Prospective validation of Consensus criteria for the diagnosis of dementia with Lewy bodies

McKeith, Ian G.; Ballard, Clive; Perry, Robert H.; Ince, Paul G.; O’Brien, John; Neill, D. W.; Lowery, K.; Jaros, Evelyn; Barber, Robert; Thompson, Peter M.; Swann, Alan; Fairbairn, Andrew; Perry, Elaine K.

doi:10.1212/wnl.54.5.1050

Cited by 400 publications

(249 citation statements)

References 37 publications

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“…3D-SSP images of patient 18 show typical reduction pattern of DLB. 3D-SSP images of patients 19 and 21 show severe reduction in frontal, parietal, and temporal lobes and mild-to-moderate reduction in precuneus and posterior cingulate gyrus, and primary sensorimotor cortex is spared so that this reduction pattern is considered as AD, but patient 19 shows unilateral mild occipital hypo- reported, in an autopsy study, relationships between primary and secondary clinical diagnoses that confirmed previous reports that the majority of DLB cases also met criteria for the other dementia subtypes, particularly possible AD (8). According to this report, the majority of probable DLB patients were diagnosed neuropathologically as DLB, but the majority of possible DLB patients were not diagnosed pathologically as DLB, but as progressive supranuclear palsy or AD.…”

Section: Discussionsupporting

confidence: 80%

“…However, the differential diagnosis of DLB in contrast with other degenerative diseases such as Parkinson's disease (PD), AD, and vascular dementia may not be feasible because of those clinically overlapping symptoms, especially in the case of possible DLB. The reported sensitivity rates for a clinical diagnosis of probable DLB have varied from 0.22 to 0.83 and the specificity from 0.79 to 1.0 (5)(6)(7)(8).…”

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confidence: 99%

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Evaluation of Probable or Possible Dementia with Lewy Bodies Using 123I-IMP Brain Perfusion SPECT, 123I-MIBG, and 99mTc-MIBI Myocardial SPECT

Inui¹,

Toyama²,

Manabe³

et al. 2007

Journal of Nuclear Medicine

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We evaluated the diagnostic usefulness of combination studies with a statistical mapping method in N-isopropyl-p-123 Iiodoamphetamine ( 123 I-IMP) brain perfusion SPECT, cardiac sympathetic nerve function by 123 I-metaiodobenzylguanidine ( 123 I-MIBG), and myocardial function by electrocardiographically gated 99m Tc-sestamibi ( 99m Tc-MIBI) SPECT for patients with probable or possible dementia with Lewy bodies (DLB). Methods: Twelve patients with probable DLB (7 male, 5 female; mean age 6 SD, 72.3 6 5.63 y; range, 65-82 y) and 9 patients with possible DLB (3 male, 6 female; mean age 6 SD, 73.1 6 9.23 y; range, 59-88 y) were enrolled in this study. 123 I-IMP SPECT images were analyzed with 3-dimensional stereotactic surface projections (3D-SSP) and the severity of ischemia was classified objectively using quantitatively analytic and display software; stereotactic extraction estimation (SEE) methods were compared with a normal database. In addition, we evaluated 123 I-MIBG heart-to-mediastinum (H/M) uptake ratios. Moreover, we performed 99m Tc-MIBI SPECT to evaluate myocardial perfusion and the left ventricular ejection fraction (LVEF) compared with a normal database. Results: 3D-SSP images of group comparison with healthy control subjects showed significantly decreased perfusion in the parietotemporal, occipital cortex, posterior cingulated, and precuneus regions in the probable DLB group but no significant reduction in the possible DLB group. Mean H/M ratios in the probable DLB group were significantly lower than those of the possible DLB group and the control group, respectively. Ten of 12 patients (83.3%) with probable DLB and 1 of 9 patients (11.1%) with possible DLB showed severe reduction in the bilateral occipital lobe and also a low 123 I-MIBG uptake. One patient (8.3%) with probable DLB and 2 patients (22.2%) with possible DLB showed no bilateral occipital hypoperfusion but showed low 123 I-MIBG uptake. One patient (8.3%) with probable DLB and 6 patients (66.7%) with possible DLB showed no occipital hypoperfusion and normal 123 I-MIBG uptake. 99m Tc-MIBI gated SPECT did not indicate any wall motion abnormality in any subjects. Conclusion: These results suggest that combined examination of cerebral blood flow with 3D-SSP and SEE analysis, and cardiac sympathetic nerve function with 123 I-MIBG, would be a useful supporting diagnostic method in patients with DLB-particularly, in possible DLB and when cerebral blood flow does not indicate occipital hypoperfusion.

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Section: Discussionsupporting

confidence: 80%

mentioning

confidence: 99%

Evaluation of Probable or Possible Dementia with Lewy Bodies Using 123I-IMP Brain Perfusion SPECT, 123I-MIBG, and 99mTc-MIBI Myocardial SPECT

Inui¹,

Toyama²,

Manabe³

et al. 2007

Journal of Nuclear Medicine

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“…We did not have autopsy confirmation of the diagnoses in the subjects, however we used a consensus clinical diagnosis, which we have previously shown to have good accuracy against autopsy [16]. In addition, all 9 of our DLB subjects who had dopamine transporter imaging had abnormal scans consistent with DLB as the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Nine of the DLB subjects had a 123 I-FP-CIT SPECT scan, all of whom demonstrated reduced dopamine transporter uptake in the basal ganglia. All diagnoses were made by consensus between two experienced clinicians, a method we have previously validated against autopsy diagnosis [16]. Diagnoses were made independent of MRI scanning.…”

Section: Subjectsmentioning

confidence: 99%

High Resolution Imaging of the Medial Temporal Lobe in Alzheimer's Disease and Dementia with Lewy Bodies

Firbank

Blamire

Teodorczuk

et al. 2010

JAD

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Abstract. We used high resolution (0.3 mm in-plane) coronal 3T magnetic resonance (MR) imaging of the medial temporal lobe in 16 subjects with Alzheimer's disease (AD), 16 with dementia with Lewy bodies (DLB), and 16 similarly aged healthy subjects. On the anterior section of the hippocampus body, regions of interest were manually drawn blind to diagnosis on the CA1, CA2, and CA3/4 subregions, and the width of the subiculum and entorhinal cortex was measured. Controlling for intracranial volume, age, and years of education, we found the subiculum thickness was significantly reduced in AD (2.03 ± 0.29 mm) compared to both control (2.37 ± 0.28 mm, p = 0.008) and DLB (2.35 ± 0.24 mm, p = 0.001) subjects. The area of CA1 was likewise reduced in AD compared to controls and DLB. In the hippocampus images, a hypointense line is visible between CA1 and CA3/4. This line was significantly less distinct in AD, suggesting disease related changes to this region. Future studies should investigate whether subiculum thickness or the hypointense line could be a diagnostic feature to help discriminate AD from DLB.

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“…The majority were followed longitudinally at the Johns Hopkins University Morris Udall Parkinson's Disease Center, and the diagnosis of PD was confirmed at autopsy [6,17,20]. These individuals had histories of PD for 7-20 years, with or without dementia, and their brains had α-synuclein lesions in the SN and other brain regions [34]. There were no significant lesions indicative of other neurodegenerative disorders, i.e., tauopathies [13] or multiple system atrophy [18,40].…”

Section: Subjectsmentioning

confidence: 99%

Morphometry of the human substantia nigra in ageing and Parkinson’s disease

Rudow¹,

O’Brien

Savonenko³

et al. 2008

Acta Neuropathol

164

117

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To investigate the relation between the loss of substantia nigra (SN) neurons in normal ageing and Parkinson's disease (PD), we measured the total number and the cell body volume of pigmented (neuromelanin) neurons in the SN. We examined young (n = 7, mean age: 19.9), middle-aged (n = grudow1@jhmi.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript 9, mean age: 50.1), and older controls from the Baltimore Longitudinal Study of Aging (n = 7, mean age: 87.6), as well as PD cases (n = 8, mean age: 74.8). On random-systematically selected paraffin Nissl-stained sections, we used the Optical Fractionator to estimate the total number of neurons on one side of the SN. Using the Nucleator probe, we measured the volume of these neurons. In young and older controls, we also estimated the total number and volume of tyrosine hydroxylase (TH) positive (+) nigral neurons. We observed a significant loss of pigmented (-28.3%, P < 0.01) and TH (+) (−36.2%, P < 0.001) neurons in older controls compared with younger subjects. Analysis of the size distribution of pigmented and TH (+) neurons showed a significant hypertrophy in older controls compared to young controls (P < 0.01). In contrast, in PD we observed a significant atrophy of pigmented neurons compared to all control groups (P < 0.01). These data suggest that neuronal hypertrophy represents a compensatory mechanism within individual SN neurons that allows for normal motor function despite the loss of neurons in normal ageing. Presumably, this compensatory mechanism breaks down or is overwhelmed by the pathological events of PD leading to the onset of the characteristic motor disturbances.

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Prospective validation of Consensus criteria for the diagnosis of dementia with Lewy bodies

Cited by 400 publications

References 37 publications

Evaluation of Probable or Possible Dementia with Lewy Bodies Using 123I-IMP Brain Perfusion SPECT, 123I-MIBG, and 99mTc-MIBI Myocardial SPECT

Evaluation of Probable or Possible Dementia with Lewy Bodies Using 123I-IMP Brain Perfusion SPECT, 123I-MIBG, and 99mTc-MIBI Myocardial SPECT

High Resolution Imaging of the Medial Temporal Lobe in Alzheimer's Disease and Dementia with Lewy Bodies

Morphometry of the human substantia nigra in ageing and Parkinson’s disease

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