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Differentiating between visual hallucination-free dementia with Lewy bodies and corticobasal syndrome on the basis of neuropsychology and perfusion single-photon emission computed tomography.

Misch MR, Mitchell S, Francis PL, Sherborn K, Meradje K, McNeely AA, Honjo K, Zhao J, Scott CJ, Caldwell CB, Ehrlich L, Shammi P, MacIntosh BJ, Bilbao JM, Lang AE, Black SE, Masellis M - Alzheimers Res Ther (2014)

Bottom Line: Given the clinical overlap between these disorders, neuropsychological and imaging markers may aid in distinguishing these entities.MRI measures were not significantly different between the patient groups.Development of reliable neuropsychological and imaging markers that improve diagnostic accuracy will become increasingly important as disease modifying therapies become available.

View Article: PubMed Central - PubMed

Affiliation: L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada.

ABSTRACT

Introduction: Dementia with Lewy bodies (DLB) and Corticobasal Syndrome (CBS) are atypical parkinsonian disorders with fronto-subcortical and posterior cognitive dysfunction as common features. While visual hallucinations are a good predictor of Lewy body pathology and are rare in CBS, they are not exhibited in all cases of DLB. Given the clinical overlap between these disorders, neuropsychological and imaging markers may aid in distinguishing these entities.

Methods: Prospectively recruited case-control cohorts of CBS (n =31) and visual hallucination-free DLB (n =30), completed neuropsychological and neuropsychiatric measures as well as brain perfusion single-photon emission computed tomography and structural magnetic resonance imaging (MRI). Perfusion data were available for forty-two controls. Behavioural, perfusion, and cortical volume and thickness measures were compared between the groups to identify features that serve to differentiate them.

Results: The Lewy body with no hallucinations group performed more poorly on measures of episodic memory compared to the corticobasal group, including the delayed and cued recall portions of the California Verbal Learning Test (F (1, 42) =23.1, P <0.001 and F (1, 42) =14.0, P =0.001 respectively) and the delayed visual reproduction of the Wechsler Memory Scale-Revised (F (1, 36) =9.7, P =0.004). The Lewy body group also demonstrated reduced perfusion in the left occipital pole compared to the corticobasal group (F (1,57) =7.4, P =0.009). At autopsy, the Lewy body cases all demonstrated mixed dementia with Lewy bodies, Alzheimer's disease and small vessel arteriosclerosis, while the corticobasal cases demonstrated classical corticobasal degeneration in five, dementia with agyrophilic grains + corticobasal degeneration + cerebral amyloid angiopathy in one, Progressive Supranuclear Palsy in two, and Frontotemporal Lobar Degeneration-Ubiquitin/TAR DNA-binding protein 43 proteinopathy in one. MRI measures were not significantly different between the patient groups.

Conclusions: Reduced perfusion in the left occipital region and worse episodic memory performance may help to distinguish between DLB cases who have never manifested with visual hallucinations and CBS at earlier stages of the disease. Development of reliable neuropsychological and imaging markers that improve diagnostic accuracy will become increasingly important as disease modifying therapies become available.

No MeSH data available.


Related in: MedlinePlus

Regions of interest (ROIs) that show differential perfusion in the case versus control analyses. Views are shown in standard radiological orientation.
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Fig1: Regions of interest (ROIs) that show differential perfusion in the case versus control analyses. Views are shown in standard radiological orientation.

Mentions: The second phase of the SPECT imaging analyses set out to identify regions of perfusion difference between the VHF-DLB group and the CBS group. A ROI analysis was performed using selected candidate brain regions that were found to show reduced perfusion in the case versus control analysis, but that did not overlap between the CBS and VHF-DLB groups (Figure 1). Reconstructed SPECT images were co-registered to a template that was an average of 14 healthy, elderly control scans. A T1-weighted MRI with dimensions similar to the SPECT template was the source of 79 bilateral ROIs as previously described [53]. To obtain ROI intensity values, we used a common transformation to move from the SPECT template space to MRI space. The cerebellum was used as the reference region in a manner similar to that described in the SPM analysis to generate semi-quantitative perfusion ratios in each ROI [53].Figure 1


Differentiating between visual hallucination-free dementia with Lewy bodies and corticobasal syndrome on the basis of neuropsychology and perfusion single-photon emission computed tomography.

Misch MR, Mitchell S, Francis PL, Sherborn K, Meradje K, McNeely AA, Honjo K, Zhao J, Scott CJ, Caldwell CB, Ehrlich L, Shammi P, MacIntosh BJ, Bilbao JM, Lang AE, Black SE, Masellis M - Alzheimers Res Ther (2014)

Regions of interest (ROIs) that show differential perfusion in the case versus control analyses. Views are shown in standard radiological orientation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4256921&req=5

Fig1: Regions of interest (ROIs) that show differential perfusion in the case versus control analyses. Views are shown in standard radiological orientation.
Mentions: The second phase of the SPECT imaging analyses set out to identify regions of perfusion difference between the VHF-DLB group and the CBS group. A ROI analysis was performed using selected candidate brain regions that were found to show reduced perfusion in the case versus control analysis, but that did not overlap between the CBS and VHF-DLB groups (Figure 1). Reconstructed SPECT images were co-registered to a template that was an average of 14 healthy, elderly control scans. A T1-weighted MRI with dimensions similar to the SPECT template was the source of 79 bilateral ROIs as previously described [53]. To obtain ROI intensity values, we used a common transformation to move from the SPECT template space to MRI space. The cerebellum was used as the reference region in a manner similar to that described in the SPM analysis to generate semi-quantitative perfusion ratios in each ROI [53].Figure 1

Bottom Line: Given the clinical overlap between these disorders, neuropsychological and imaging markers may aid in distinguishing these entities.MRI measures were not significantly different between the patient groups.Development of reliable neuropsychological and imaging markers that improve diagnostic accuracy will become increasingly important as disease modifying therapies become available.

View Article: PubMed Central - PubMed

Affiliation: L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada.

ABSTRACT

Introduction: Dementia with Lewy bodies (DLB) and Corticobasal Syndrome (CBS) are atypical parkinsonian disorders with fronto-subcortical and posterior cognitive dysfunction as common features. While visual hallucinations are a good predictor of Lewy body pathology and are rare in CBS, they are not exhibited in all cases of DLB. Given the clinical overlap between these disorders, neuropsychological and imaging markers may aid in distinguishing these entities.

Methods: Prospectively recruited case-control cohorts of CBS (n =31) and visual hallucination-free DLB (n =30), completed neuropsychological and neuropsychiatric measures as well as brain perfusion single-photon emission computed tomography and structural magnetic resonance imaging (MRI). Perfusion data were available for forty-two controls. Behavioural, perfusion, and cortical volume and thickness measures were compared between the groups to identify features that serve to differentiate them.

Results: The Lewy body with no hallucinations group performed more poorly on measures of episodic memory compared to the corticobasal group, including the delayed and cued recall portions of the California Verbal Learning Test (F (1, 42) =23.1, P <0.001 and F (1, 42) =14.0, P =0.001 respectively) and the delayed visual reproduction of the Wechsler Memory Scale-Revised (F (1, 36) =9.7, P =0.004). The Lewy body group also demonstrated reduced perfusion in the left occipital pole compared to the corticobasal group (F (1,57) =7.4, P =0.009). At autopsy, the Lewy body cases all demonstrated mixed dementia with Lewy bodies, Alzheimer's disease and small vessel arteriosclerosis, while the corticobasal cases demonstrated classical corticobasal degeneration in five, dementia with agyrophilic grains + corticobasal degeneration + cerebral amyloid angiopathy in one, Progressive Supranuclear Palsy in two, and Frontotemporal Lobar Degeneration-Ubiquitin/TAR DNA-binding protein 43 proteinopathy in one. MRI measures were not significantly different between the patient groups.

Conclusions: Reduced perfusion in the left occipital region and worse episodic memory performance may help to distinguish between DLB cases who have never manifested with visual hallucinations and CBS at earlier stages of the disease. Development of reliable neuropsychological and imaging markers that improve diagnostic accuracy will become increasingly important as disease modifying therapies become available.

No MeSH data available.


Related in: MedlinePlus