Dementia with Lewy bodies: a comparison of clinical diagnosis. FP-CIT single photon emission computed tomography imaging and autopsy

Walker, Z. and Jaros, E. and Walker, R.W.H. and Lee, L. and Costa, D.C. and Livingston, G. and Ince, P.G. and Perry, R. and McKeith, I. and Katona, C. (2007) Dementia with Lewy bodies: a comparison of clinical diagnosis. FP-CIT single photon emission computed tomography imaging and autopsy. Journal of Neurology, Neurosurgery and Psychiatry, 78 (11). pp. 1176-1181. ISSN 0022-3050. (The full text of this publication is not available from this repository)

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Official URL
http://dx.doi.org/10.1136/jnnp.2006.110122

Abstract

Background: Dementia with Lewy bodies (DLB) is a common form of dementia. The presence of Alzheimer's disease ( AD) pathology modifies the clinical features of DLB, making it harder to distinguish DLB from AD clinically during life. Clinical diagnostic criteria for DLB applied at presentation can fail to identify up to 50% of cases. Our aim was to determine, in a series of patients with dementia in whom autopsy confirmation of diagnosis was available, whether functional imaging of the nigrostriatal pathway improves the accuracy of diagnosis compared with diagnosis by means of clinical criteria alone. Methods: A single photon emission computed tomography ( SPECT) scan was carried out with a dopaminergic presynaptic ligand [I-123]-2beta-carbometoxy-3beta-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT; ioflupane) on a group of patients with a clinical diagnosis of DLB or other dementia. An abnormal scan was defined as one in which right and left posterior putamen binding, measured semiquantitatively, was more than 2 SDs below the mean of the controls. Results: Over a 10 year period it was possible to collect 20 patients who had been followed from the time of first assessment and time of scan through to death and subsequent detailed neuropathological autopsy. Eight patients fulfilled neuropathological diagnostic criteria for DLB. Nine patients had AD, mostly with coexisting cerebrovascular disease. Three patients had other diagnoses. The sensitivity of an initial clinical diagnosis of DLB was 75% and specificity was 42%. The sensitivity of the FP-CIT scan for the diagnosis of DLB was 88% and specificity was 100%. Conclusion: FP-CIT SPECT scans substantially enhanced the accuracy of diagnosis of DLB by comparison with clinical criteria alone.

Item Type: Article
Additional information:
Uncontrolled keywords: STRIATAL DOPAMINE TRANSPORTER ALZHEIMERS-DISEASE BODY DISEASE CONSORTIUM CRITERIA BINDING BRAIN SPECT DLB
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Divisions: Faculties > Science Technology and Medical Studies > Kent Institute of Medicine and Health Sciences (KIMHS)
Depositing User: M.P. Stone
Date Deposited: 04 Aug 2008 11:40
Last Modified: 15 Sep 2008 07:38
Resource URI: http://kar.kent.ac.uk/id/eprint/12304 (The current URI for this page, for reference purposes)
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