Early diagnosis of Lewy body disease in patients with late‐onset psychiatric disorders using clinical history of rapid eye movement sleep behavior disorder and [<sup>123</sup>I]‐metaiodobenzylguanidine cardiac scintigraphy

Fujishiro, Hiroshige; Okuda, Masato; Iwamoto, Kunihiro; Miyata, Seiko; Torii, Youta; Iritani, Shuji; Ozaki, Norio

doi:10.1111/pcn.12651

Cited by 25 publications

(31 citation statements)

References 42 publications

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“…Reduced meta-iodobenzylguanidine (MIBG) uptake is an indicative biomarker for DLB 2 and has also been reported to occur in a small series of patients with late-onset psychiatric disorder and PSG-confirmed RBD, 32 reinforcing its association with underlying α-synucleinopathy. Of 2 patients with amnestic MCI with low MIBG uptake, one developed DLB after 2 years; the other had no clinical follow-up reported.…”

Section: Polysomnographic Confirmation Of Rem Sleep Without Atoniamentioning

confidence: 90%

“…53 Further studies need to confirm these findings and to determine the value of other DLB biomarkers in psychiatric-onset cases. 32,52,56 In summary, it is not yet clear how to identify patients with prominent late-onset psychiatric symptoms who may have underlying LB disease and subsequently progress to DLB. It is premature to try to construct formal criteria for psychiatriconset DLB, but clinicians in mental health and other settings need to be aware that this possibility exists, not least because of the risk of severe antipsychotic sensitivity reactions with increased morbidity and mortality.…”

Section: Identification Of Delirium-onset Dlbmentioning

confidence: 99%

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Research criteria for the diagnosis of prodromal dementia with Lewy bodies

et al. 2020

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The prodromal phase of dementia with Lewy bodies (DLB) includes (1) mild cognitive impairment (MCI), (2) delirium-onset, and (3) psychiatric-onset presentations. The purpose of our review is to determine whether there is sufficient information yet available to justify development of diagnostic criteria for each of these. Our goal is to achieve evidence-based recommendations for the recognition of DLB at a predementia, symptomatic stage. We propose operationalized diagnostic criteria for probable and possible mild cognitive impairment with Lewy bodies, which are intended for use in research settings pending validation for use in clinical practice. They are compatible with current criteria for other prodromal neurodegenerative disorders including Alzheimer and Parkinson disease. Although there is still insufficient evidence to propose formal criteria for delirium-onset and psychiatric-onset presentations of DLB, we feel that it is important to characterize them, raising the index of diagnostic suspicion and prioritizing them for further investigation.

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Section: Polysomnographic Confirmation Of Rem Sleep Without Atoniamentioning

confidence: 90%

Section: Identification Of Delirium-onset Dlbmentioning

confidence: 99%

Research criteria for the diagnosis of prodromal dementia with Lewy bodies

et al. 2020

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“…Also, patient #1 presented two core clinical features (namely fluctuating cognition and parkinsonism), five supportive clinical features (namely sensitivity to antipsychotic agents, postural instability, repeated falls, autonomic dysfunction, and depression), one indicative biomarker (reduced dopamine transporter uptake in basal ganglia by SPECT), and two supportive biomarkers (relative preservation of medial temporal lobe structures on MRI scan, generalized low uptake on PET metabolism scan with reduced occipital activity) (9). Others DLB prodromal symptoms include dysautonomia, olfactory dysfunction, rapid eye movement sleep behavior disorder (RBD) (11). The patient suffered from resistant constipation and repeated falls when he was admitted, but no other DLB usual prodromes were found in his history.…”

Section: Case Reports First Case: Patient #1mentioning

confidence: 99%

Late-Onset OCD as a Potential Harbinger of Dementia With Lewy Bodies: A Report of Two Cases

2020

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Objectives: Obsessive-compulsive disorder usually begins in adolescence or young adulthood. OCD cases appearing after the age of 50 years are rare, most often associated with inflammatory, brain lesions, or neurodegenerative comorbidities. We describe two cases of late-onset obsessive compulsive disorder followed by the development of Dementia with Lewy Bodies and review the links between these two disorders. Methods and Results: We describe the clinical history of two patients that first showed OCD symptoms at an atypical age (>60 years). After several failed treatment attempts, they were hospitalized in our unit. Both presented severe sensitivity to antipsychotic agents that led to a diagnosis of Dementia with Lewy Bodies. Administration of cholinesterase inhibitors was associated with decrease of psychiatric symptoms in both cases. In addition to those clinical observations, a systematic review of the literature suggests that, beyond prefrontal cortex, temporal lobe and putamen have important roles in OCD pathophysiology. Based on these findings, we discuss four hypotheses to explain the sequential appearance of OCD and DLB symptoms. First, we considered the possibility that comorbidity of OCD with DLB was coincidental. Second, we propose to interpret OCD symptoms as motor stereotypies. Third, we hypothesize that late-onset OCD might be a symptom of late-onset depression. Four, we hypothesize that through early deterioration of basal ganglia, DLB caused the onset of OCD. Conclusion: In conclusion, we recommend that cases of late-onset treatment-resistant OCD should be carefully tested for possible organic etiologies, and for DLB in particular.

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“…However, recently it was reported that a low cardiac MIBG uptake, but not a decreasing binding ratio on a dopamine transporter single photon emission computed tomography (DAT-SPECT), was helpful for early differential diagnosis of LBD from late-onset psychiatric disorders, even before parkinsonism or dementia appear. 13 In another study, it was reported that low cardiac MIBG uptake is detected before the diagnosis of probable DLB. 14 The high specificity of MIBG to detect LBD was repeatedly reported.…”

Section: Introductionmentioning

confidence: 97%

Clinical characteristics of elderly depressive patients with low metaiodobenzylguanidine uptake

et al. 2019

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Backglound: Recently, depression with Lewy body pathology before the appearance of parkinsonism and cognitive dysfunction has been drawing attention. Low cardiac metaiodobenzylguanidine (MIBG) uptake is helpful for early differentiation of Lewy body disease (LBD) from late-onset psychiatric disorders even before parkinsonism or dementia appears. In this study, we used MIBG uptake as a tool in suspected LBD, and evaluated the relationship of MIBG results to clinical characteristics and depressive symptoms. Methods: Fifty-two elderly inpatients with depression were included in this study. The Hamilton Depression Rating Scale (HDRS) was administered at admission, and 123 I-MIBG cardiac scintigraphy was performed. Of 52 patients, 38 had normal and 14 had reduced MIBG uptake. Results: Correlation analyses of the late phase heart-to-mediastinum (H/M) ratio on the MIBG test and each item of the HDRS revealed that the H/M ratio was significantly correlated with scores of "agitation", "anxietysomatic", and "retardation" on the HDRS. Mean HDRS composite scores 4 of "somatic and psychic anxiety (Marcos)" and "somatic anxiety/somatization factor (Pancheri)" were higher in the low uptake group than in the normal uptake group. Conclusion: Elderly patients with depression who manifested an obvious somatic anxiety tend to show low MIBG uptake, and are more likely to have Lewy body pathology.

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Early diagnosis of Lewy body disease in patients with late‐onset psychiatric disorders using clinical history of rapid eye movement sleep behavior disorder and [¹²³I]‐metaiodobenzylguanidine cardiac scintigraphy

Cited by 25 publications

References 42 publications

Research criteria for the diagnosis of prodromal dementia with Lewy bodies

Research criteria for the diagnosis of prodromal dementia with Lewy bodies

Late-Onset OCD as a Potential Harbinger of Dementia With Lewy Bodies: A Report of Two Cases

Clinical characteristics of elderly depressive patients with low metaiodobenzylguanidine uptake

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Early diagnosis of Lewy body disease in patients with late‐onset psychiatric disorders using clinical history of rapid eye movement sleep behavior disorder and [123I]‐metaiodobenzylguanidine cardiac scintigraphy

Cited by 25 publications

References 42 publications

Research criteria for the diagnosis of prodromal dementia with Lewy bodies

Research criteria for the diagnosis of prodromal dementia with Lewy bodies

Late-Onset OCD as a Potential Harbinger of Dementia With Lewy Bodies: A Report of Two Cases

Clinical characteristics of elderly depressive patients with low metaiodobenzylguanidine uptake

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Early diagnosis of Lewy body disease in patients with late‐onset psychiatric disorders using clinical history of rapid eye movement sleep behavior disorder and [¹²³I]‐metaiodobenzylguanidine cardiac scintigraphy