Influence of Alzheimer pathology on clinical diagnostic accuracy in dementia with Lewy bodies

AbstractBackgroundDopaminergic imaging has high diagnostic accuracy for dementia with Lewy bodies (DLB) at the dementia stage. We report the first investigation of dopaminergic imaging at the prodromal stage.MethodsWe recruited 75 patients over 60 with mild cognitive impairment (MCI), 33 with probable MCI with Lewy body disease (MCI-LB), 15 with possible MCI-LB and 27 with MCI with Alzheimer's disease. All underwent detailed clinical, neurological and neuropsychological assessments and FP-CIT [123I-N-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)] dopaminergic imaging. FP-CIT scans were blindly rated by a consensus panel and classified as normal or abnormal.ResultsThe sensitivity of visually rated FP-CIT imaging to detect combined possible or probable MCI-LB was 54.2% [95% confidence interval (CI) 39.2–68.6], with a specificity of 89.0% (95% CI 70.8–97.6) and a likelihood ratio for MCI-LB of 4.9, indicating that FP-CIT may be a clinically important test in MCI where any characteristic symptoms of Lewy body (LB) disease are present. The sensitivity in probable MCI-LB was 61.0% (95% CI 42.5–77.4) and in possible MCI-LB was 40.0% (95% CI 16.4–67.7).ConclusionsDopaminergic imaging had high specificity at the pre-dementia stage and gave a clinically important increase in diagnostic confidence and so should be considered in all patients with MCI who have any of the diagnostic symptoms of DLB. As expected, the sensitivity was lower in MCI-LB than in established DLB, although over 50% still had an abnormal scan. Accurate diagnosis of LB disease is important to enable early optimal treatment for LB symptoms.

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Clinical Diagnostic Criteria for Dementia with Lewy Bodies

Dementia with Lewy Bodies ◽

10.1007/978-4-431-55948-1_5 ◽

2016 ◽

pp. 59-71 ◽

Cited By ~ 1

Author(s):

Ian G. McKeith

Keyword(s):

Diagnostic Criteria ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Clinical Diagnostic ◽

Clinical Diagnostic Criteria

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Dementia in dementia with Lewy bodies may not be attributable to Alzheimer pathology

Annals of Neurology ◽

10.1002/ana.20271 ◽

2004 ◽

Vol 56 (4) ◽

pp. 604-604

Author(s):

Jonathan M. Schott ◽

Andrew J. Lees ◽

Martin N. Rossor

Keyword(s):

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Alzheimer Pathology

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Clinical Diagnostic Classification of Dementia with Lewy Bodies

Mapping the Progress of Alzheimer’s and Parkinson’s Disease - Advances in Behavioral Biology ◽

10.1007/978-0-306-47593-1_81 ◽

2002 ◽

pp. 473-476

Author(s):

Daniel I. Kaufer

Keyword(s):

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Diagnostic Classification ◽

Clinical Diagnostic

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Diagnostic Accuracy of 123I-Meta-Iodobenzylguanidine Myocardial Scintigraphy in Dementia with Lewy Bodies: A Multicenter Study

PLoS ONE ◽

10.1371/journal.pone.0120540 ◽

2015 ◽

Vol 10 (3) ◽

pp. e0120540 ◽

Cited By ~ 83

Author(s):

Mitsuhiro Yoshita ◽

Heii Arai ◽

Hiroyuki Arai ◽

Tetsuaki Arai ◽

Takashi Asada ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Multicenter Study ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Myocardial Scintigraphy

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Multivariate Spatial Covariance Analysis of 99MTc-Exametazime SPECT Images in Dementia with Lewy Bodies and Alzheimer'S Disease: Utility in Differential Diagnosis

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2013.2 ◽

2013 ◽

Vol 33 (4) ◽

pp. 612-618 ◽

Cited By ~ 13

Author(s):

Sean J Colloby ◽

John-Paul Taylor ◽

Christopher M Davison ◽

Jim J Lloyd ◽

Michael J Firbank ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Blood Flow ◽

Diagnostic Accuracy ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Diagnostic Value ◽

Covariance Analysis ◽

Spatial Covariance ◽

Good Diagnostic Accuracy ◽

Spect Images

We examined 99mTc-exametazime brain blood flow single-photon emission computed tomography (SPECT) images using a spatial covariance analysis (SCA) approach to assess its diagnostic value in distinguishing dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). Voxel SCA was simultaneously applied to a set of preprocessed images (AD, n = 40; DLB, n = 26), generating a series of eigenimages representing common intercorrelated voxels in AD and DLB. Linear regression derived a spatial covariance pattern (SCP) that discriminated DLB from AD. To investigate the diagnostic value of the model SCP, the SCP was validated by applying it to a second, independent, AD and DLB cohort (AD, n = 34; DLB, n = 29). Mean SCP expressions differed between AD and DLB ( F1,64 = 36.2, P < 0.001) with good diagnostic accuracy (receiver operating characteristic (ROC) curve area 0.87, sensitivity 81%, specificity 88%). Forward application of the model SCP to the independent cohort revealed similar differences between groups (F1,61 = 38.4, P < 0.001), also with good diagnostic accuracy (ROC 0.86, sensitivity 80%, specificity 80%). Multivariate analysis of blood flow SPECT data appears to be robust and shows good diagnostic accuracy in two independent cohorts for distinguishing DLB from AD.

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