter SPECT imaging with 123I-FP-CIT in patients with possible dementia with Lewy bodies: Randomised study

2015 ◽  
Vol 206 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Zuzana Walker ◽  
Emilio Moreno ◽  
Alan Thomas ◽  
Fraser Inglis ◽  
Naji Tabet ◽  
...  
Keyword(s):  
Dementia With Lewy Bodies ◽  
Single Photon ◽  
Photon Emission ◽  
Lewy Bodies ◽  
Control Group ◽  
Emission Computed Tomography ◽  
Clinical Settings ◽  
Randomised Study ◽  
Spect Scan ◽  
Work Up

BackgroundDementia with Lewy bodies (DLB) is underrecognised in clinical settings.AimsTo investigate whether performing a 123I-ioflupane injection (123I-FP-CIT also called DaTSCANTM) 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).MethodWe 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.ResultsThere 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%).ConclusionsImaging significantly contributed to a more certain diagnosis, proving to be a useful adjunct in the work-up of patients with possible DLB.

scholarly journals Assessing Nigrostriatal Dopaminergic Pathways via 123I-FP-CIT SPECT in Dementia With Lewy Bodies in a Psychiatric Patient Cohort

2021 ◽  
Vol 13 ◽  
Author(s):  
Niels Hansen ◽  
Claudia Lange ◽  
Charles Timäus ◽  
Jens Wiltfang ◽  
Caroline Bouter
Keyword(s):  
Dementia With Lewy Bodies ◽  
Psychiatric Symptoms ◽  
Single Photon ◽  
Medical Center ◽  
Psychiatric Patients ◽  
Photon Emission ◽  
Lewy Bodies ◽  
Emission Computed Tomography ◽  
Psychiatric Symptomatology ◽  
Memory Clinics

Background(123)-I-2-ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortro- pane single photon emission computed tomography (123I-FP-CIT SPECT) was validated to distinguish Alzheimer’s dementia from dementia with Lewy Bodies (DLB) by European medical agencies. Little evidence exists that validates 123 I-FP-CIT SPECT as a supplementary method to diagnose probable DLB in a psychiatric cohort of patients with psychiatric symptomatology and suspected DLB. We aim to elucidate differences in the clinical phenotype of DLB between those patients with and those without a positive 123 I-FP-CIT SPECT indicating a nigrostriatal deficit.MethodsTo investigate this, we included 67 patients from the Department of Psychiatry and Psychotherapy at University Medical Center Göttingen (UMG) in our study who had undergone 123I-FP-CIT SPECT in the Department of Nuclear Medicine (UMG) by evaluating their patient files.Results55% with a positive-123I-FP-CIT SPECT and probable DLB after the 123I-FP-CIT SPECT exhibited psychiatric features. The number of probable DLB patients in those exhibiting psychiatric symptoms was higher post-123I-FP-CIT SPECT than pre-123I-FP-CIT SPECT assessed cross-sectionally over a 6-year period (p &lt; 0.05). In addition, prodromal DLB and prodromal DLB patients with a psychiatric-phenotype yielded higher numbers post-123I-FP-CIT SPECT than pre-123I-FP-CIT SPECT (p &lt; 0.05). Furthermore, we discovered no phenotypical differences between those DLB patients with a positive and those with a negative 123I-FP-CIT SPECT. 123I-FP-CIT SPECT-positive DLB patients in our psychiatric cohort revealed a psychiatric onset more often (52%); DLB was less often characterized by an MCI onset (26%) (p &lt; 0.005).ConclusionsOur findings support 123I-FP-CIT SPECT as an adjuvant tool for improving the diagnosis of probable DLB and prodromal DLB in a cohort of psychiatric patients with often concomitant psychiatric symptomatology. The psychiatric-onset is more frequent than an MCI-onset in DLB patients presenting nigrostriatal dysfunction, giving us an indication of the relevance of deep clinical phenotyping in memory clinics that includes the assessment of psychopathology.

scholarly journals Covariant perfusion patterns provide clues to the origin of cognitive fluctuations and attentional dysfunction in Dementia with Lewy bodies

2013 ◽  
Vol 25 (12) ◽  
pp. 1917-1928 ◽  
Author(s):  
John-Paul Taylor ◽  
Sean J. Colloby ◽  
Ian G. McKeith ◽  
John T. O'Brien
Keyword(s):  
Cognitive Function ◽  
Dementia With Lewy Bodies ◽  
Single Photon ◽  
Motor Pattern ◽  
Photon Emission ◽  
Lewy Bodies ◽  
Emission Computed Tomography ◽  
Spatial Covariance ◽  
Attentional Function ◽  
Attentional Dysfunction

ABSTRACTBackground:Fluctuating cognition (FC), particularly in attention, is a core and defining symptom in dementia with Lewy bodies (DLB) but is seen much less frequently in Alzheimer's dementia (AD). However, its neurobiological origin is poorly understood. The aim of our study was therefore to characterize perfusion patterns in DLB patients that are associated with the severity and frequency of FC as measured both clinically and using objective neuropsychological assessments.Methods:Spatial covariance analyses were applied to data derived from single photon emission computed tomography (SPECT) HMPAO brain imaging in 19 DLB and 23 AD patients. Patients underwent clinical assessment of their FC and cognitive function as well as objective testing of their attention.Results:Covariant perfusion principal components (PCs) were not associated with either FC or cognitive or attentional measures in AD. However, in DLB patients, the second PC (defined as DLB-cognitive motor pattern, DLB-PCI2) which was characterized by bilateral relative increases in cerebellum, basal ganglia, and supplementary motor areas and widespread bilateral decreases in parietal regions, positively correlated with poorer cognitive function, increased FC and worse attentional function measured both clinically and neurophysiologically (p < 0.05) as well as with the severity of bradykinesia (p = 0.04).Conclusions:FC in DLB appears distinct from those seen in AD, and likely to be driven by internal neurobiological perturbations in brain circuitry as evidenced using spatial covariance analyses of cerebral perfusion. FC and certain aspects of attentional dysfunction in DLB may, in part, depend upon both distributed motor and non-motor networks.

scholarly journals Deep learning-based imaging classification identified cingulate island sign in dementia with Lewy bodies

2019 ◽  
Author(s):  
Tomomichi Iizuka ◽  
Makoto Fukasawa ◽  
Masashi Kameyama
Keyword(s):  
Deep Learning ◽  
Dementia With Lewy Bodies ◽  
Single Photon ◽  
Photon Emission ◽  
Lewy Bodies ◽  
Brain Perfusion ◽  
Emission Tomography ◽  
Single Photon Emission ◽  
Photon Emission Tomography ◽  
Imaging Classification

abstractThe differentiation of dementia with Lewy bodies (DLB) from Alzheimer’s disease (AD) using brain perfusion single photon emission tomography is important but has been a challenge because these conditions have common features. The cingulate island sign (CIS) is the most recently identified specific feature of DLB for a differential diagnosis. The present study aimed to examine the usefulness of deep learning-based imaging classification for the diagnoses of DLB and AD. We also investigated whether CIS was focused by the deep convolutional neural network (CNN) during differentiation.Brain perfusion single photon emission tomography images were acquired from 80 patients each with DLB and with AD and 80 individuals with normal cognition (NL). The CNN was trained on brain surface perfusion images. Gradient-weighted class activation mapping (Grad-CAM) was applied to the CNN for visualization of the features that the trained CNN focused on.Binary classifications between DLB and NL, DLB and AD and AD and NL were 94.69%, 87.81% and 94.38% accurate, respectively. The CIS ratios closely correlated with softmax output scores for DLB-AD discrimination (DLB/AD scores). The Grad-CAM highlighted CIS in the DLB discrimination. Visualization of learning process by guided Grad-CAM revealed that CIS became more focused by the CNN as the training progressed. DLB/AD score was significantly associated with three core-features of DLB.Deep learning-based imaging classification was useful not only for objective and accurate differentiation of DLB from AD but also for predicting clinical features of DLB. The CIS was identified as a specific feature during DLB classification. The visualization of specific features and learning process could have important implications for the potential of deep learning to discover new imaging features.

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