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The role of I-ioflupane SPECT dopamine transporter imaging in the diagnosis and treatment of patients with dementia with Lewy bodies.

Antonini A - Neuropsychiatr Dis Treat (2007)

Bottom Line: By contrast, acetyl-cholinesterase inhibitors such as rivastigmine have shown benefit not only on cognitive but also on psychiatric symptoms.Recent evidence shows that striatal dopamine transporter binding of (123)I-ioflupane SPECT is reduced in DLB and this is consistent with a significant loss of nigral dopamine neurons in this disorder.Given the availability of SPECT, this investigation represents a useful marker to support clinical diagnosis and can help establishing appropriate treatment for this disorder.

View Article: PubMed Central - PubMed

Affiliation: Parkinson Institute, Istituti Clinici di Perfezionamento, 20126 Milano, Italy. angelo3000@yahoo.com

ABSTRACT
The diagnosis of dementia with Lewy bodies (DLB) is difficult if one relies solely on clinical features. Current International Consensus Criteria for DLB have high specificity but a significant percentage of patients might be misdiagnosed. Reasons for clinical uncertainty regard the presence of concomitant motor signs in patients with Alzheimer's disease as well as the observation that cognitive abnormalities in DLB might develop with memory impairment without significant parkinsonism. This has clinical relevance as DLB patients may be particularly sensitive to antipsychotics and even the effectiveness of atypical neuroleptics such as quetiapine for the treatment of agitation and hallucinations has been questioned by double-blind, placebo-controlled, randomized studies. By contrast, acetyl-cholinesterase inhibitors such as rivastigmine have shown benefit not only on cognitive but also on psychiatric symptoms. Recent evidence shows that striatal dopamine transporter binding of (123)I-ioflupane SPECT is reduced in DLB and this is consistent with a significant loss of nigral dopamine neurons in this disorder. Several studies have demonstrated the diagnostic accuracy of (123)I-ioflupane in the differential diagnosis of parkinsonism. Given the availability of SPECT, this investigation represents a useful marker to support clinical diagnosis and can help establishing appropriate treatment for this disorder.

No MeSH data available.


Related in: MedlinePlus

The images depict striatal dopamine transporter binding of with 123I-ioflupane – SPECT in one patient with dementia with Lewy bodies (DLB) (right panel) and in one with Alzheimer’s disease (AD) (left panel). It can be appreciated that 123I-ioflupane uptake in the basal ganglia is normal in AD but markedly reduced in the DLB patient, consistent with significant impairment of striatal dopamine nerve terminals.
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f1-ndt-3-287: The images depict striatal dopamine transporter binding of with 123I-ioflupane – SPECT in one patient with dementia with Lewy bodies (DLB) (right panel) and in one with Alzheimer’s disease (AD) (left panel). It can be appreciated that 123I-ioflupane uptake in the basal ganglia is normal in AD but markedly reduced in the DLB patient, consistent with significant impairment of striatal dopamine nerve terminals.

Mentions: There is good consistency between visual and semi-quantitative assessment, making 123I-ioflupane imaging easy to use also in a clinical routine setting (Ottaviani et al 2006). Because DLB, PD with dementia, and PD are characterized by involvement of dopamine nigral neurons, imaging of striatal DAT helps in identifying these patients. Degeneration might be more widespread in DLB and might also involve projections to the caudate nucleus possibly contributing to cognitive impairment (Figure 1) (Lucignani et al 2002; Walker et al 2004).


The role of I-ioflupane SPECT dopamine transporter imaging in the diagnosis and treatment of patients with dementia with Lewy bodies.

Antonini A - Neuropsychiatr Dis Treat (2007)

The images depict striatal dopamine transporter binding of with 123I-ioflupane – SPECT in one patient with dementia with Lewy bodies (DLB) (right panel) and in one with Alzheimer’s disease (AD) (left panel). It can be appreciated that 123I-ioflupane uptake in the basal ganglia is normal in AD but markedly reduced in the DLB patient, consistent with significant impairment of striatal dopamine nerve terminals.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2654798&req=5

f1-ndt-3-287: The images depict striatal dopamine transporter binding of with 123I-ioflupane – SPECT in one patient with dementia with Lewy bodies (DLB) (right panel) and in one with Alzheimer’s disease (AD) (left panel). It can be appreciated that 123I-ioflupane uptake in the basal ganglia is normal in AD but markedly reduced in the DLB patient, consistent with significant impairment of striatal dopamine nerve terminals.
Mentions: There is good consistency between visual and semi-quantitative assessment, making 123I-ioflupane imaging easy to use also in a clinical routine setting (Ottaviani et al 2006). Because DLB, PD with dementia, and PD are characterized by involvement of dopamine nigral neurons, imaging of striatal DAT helps in identifying these patients. Degeneration might be more widespread in DLB and might also involve projections to the caudate nucleus possibly contributing to cognitive impairment (Figure 1) (Lucignani et al 2002; Walker et al 2004).

Bottom Line: By contrast, acetyl-cholinesterase inhibitors such as rivastigmine have shown benefit not only on cognitive but also on psychiatric symptoms.Recent evidence shows that striatal dopamine transporter binding of (123)I-ioflupane SPECT is reduced in DLB and this is consistent with a significant loss of nigral dopamine neurons in this disorder.Given the availability of SPECT, this investigation represents a useful marker to support clinical diagnosis and can help establishing appropriate treatment for this disorder.

View Article: PubMed Central - PubMed

Affiliation: Parkinson Institute, Istituti Clinici di Perfezionamento, 20126 Milano, Italy. angelo3000@yahoo.com

ABSTRACT
The diagnosis of dementia with Lewy bodies (DLB) is difficult if one relies solely on clinical features. Current International Consensus Criteria for DLB have high specificity but a significant percentage of patients might be misdiagnosed. Reasons for clinical uncertainty regard the presence of concomitant motor signs in patients with Alzheimer's disease as well as the observation that cognitive abnormalities in DLB might develop with memory impairment without significant parkinsonism. This has clinical relevance as DLB patients may be particularly sensitive to antipsychotics and even the effectiveness of atypical neuroleptics such as quetiapine for the treatment of agitation and hallucinations has been questioned by double-blind, placebo-controlled, randomized studies. By contrast, acetyl-cholinesterase inhibitors such as rivastigmine have shown benefit not only on cognitive but also on psychiatric symptoms. Recent evidence shows that striatal dopamine transporter binding of (123)I-ioflupane SPECT is reduced in DLB and this is consistent with a significant loss of nigral dopamine neurons in this disorder. Several studies have demonstrated the diagnostic accuracy of (123)I-ioflupane in the differential diagnosis of parkinsonism. Given the availability of SPECT, this investigation represents a useful marker to support clinical diagnosis and can help establishing appropriate treatment for this disorder.

No MeSH data available.


Related in: MedlinePlus