Author response: Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium

McKeith, Ian G.

doi:10.1212/wnl.0000000000004919

Cited by 1,053 publications

(2,500 citation statements)

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“…Most experts agree that using Cholinesterase inhibitors as a first line treatment to ameliorate cognitive decline in these patients is reasonable [2,3] Despite the evidence presented above, Donepezil use remains off-label in the US. Rivastigmine is the only approved medication for Parkinson's disease Dementia but remains off-label for DLB in the US.…”

Section: Discussionmentioning

confidence: 99%

“…The most recent consensus report of DLB consortium proposes essential, core and supportive clinical features [1][2][3]. The following are the core clinical features of the disease: Cognitive Fluctuations, Visual Hallucinations, Parkinsonism and REM sleep behavior disorder [3].…”

Section: Introductionmentioning

confidence: 99%

“…The most recent consensus has also re-assigned all of the suggestive features to the supportive clinical feature and indicative biomarkers categories. The severe sensitivity to neuroleptic agents is now one of the supportive clinical features and the low dopamine transporter uptake Imaging is within the indicative biomarkers [3].…”

Section: Introductionmentioning

confidence: 99%

“…by the 123Iodine FP-CIT SPECT imaging is considered indicative of DLB and along with other clinical features ascertains the diagnosis [3]. Polysomnography diagnostic of REM sleep behavior disorder and 123Iodine-MIBG myocardial scintigraphy are also accepted indicative biomarkers [3].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Evidence-Based Review of Therapeutic Approaches in Dementia with Lewy Bodies

Ouf¹,

Szigeti²

2017

J Alzheimers Dis Parkinsonism

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evidence-Based Review of Therapeutic Approaches in Dementia with Lewy Bodies

Ouf¹,

Szigeti²

2017

J Alzheimers Dis Parkinsonism

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“…Fourth, although FDG-PET is included in the diagnostic workup of dementing disorders in only some European Countries [7], many groups might not acknowledge the need to achieve more evidence because they already consider FDG-PET an effective and established diagnostic tool in these conditions. Indeed, the exam is already included as a main or supportive feature in the diagnostic criteria of many diseases, including dementia with Lewy bodies [8], behavioral variant frontotemporal dementia [9], primary progressive aphasia [10], and PSP [11] while in Alzheimer's disease (AD) it is a recognized marker of downstream neurodegeneration [12]. Then, people say, we all already fruitfully using it in clinical practice, why should we spend money and time to show what we already know?…”

mentioning

confidence: 99%

Brain FDG-PET: clinical use in dementing neurodegenerative conditions

Nobili

Schmidt

Carrió

et al. 2018

Eur J Nucl Med Mol Imaging

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Discriminative Accuracy of [¹⁸F]flortaucipir Positron Emission Tomography for Alzheimer Disease vs Other Neurodegenerative Disorders

Ossenkoppele

Rabinovici

Smith

et al. 2018

JAMA

310

391

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IMPORTANCE The positron emission tomography (PET) tracer [ 18 F]flortaucipir allows in vivo quantification of paired helical filament tau, a core neuropathological feature of Alzheimer disease (AD), but its diagnostic utility is unclear. OBJECTIVE To examine the discriminative accuracy of [ 18 F]flortaucipir for AD vs non-AD neurodegenerative disorders. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, 719 participants were recruited from 3 dementia centers in South Korea, Sweden, and the United States between June 2014 and November 2017 (160 cognitively normal controls, 126 patients with mild cognitive impairment [MCI], of whom 65.9% were amyloid-β [Aβ] positive [ie, MCI due to AD], 179 patients with AD dementia, and 254 patients with various non-AD neurodegenerative disorders).EXPOSURES The index test was the [ 18 F]flortaucipir PET standardized uptake value ratio (SUVR) in 5 predefined regions of interest (ROIs). Cut points for tau positivity were determined using the mean +2 SDs observed in controls and Youden Index for the contrast AD dementia vs controls. MAIN OUTCOMES AND MEASURESThe reference standard was the clinical diagnosis determined at the specialized memory centers. In the primary analysis, the discriminative accuracy (ie, sensitivity and specificity) of [ 18 F]flortaucipir was examined for AD dementia vs all non-AD neurodegenerative disorders. In secondary analyses, the area under the curve (AUC) of [ 18 F]flortaucipir SUVR was compared with 3 established magnetic resonance imaging measures (hippocampal volumes and AD signature and whole-brain cortical thickness), and sensitivity and specificity of [ 18 F]flortaucipir in MCI due to AD vs non-AD neurodegenerative disorders were determined. RESULTS Among 719 participants, the overall mean (SD) age was 68.8 (9.2) years and 48.4% were male. The proportions of patients who were amyloid-β positive were 26.3%, 65.9%, 100%, and 23.8% among cognitively normal controls, patients with MCI, patients with AD dementia, and patients with non-AD neurodegenerative disorders, respectively. [ 18 F]flortaucipir uptake in the medial-basal and lateral temporal cortex showed 89.9% (95% CI, 84.6%-93.9%) sensitivity and 90.6% (95% CI, 86.3%-93.9%) specificity using the threshold based on controls (SUVR, 1.34), and 96.8% (95% CI, 92.0%-99.1%) sensitivity and 87.9% (95% CI, 81.9%-92.4%) specificity using the Youden Index-derived cutoff (SUVR, 1.27) for distinguishing AD dementia from all non-AD neurodegenerative disorders. The AUCs for all 5 [ 18 F]flortaucipir ROIs were higher (AUC range, 0.92-0.95) compared with the 3 volumetric MRI measures (AUC range, 0.63-0.75; all ROIs P < .001). Diagnostic performance of the 5 [ 18 F]flortaucipir ROIs were lower in MCI due to AD (AUC range, 0.75-0.84).CONCLUSIONS AND RELEVANCE Among patients with established diagnoses at a memory disorder clinic, [ 18 F]flortaucipir PET was able to discriminate AD from other neurodegenerative diseases. The accuracy and potential utility of this test in patient care require further rese...

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Author response: Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium

Cited by 1,053 publications

References 2 publications

Evidence-Based Review of Therapeutic Approaches in Dementia with Lewy Bodies

Evidence-Based Review of Therapeutic Approaches in Dementia with Lewy Bodies

Brain FDG-PET: clinical use in dementing neurodegenerative conditions

Discriminative Accuracy of [¹⁸F]flortaucipir Positron Emission Tomography for Alzheimer Disease vs Other Neurodegenerative Disorders

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Author response: Diagnosis and management of dementia with Lewy bodies: Fourth consensus report of the DLB Consortium

Cited by 1,053 publications

References 2 publications

Evidence-Based Review of Therapeutic Approaches in Dementia with Lewy Bodies

Evidence-Based Review of Therapeutic Approaches in Dementia with Lewy Bodies

Brain FDG-PET: clinical use in dementing neurodegenerative conditions

Discriminative Accuracy of [18F]flortaucipir Positron Emission Tomography for Alzheimer Disease vs Other Neurodegenerative Disorders

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Product

Resources

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Discriminative Accuracy of [¹⁸F]flortaucipir Positron Emission Tomography for Alzheimer Disease vs Other Neurodegenerative Disorders