123I-metaiodobenzylguanidine myocardial scintigraphy with early images alone is useful for the differential diagnosis of dementia with Lewy bodies

Manabe, Yuta; Inui, Yumiko; Toyama, Hiroshi; Kosaka, Kenji

doi:10.1016/j.pscychresns.2016.12.011

Cited by 19 publications

(17 citation statements)

References 14 publications

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“…In particular, MIBG-imaging provides a highly accurate diagnosis even with early images alone and is less invasive to patients; consequently, it may be worthwhile to consider more proactively the implementation of MIBG-imaging. 8 The two groups differed from each other in clinical diagnoses made prior to the definite diagnosis of DLB. The top three diagnoses were PD, ATD, and depression in Group N, and ATD, delirium, and depression in Group P. These differences may be explained by the phenomenon that depending on which symptoms patients and their family members attach importance to, the medical care unit they visit varies: DLB patients in whom motor symptoms attract more attention than the other symptoms inevitably select Group N, whereas DLB patients in whom cognitive impairment and behavioural and psychological symptoms of dementia attract more attention select Group P. One of the reasons why delirium was frequently used for diagnosis before a definite diagnosis of DLB in Group P is because generally speaking, the frequency of asking for the management of delirium in psychiatry departments is high in Japan.…”

Section: Discussionmentioning

confidence: 90%

“…In addition, the new DLB clinical diagnostic criteria has set indicative biomarkers for the management of DLB, indicating more weight should be attached to the importance of objective indicators such as DAT‐SPECT and MIBG‐imaging. In particular, MIBG‐imaging provides a highly accurate diagnosis even with early images alone and is less invasive to patients; consequently, it may be worthwhile to consider more proactively the implementation of MIBG‐imaging …”

Section: Discussionmentioning

confidence: 99%

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Fact‐finding survey on diagnostic procedures and therapeutic interventions for parkinsonism accompanying dementia with Lewy bodies

2019

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BackgroundWe performed a questionnaire survey of medical doctors engaged in the management of dementia to identify the actual status of treatment for dementia with Lewy bodies (DLB) in Japan.MethodsAmong participating medical doctors, we selected neurologists (Group N) and psychiatrists (Group P) because these physicians are usually involved in the management of DLB patients. The two groups were compared based on their diagnosis and treatment of DLB and in particular, parkinsonism.ResultsNeurological examinations and biomarker tests were less frequently performed by Group P than Group N. Antipsychotics and other psychotropics excluding anti‐dementia drugs were significantly more frequently administered by Group P than Group N. The proportion of physicians who selected l‐dopa as a first‐line therapy for parkinsonism was significantly higher in Group N than in Group P. Despite these between‐group differences, the following findings were common to the two groups: there was a discrepancy between the symptom that patients expressed the greatest desire to treat, and the awareness of physicians regarding the treatment of these symptoms; the initial agent was l‐dopa; and physicians exercised caution against the occurrence of hallucinations, delusions, and other adverse drug reactions.ConclusionsThe results of the present survey offer valuable insight for the formulation of future DLB therapeutic strategies.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Fact‐finding survey on diagnostic procedures and therapeutic interventions for parkinsonism accompanying dementia with Lewy bodies

2019

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“…In a case series of 90 patients with DLB, more than half displayed dysautonomic symptoms (particularly OH) prior to the onset of cognitive impairment [70]. In agreement with such findings, functional imaging studies show that early on in DLB, as well in PD, amine uptake in postganglionic sympathetic neurons to the heart is already impaired [71].…”

Section: Dysautonomia Across α-Synucleinopathiesmentioning

confidence: 60%

Early autonomic and cognitive dysfunction in PD, DLB and MSA: blurring the boundaries between α-synucleinopathies

et al. 2020

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Differential diagnosis between Parkinson's disease, dementia with Lewy bodies and multiple system atrophy can be difficult, especially because in early phase they might present with overlapping clinical features. Notably, orthostatic hypotension and cognitive dysfunction are common nonmotor aspects of parkinsonian syndromes and can be both present from the earliest stages of all α-synucleinopathies, indicating a common neurobiological basis in their strong relationship. In view of the increasing awareness about the prevalence of mild cognitive dysfunction in multiple system atrophy, the relevance of autonomic dysfunction in demented parkinsonian patients, the critical role of non-motor symptoms in clustering Parkinson's disease patients and the shift to studying patients in the prodromal phase, we will discuss some intrinsic limitations of current clinical diagnostic criteria, even when applied by movement disorder specialists. In particular, we will focus on the early coexistence of autonomic and cognitive dysfunction in the setting of overt or latent parkinsonism as pitfalls in the differential diagnosis of α-synucleinopathies. As early and accurate diagnosis remains of outmost importance for counselling of patients and timely enrolment into disease-modifying clinical trials, a continuous effort of research community is ongoing to further improve the clinical diagnostic accuracy of α-synucleinopathies.

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“…38 Apesar de ter sido detetada uma sensibilidade similar entre 123 I-FP--CIT SPECT e a cintigrafia miocárdica com 123 I-MIBG na deteção de DCLewy, a cintigrafia miocárdica poderá ser mais específica para a exclusão de outros tipos de demência, eventualmente com valor superior na diferenciação entre DCLewy e DA comparativamente com a SPECT e RM cerebral. 38,[44][45][46] A combinação da cintigrafia miocárdica 123 I-MIBG e da 123 I-FP-CIT SPECT aumenta a especificidade e a sensibilidade no diagnóstico diferencial entre DCLewy e DA, comparativamente à utilização de um só método. 47 A cintigrafia miocárdica apresenta algumas desvantagens, tais como a grande prevalência, na população, de doenças que poderão interferir com a captação de 123 I--MIBG (e.g.…”

Section: Métodos Complementares De Diagnósticounclassified

Consenso Português para o Diagnóstico e Gestão Clínica da Demência com Corpos de Lewy (PORTUCALE)

et al. 2020

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Lewy body dementia is a common cause of dementia leading to the progressive deterioration of cognitive function and motor skills, behavioral changes, and loss of autonomy, impairing the quality of life of patients and their families. Even though it is the second leading cause of neurodegenerative dementia, diagnosis is still challenging, due to its heterogenous clinical presentation, especially in the early stages of the disease. Accordingly, Lewy body dementia is often misdiagnosed and clinically mismanaged. The lack of diagnostic accuracy has important implications for patients, given their increased susceptibility to the adverse effects of certain drugs, such as antipsychotics, which may worsen some symptoms associated with Lewy body dementia. Therefore, a specialist consensus based on the analysis of the most updated and relevant literature, and on clinical experience, is useful to all professionals involved in the care of these patients. This work aims to inform and provide recommendations about the best diagnostic and therapeutic approaches in Lewy body dementia in Portugal. Moreover, we suggest some strategies in order to raise the awareness of physicians, policy makers, and the society at large regarding this disease.

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123I-metaiodobenzylguanidine myocardial scintigraphy with early images alone is useful for the differential diagnosis of dementia with Lewy bodies

Cited by 19 publications

References 14 publications

Fact‐finding survey on diagnostic procedures and therapeutic interventions for parkinsonism accompanying dementia with Lewy bodies

Fact‐finding survey on diagnostic procedures and therapeutic interventions for parkinsonism accompanying dementia with Lewy bodies

Early autonomic and cognitive dysfunction in PD, DLB and MSA: blurring the boundaries between α-synucleinopathies

Consenso Português para o Diagnóstico e Gestão Clínica da Demência com Corpos de Lewy (PORTUCALE)

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