Better cognitive and psychopathologic response to donepezil in patients prospectively diagnosed as dementia with Lewy bodies: a preliminary study

Samuel, William; Caligiuri, Michael P.; Galasko, Douglas; Lacro, Jonathan P.; Marini, Merri; McClure, Fauzia Simjee; Warren, Kathleen A.; Jeste, Dilip V.

doi:10.1002/1099-1166(200009)15:9<794::aid-gps178>3.0.co;2-1

Cited by 149 publications

(77 citation statements)

References 27 publications

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“…For instance, neuroleptic drugs, commonly used for psychiatric symptoms and behavioral disturbances in dementia, can induce severe sensitivity reactions in DLB patients, exacerbating motor and mental instability and leading to a 2-to 3-fold increase in mortality (10). Cholinergic deficits appear greater in DLB, which might explain the greater improvement in visual, mood, and cognitive symptoms with cholinesterase inhibitors than usually seen in AD (11). A diagnosis of DLB would also prompt the clinician to consider additional DLB-specific problems, such as extrapyramidal motor signs, gait and balance problems, autonomic dysfunction, and sleep disorders.…”

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confidence: 60%

The ¹⁸F-FDG PET Cingulate Island Sign and Comparison to ¹²³I-β-CIT SPECT for Diagnosis of Dementia with Lewy Bodies

Lim¹,

Katsifis²,

Villemagne³

et al. 2009

J Nucl Med

262

189

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Neuroimaging is increasingly used to supplement the clinical diagnosis of dementia with Lewy bodies (DLB) by showing reduced occipital metabolism and perfusion and reduced striatal dopaminergic innervation. We aimed to optimize the interpretation of 18 F-FDG PET images for differentiating DLB from Alzheimer disease (AD) and to compare the results with dopamine transporter imaging using 123 I-b-carbomethoxy-3ß-(4-iodophenyl)-tropane ( 123 I-b-CIT) SPECT. Methods: Fourteen subjects with a clinical diagnosis of DLB and 10 with AD underwent both 18 F-FDG PET and 123 I-b-CIT SPECT. Four DLB and 1 AD diagnoses were subsequently confirmed at autopsy. Diagnostic accuracy was calculated for visual interpretation by 3 readers of standard 3-plane and stereotactic surface projection 18 F-FDG PET images, receiver-operating-characteristic analysis of regional 18 F-FDG uptake, and a cutoff value for the striatal-to-occipital binding ratio of b-CIT defined by receiver-operating-characteristic analysis. Results: Visual interpretation of 3-plane 18 F-FDG PET images had a sensitivity of 83% and specificity of 93% for DLB, slightly higher than the results with the stereotactic surface projection images. Regionally, hypometabolism in the lateral occipital cortex had the highest sensitivity (88%), but relative preservation of the mid or posterior cingulate gyrus (cingulate island sign) had the highest specificity (100%). Region-of-interest analysis revealed that occipital hypometabolism and relative preservation of the posterior cingulate both had a sensitivity of 77% and specificity of 80%. b-CIT achieved 100% accuracy and greater effect size than did 18 F-FDG PET (Cohen d 5 4.1 vs. 1.9). Conclusion: Both 18 F-FDG PET and 123 I-b-CIT SPECT appear useful for the diagnosis of DLB, although the latter provides more robust results. The cingulate island sign may enhance the specificity of 18 F-FDG PET.

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confidence: 60%

The ¹⁸F-FDG PET Cingulate Island Sign and Comparison to ¹²³I-β-CIT SPECT for Diagnosis of Dementia with Lewy Bodies

Lim¹,

Katsifis²,

Villemagne³

et al. 2009

J Nucl Med

262

189

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“…A pharmacological approach to the psychiatric symptoms in DLB is sometimes difficult due to neu- Nasogastric tubing roleptic supersensitivity. Although the acetylcholinesterase inhibitor donepezil (3)(4)(5), quetiapine (14) and Yi-Gan San (15) were reported to be beneficial on psychiatric symptoms in DLB, all of them were not effective in this case. We first administered amitriptyline to this patient.…”

Section: Discussionmentioning

confidence: 93%

“…Neurolepic supersensitivity sometimes makes it difficult to treat these symptoms (2). Some studies have shown the usefulness of the acetylcholinesterase inhibitor donepezil on psychiatric symptoms in DLB (3)(4)(5). We herein present a woman with probable DLB who showed catatonia and refusal to eat.…”

Section: Introductionmentioning

confidence: 99%

Amitriptyline and Lorazepam Improved Catatonia and Occipital Hypoperfusion in a Patient with DLB

Maeda

Ogawa

2011

Intern. Med.

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A 76-year-old woman presented with catatonia, refusal to eat due to delusion, and visual hallucination. Single photon emission computed tomography showed remarkable occipital hypoperfusion and frontal hyperperfusion.123 I metaiodobenzyl guanidine myocardial scintigraphy revealed decreased uptake. She was diagnosed as probable dementia with Lewy bodies (DLB). Intravenous or oral L-dopa had no effect on catatonia. Amitriptyline and lorazepam improved catatonia and visual hallucination. Cerebral blood flow of the frontal and occipital lobes seemed to be normalized. Occipital hypoperfusion is one of the features of DLB. Although the mechanism of perfusion abnormality in DLB remains to be clarified, our case suggested that it might be reversible.

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“…Donepezil has been shown to decrease visual hallucinations, agitation, apathy, and reduce caregiver burden at highest dose. [61][62][63][64] Rivastigmine similarly has been shown to reduce visual hallucinations, delusions, agitation, and apathy and improve sleep. 30,65,66 There is also the suggestion that rivastigmine leads to improvement in cognitive testing.…”

Section: Treatmentmentioning

confidence: 99%

Dementia with Lewy Bodies

Mayo

Bordelon

2014

Semin Neurol

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).Dementia with Lewy bodies (DLB) is an atypical parkinsonian disorder characterized as a synucleinopathy based on the cardinal pathologic finding, the Lewy body, a neuronal inclusion comprised of aggregated α-synuclein. Lewy bodies are found in brainstem nuclei in both Parkinson disease (PD) as well as in DLB, though in DLB there is a concomitant presence of Lewy bodies in the cortex and subcortical white matter. The cortical Lewy bodies may not demonstrate the classic structure of an eosinophilic core with surrounding halo; however, they contain α-synuclein. Clinically, DLB manifests with fluctuating alertness, visual hallucinations, and parkinsonian motor symptoms, and has features of both a cortical and a subcortical dementia. EpidemiologyDementia with Lewy bodies is the second most common pathologic diagnosis of dementia, next to Alzheimer disease (AD) and accounts for 25% of all dementias. 1 The prevalence of DLB is estimated to be 0.7% of the population over 65 years of age. 2 Given the challenge of clinical diagnostic accuracy in dementia, there is a wide variation in estimates of the prevalence among dementia patients, ranging from 3 to 26.3% in those over the age of 65 years. 3,4 The incidence of DLB is 3.5 per 100,000 person years and this increases with age. 5 There is a slightly greater male predominance of 1.9:1. 6 Risk factors of DLB include advanced age, hypertension, hyperlipidemia, and carriers of one or more APOE ε4 alleles. 7-9 As in PD, there is overrepresentation of the CYP2D6B allele, and a greater heterozygous frequency of glucocerebrosidase 1 (GBA1) estimated at 3.5% versus 2.9% in Parkinson disease dementia (PDD) and 0.4% in the general population. 10 A separate study also found a significant association between GBA1 mutation carrier status and DLB with an odds ratio of 8.28 versus 6.48 in PDD. 11 PathophysiologyDementia with Lewy bodies is considered a synucleinopathy, along with PD and multiple system atrophy (MSA). It is distinguished pathologically by the presence of Lewy bodies, which are intracellular inclusions with an eosinophilic core Keywords ► dementia with Lewy bodies ► Lewy body ► synucleinopathy ► dementia ► parkinsonism AbstractDementia with Lewy bodies (DLB) is the second most common diagnosis of dementia after Alzheimer disease (AD). The essential pathologic feature is the Lewy body, a neuronal inclusion containing α-synuclein, found in brainstem nuclei and the neocortex. Clinical features include early fluctuations in attention, hallucinations, and parkinsonism, with progression to a combined cortical and subcortical dementia. To distinguish it from Parkinson disease dementia, a time course of one year from cognitive changes to motor feature onset has been established. There is more severe impairment of verbal fluency, executive function, and visuospatial abilities in DLB patients. Both rapid eye movement sleep behavior disorder and neuroleptic sensitivity are notable in this patient group. Treatment is aimed at symptom management. Cholinesterase inhibitors can be bene...

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Better cognitive and psychopathologic response to donepezil in patients prospectively diagnosed as dementia with Lewy bodies: a preliminary study

Cited by 149 publications

References 27 publications

The ¹⁸F-FDG PET Cingulate Island Sign and Comparison to ¹²³I-β-CIT SPECT for Diagnosis of Dementia with Lewy Bodies

The ¹⁸F-FDG PET Cingulate Island Sign and Comparison to ¹²³I-β-CIT SPECT for Diagnosis of Dementia with Lewy Bodies

Amitriptyline and Lorazepam Improved Catatonia and Occipital Hypoperfusion in a Patient with DLB

Dementia with Lewy Bodies

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Better cognitive and psychopathologic response to donepezil in patients prospectively diagnosed as dementia with Lewy bodies: a preliminary study

Cited by 149 publications

References 27 publications

The 18F-FDG PET Cingulate Island Sign and Comparison to 123I-β-CIT SPECT for Diagnosis of Dementia with Lewy Bodies

The 18F-FDG PET Cingulate Island Sign and Comparison to 123I-β-CIT SPECT for Diagnosis of Dementia with Lewy Bodies

Amitriptyline and Lorazepam Improved Catatonia and Occipital Hypoperfusion in a Patient with DLB

Dementia with Lewy Bodies

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Product

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The ¹⁸F-FDG PET Cingulate Island Sign and Comparison to ¹²³I-β-CIT SPECT for Diagnosis of Dementia with Lewy Bodies

The ¹⁸F-FDG PET Cingulate Island Sign and Comparison to ¹²³I-β-CIT SPECT for Diagnosis of Dementia with Lewy Bodies