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.

Piracetam in postconcussion syndrome: preliminary results of a randomized study using SPECT

2007 ◽  
Vol 04 (02) ◽  
pp. 109-114
Author(s):  
Deepak Agrawal ◽  
NK Gowda
Keyword(s):  
Cerebral Perfusion ◽  
Single Photon ◽  
Photon Emission ◽  
Clinical Manifestations ◽  
Test Group ◽  
Control Group ◽  
Emission Computed Tomography ◽  
Fisher Exact Test ◽  
Postconcussion Syndrome ◽  
Spect Scan

AbstractAim of this study was to study the changes in regional cerebral perfusion following administration of the drug piracetam using single photon emission computed tomography (SPECT) in patients with postconcussion syndrome (PCS). Twenty consecutive male patients 18–65 years of age, with mild traumatic brain injury and PCS who had an normal initial CT head but an abnormal SPECT scan (carried out within 72 hours of the injury), were included in the study. Patients were randomized to either receive a daily dose of 2.4g of piracetam for six weeks (n = 10) (piracetam group), or no piracetam (n = 10) (control group). A repeat SPECT scan was performed at six weeks of follow up and any subjective improvement in symptoms (if any) noted. While the pre-treatment mean ratio for the piracetam treated group (0.86) and controls (0.85) did not differ significantly (p = 0.304; 95% CI - 0.041,.0136), there was a significant rise in the post treatment ratio in the piracetam group (mean: 0.959) as compared to the controls (mean: 0.882) (p = <0.001; 95% CI -.0114, -0.038). Nine patients (90%) also had improvement in their symptoms of PCS, compared to only three patients in the test group (Fisher exact test; 2 tailed: p = 0.01). Our study suggests that the cerebral perfusion defects seen on SPECT imaging may per se be responsible for the clinical manifestations of PCS. Low-dose piracetam appears to improve regional cerebral blood flow and reverse perfusion abnormalities in these patients. This study paves the way for further randomized, placebo controlled trials with piracetam for more definitive results.

scholarly journals Neuropathological Changes in Dementia With Lewy Bodies and the Cingulate Island Sign

2019 ◽  
Vol 78 (8) ◽  
pp. 717-724 ◽  
Author(s):  
Lina Patterson ◽  
Michael J Firbank ◽  
Sean J Colloby ◽  
Johannes Attems ◽  
Alan J Thomas ◽  
...  
Keyword(s):  
Dementia With Lewy Bodies ◽  
Single Photon ◽  
Photon Emission ◽  
Lewy Bodies ◽  
Amyloid Β ◽  
Posterior Cingulate Cortex ◽  
Anterior Cingulate ◽  
Parahippocampal Gyrus ◽  
Emission Computed Tomography ◽  
Neurodegenerative Pathology

Abstract The cingulate island sign (CIS) refers to the relative sparing of metabolism in the posterior cingulate cortex (PCC) and represents an important biomarker in distinguishing dementia with Lewy bodies (DLB) from Alzheimer disease (AD). The underlying basis of the CIS is unknown; therefore, our aim was to investigate which neurodegenerative changes underpin the formation of CIS. Using quantitative neuropathology, α-synuclein, phosphorylated Tau, and amyloid-β pathology was assessed in 12 DLB, 9 AD and 6 age-matched control patients in the anterior cingulate (ACC), midcingulate, PCC, precuneus/cuneus and parahippocampal gyrus. All participants had undergone 99mTc-hexamethylpropyleneamine oxime (HMPAO) single-photon emission computed tomography imaging during life to define the presence or absence of CIS. In the DLB group, no significant correlations were observed between CIS ratios and neurodegenerative pathology in PCC. In DLB, however, the ACC showed lower HMPAO uptake, as well as significantly higher α-synuclein and amyloid-β burden compared with PCC, possibly underlying the relative preservation of perfusion in PCC when compared with ACC. Our findings suggest that neurodegenerative pathology does not directly correlate with the CIS in DLB, and other metabolic or pathological changes are therefore more likely to be relevant for the development of the CIS.

Efficacy of Single Photon Emission Computed Tomography in Differentiating Dementia with Lewy Bodies - A Review of Neurotransmitter and Perfusion Imaging

2009 ◽  
Vol 4 (1) ◽  
pp. 82 ◽  
Author(s):  
Shirlony Morgan ◽  
Zuzana Walker ◽  
◽  
Keyword(s):  
Computed Tomography ◽  
Dementia With Lewy Bodies ◽  
Single Photon ◽  
Photon Emission ◽  
Lewy Bodies ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Emission Computed ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography

The accuracy of the clinical diagnosis of dementia with Lewy bodies continues to be relatively poor. Several neuroimaging techniques have been used to facilitate a more accurate diagnosis. Thus far, functional neuroimaging has provided the most help. This article concentrates on the use of single photon emission computed tomography (SPECT) and reports on the efficacy data available from studies investigating cerebral perfusion, cardiac scintigraphy and dopaminergic neurotransmission. The results from perfusion studies are inconsistent. Cardiac scintigraphy shows more promise, but it is not yet known whether co-morbid cardiac conditions, which are common in the elderly, will limit the clinical use of this method. The radioligand123I–FP-CIT binds to dopamine transporters in nigrostriatal nerve terminals and provides a way of assessing the neurodegeneration caused by Lewy body pathology. Abnormal123I–FP-CIT has been shown to have high sensitivity and specificity in an autopsy study and a large multicentre trial. This article aims to give an overview of the topic.

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