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

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

Morgan Shirlony, Walker Zuzana
European Neurological Review Volume 4 Issue 1
Published: November 2009
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Abstract
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 radioligand 123I–FP-CIT binds to dopamine transporters in nigrostriatal nerve terminals and provides a way of assessing the neurodegeneration caused by Lewy body pathology. Abnormal 123I–FP-CIT has been shown to have high sensitivity and specificity in an autopsy study and a la rge multicentre trial. This article aims to give an overview of the topic.

Keywords
Dementia with Lewy bodies, single photon emission computed tomography (SPECT), functional imaging, perfusion imaging, neurotransmitter imaging, dopamine transporter
Disclosure: Shirlony Morgan has received radiopharmaceuticals free of charge for a research project from GE Healthcare. Zuzana Walker has received consultancy payments from GE Healthcare and Bayer Schering Pharma AG and reimbursement for travel expenses for a conference from GE Healthcare.
Received: 6 November 2008 Accepted: 2 September 2009
Correspondence: Zuzana Walker, St Margaret’s Hospital, The Plain, Epping, Essex, CM16 6TN, UK. E: z.walker@ucl.ac.uk

Dementia with Lewy bodies (DLB) is a common form of dementia. The characteristic features are: progressive dementia particularly affecting attention, visuo-spatial and executive ability; fluctuating cognition; spontaneous parkinsonian symptoms; persistent vivid visual hallucinations; hypersensitivity to neuroleptic medication; and rapid eye movement (REM) sleep behavioural disorder.1 Patients with DLB frequently have mixed pathology, and the presence of Alzheimer’s disease (AD) pathology modifies the clinical features of DLB.2 It is often hard to distinguish DLB from AD clinically during life, and AD is the main differential diagnosis. Clinical diagnostic criteria for DLB3 applied at presentation can fail to identify up to 50% of cases.4 An accurate diagnosis is important for carers in order for them to be aware of the symptomatology of the illness, the course and the prognosis, and also for professionals in order for them to provide appropriate management of motor, ognitive, psychiatric, sleep and autonomic symptoms and to avoid neuroleptic medication, which frequently leads to worsening of parkinsonian symptoms and alterations in consciousness,5 as well as being associated with increased morbidity and mortality.6,7 Furthermore, patients with DLB have a profound cholinergic deficit and may well benefit from treatment with cholinesterase inhibitors. Failure to diagnose DLB affects AD treatment trials, making it more difficult to develop and test drugs that specifically target the different underlying pathologies of DLB and AD.

At present there are several imaging techniques that can improve the identification of DLB during life. Whole-brain atrophy, rate of atrophy over time8 and white matter lesions on magnetic resonance imaging (MRI) are not helpful in differential diagnosis. Hippocampal and medial temporal lobe atrophy can detect differences between AD and DLB at a group level, but have limited sensitivity and therefore utili ty for individual patients.9–11



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Keywords:
Dementia with Lewy bodies, single photon emission computed tomography (SPECT), functional imaging, perfusion imaging, neurotransmitter, vascular Dementia, types of Dementia, Dementia symptoms, stages of Dementia, spect scan, spect imaging, perfusion imaging stroke, mri perfusion scan, brain perfusion imaging, ct perfusion imaging, neurotransmitters brain,

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