Value of
            <sup>123</sup>
            I-MIBG radioactivity in the differential diagnosis of DLB from AD

Yoshita, Mitsuhiro; Taki, Junichi; Yokoyama, Katsutoshi; Noguchi‐Shinohara, Moeko; Matsumoto, Yoshihiko; Nakajima, Kénichi; Yamada, Masahito

doi:10.1212/01.wnl.0000219640.59984.a7

Cited by 183 publications

(166 citation statements)

References 30 publications

(44 reference statements)

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“…This patient had Braak stage III-IV for neurofibrillary tangles, and no Lewy bodies were found. Based on the literature (Yoshita et al, 2006), an H/M ratio cutoff of 1.68 was used for the classification of patients based on MIBG cardiac scintigraphy. Applying the H/M ratio cutoff of 1.68, 95% (19/20) of the patients with clinically ambiguous diagnoses were correctly classified, with sensitivity and specificity values of 100% (16/16) and 75% (3/4), respectively, as compared with diagnosis at follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…The decreased cardiac uptake of MIBG in DLB reflects the postganglionic cardiac sympathetic denervation (Orimo et al, 2005). Promising results have been published, but these studies have been conducted under very strict exclusion criteria (Yoshita et al, 2001, Yoshita et al, 2006, Watanabe et al, 2001, Oide et al, 2003, Hanyu et al, 2006, Wada-Isoe et al, 2007. Indeed, patients with ischemic heart disease, heart failure, thyroid disease, or diabetes mellitus were excluded (Yoshita et al, 2001, Yoshita et al, 2006, Watanabe et al, 2001, Oide et al, 2003.…”

Section: Introductionmentioning

confidence: 99%

“…Promising results have been published, but these studies have been conducted under very strict exclusion criteria (Yoshita et al, 2001, Yoshita et al, 2006, Watanabe et al, 2001, Oide et al, 2003, Hanyu et al, 2006, Wada-Isoe et al, 2007. Indeed, patients with ischemic heart disease, heart failure, thyroid disease, or diabetes mellitus were excluded (Yoshita et al, 2001, Yoshita et al, 2006, Watanabe et al, 2001, Oide et al, 2003. Moreover, patients with arterial hypertension or hyperlipidemia (Yoshita et al, 2001, Yoshita et al, 2006 and patients on antidepressant medication like trazodone or on antipsychotics like haloperidol were excluded from these studies (Yoshita et al, 2001, Yoshita et al, 2006, Watanabe et al, 2001, Oide et al, 2003.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, patients with ischemic heart disease, heart failure, thyroid disease, or diabetes mellitus were excluded (Yoshita et al, 2001, Yoshita et al, 2006, Watanabe et al, 2001, Oide et al, 2003. Moreover, patients with arterial hypertension or hyperlipidemia (Yoshita et al, 2001, Yoshita et al, 2006 and patients on antidepressant medication like trazodone or on antipsychotics like haloperidol were excluded from these studies (Yoshita et al, 2001, Yoshita et al, 2006, Watanabe et al, 2001, Oide et al, 2003. As most patients with a cognitive deterioration are older people having comorbidities like arterial hypertension, diabetes mellitus, cardiovascular disease, thyroid disease, or hyperlipidemia, these studies do not reflect clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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P2‐198: The Diagnostic Value of Mibg Cardiac Scintigraphy for Differential Dementia Diagnosis

Engelborghs

Slaets

Acker

et al. 2014

Alzheimer's & Dementia

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Objective: Iodine-123 metaiodobenzylguanidine (MIBG) cardiac scintigraphy has shown the potential to discriminate dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). However, these studies did not reflect clinical practice, as patients with ischemic heart disease, heart failure, diabetes mellitus, arterial hypertension, and hyperlipidemia and patients treated with antidepressants like trazodone were excluded. Methods: This study aimed to evaluate the use of MIBG cardiac scintigraphy to diagnose DLB in clinical practice. Moreover, the potential diagnostic value of MIBG cardiac scintigraphy in patients with clinically ambiguous dementia diagnosis (DLB versus AD) was tested. Eighty-five patients with a possible clinical diagnosis of DLB entered the study. MIBG uptake was determined by calculating the heartto-mediastinum-uptake ratio (H/M). Results: The average H/M ratio was 1.42 ± 0.35. The number of core features for DLB and the H/M ratio were negatively correlated (p = 0.001; r = À0.360). With an H/M ratio cutoff of 1.68 in 20 patients with clinically ambiguous dementia diagnoses (DLB versus AD) at the moment of MIBG cardiac scintigraphy, 95% (19/20) of the patients were correctly classified as compared with clinical or definite diagnosis at follow-up, with sensitivity and specificity values for diagnosing DLB of 100% (16/16) and 75% (3/4), respectively. The H/M ratio was influenced only by age (p = 0.046; r = À0.217) and gender (p = 0.024) and not by any other variable studied. Conclusions: The MIBG cardiac scintigraphy H/M ratio is a possible diagnostic biomarker for DLB in routine clinical practice and might have an added diagnostic value in case of doubt between DLB and AD.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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P2‐198: The Diagnostic Value of Mibg Cardiac Scintigraphy for Differential Dementia Diagnosis

Engelborghs

Slaets

Acker

et al. 2014

Alzheimer's & Dementia

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“…57 Cardiac imaging has also been explored and [I-123] myocardial scintigraphy (MIBG) has been shown to be correlate with decreased postganglionic sympathetic innervation with DLB and PD patients with respect to AD patients. 58 There are no definitive biomarkers for DLB, though it has been suggested that a relative increase in CSF tau with decrease in Aβ-42 can distinguish between DLB and PD. 59 Additionally, it has been found that the levels of Aβ-42/Aβ-38 can differentiate between DLB and AD.…”

Section: Studiesmentioning

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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European consensus for the diagnosis of MCI and mild dementia: Preparatory phase

Festari

Massa

Ramusino

et al. 2022

Alzheimer's & Dementia

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Introduction Etiological diagnosis of neurocognitive disorders of middle‐old age relies on biomarkers, although evidence for their rational use is incomplete. A European task force is defining a diagnostic workflow where expert experience fills evidence gaps for biomarker validity and prioritization. We report methodology and preliminary results. Methods Using a Delphi consensus method supported by a systematic literature review, 22 delegates from 11 relevant scientific societies defined workflow assumptions. Results We extracted diagnostic accuracy figures from literature on the use of biomarkers in the diagnosis of main forms of neurocognitive disorders. Supported by this evidence, panelists defined clinical setting (specialist outpatient service), application stage (MCI‐mild dementia), and detailed pre‐assessment screening (clinical‐neuropsychological evaluations, brain imaging, and blood tests). Discussion The Delphi consensus on these assumptions set the stage for the development of the first pan‐European workflow for biomarkers’ use in the etiological diagnosis of middle‐old age neurocognitive disorders at MCI‐mild dementia stages. Highlights Rational use of biomarkers in neurocognitive disorders lacks consensus in Europe. A consensus of experts will define a workflow for the rational use of biomarkers. The diagnostic workflow will be patient‐centered and based on clinical presentation. The workflow will be updated as new evidence accrues.

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Value of ¹²³ I-MIBG radioactivity in the differential diagnosis of DLB from AD

Abstract: Our results indicate that dementia with Lewy bodies results in cardiac sympathetic denervation and that iodine-123 metaiodobenzylguanidine myocardial scintigraphy is a sensitive tool for discriminating dementia with Lewy bodies from Alzheimer disease even in patients without parkinsonism.

Cited by 183 publications

References 30 publications

P2‐198: The Diagnostic Value of Mibg Cardiac Scintigraphy for Differential Dementia Diagnosis

P2‐198: The Diagnostic Value of Mibg Cardiac Scintigraphy for Differential Dementia Diagnosis

Dementia with Lewy Bodies

European consensus for the diagnosis of MCI and mild dementia: Preparatory phase

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Value of 123 I-MIBG radioactivity in the differential diagnosis of DLB from AD

Abstract: Our results indicate that dementia with Lewy bodies results in cardiac sympathetic denervation and that iodine-123 metaiodobenzylguanidine myocardial scintigraphy is a sensitive tool for discriminating dementia with Lewy bodies from Alzheimer disease even in patients without parkinsonism.

Cited by 183 publications

References 30 publications

P2‐198: The Diagnostic Value of Mibg Cardiac Scintigraphy for Differential Dementia Diagnosis

P2‐198: The Diagnostic Value of Mibg Cardiac Scintigraphy for Differential Dementia Diagnosis

Dementia with Lewy Bodies

European consensus for the diagnosis of MCI and mild dementia: Preparatory phase

Contact Info

Product

Resources

About

Value of ¹²³ I-MIBG radioactivity in the differential diagnosis of DLB from AD