Highlights
- •Differences of MIBG uptake in controls, SMI, MCI, AD, and DLB were analyzed.
- •Differences of orthostatic and 24-h vital signs were also investigated.
- •DLB patients showed higher orthostatic ΔSBP compared with other groups.
- •DLB group showed lower myocardial MIBG uptake compared with other groups.
- •Autonomic dysfunctions are present in patients with DLB regardless of Parkinsonism.
Abstract
Background
Although adoption of new clinical criteria for dementia with Lewy bodies (DLB) leads
to an increase in the proportion of patients diagnosed with probable DLB, the sensitivity
of clinical diagnostic criteria of DLB is low, and there are no generally accepted
clinical or imaging biomarkers to distinguish DLB from other types of dementia. In
this study, we investigated whether neurocirculatory abnormalities and cardiac sympathetic
denervation differed in controls and patients with subjective memory impairment (SMI),
mild cognitive impairment (MCI), Alzheimer's disease (AD), and DLB. We also assessed
whether spontaneous features of Parkinsonism might be related to the neurocirculatory
abnormalities and cardiac sympathetic denervation found in DLB.
Methods
Twenty-two consecutive patients with probable DLB were enrolled in this study; 25
age-matched controls, 14 SMI, 24 MCI, and 37 AD patients were also evaluated. Metaiodobenzylguanidine
(MIBG) uptake was assessed using the ratio of the heart to the upper mediastinum (H/M
ratio), and orthostatic vital signs and ambulatory 24-hour blood pressure monitoring
values were recorded.
Results
The mean H/M ratio was significantly lower and the proportion of orthostatic hypotension
was higher in patients with DLB than in controls, SMI, MCI and AD patients. In patients
with DLB, spontaneous Parkinsonism was not related to the degree of cardiac sympathetic
denervation nor did it influence neurocirculatory abnormalities.
Conclusion
Our results suggest that MIBG scintigraphy and autonomic function tests may be useful
for distinguishing between DLB and AD in clinical practice. Myocardial postganglionic
sympathetic denervation and autonomic dysfunctions are present in patients with DLB
regardless of spontaneous Parkinsonism.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Dementia with Lewy bodies.Dialogues Clin. Neurosci. 2004; 6: 333-341
- Extrapyramidal signs by dementia severity in Alzheimer disease and dementia with Lewy bodies.Alzheimer Dis. Assoc. Disord. 2013; 27: 226-232
- Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium.Neurology. 2005; 65: 1863-1872
- 123I-metaiodobenzylguanidine myocardial scintigraphy in Lewy body-related disorders; literature review.J. Mov. Disord. 2015; 8: 55-66
- Cardiovascular autonomic dysfunction in patients with movement disorders.Cleve. Clin. J. Med. 2008; 75: S54-S58
- High prevalence of neurovascular instability in neurodegenerative dementias.Neurology. 1998; 51: 1760-1762
- Mild cognitive impairment: clinical characterization and outcome.Arch. Neurol. 1999; 56: 303-308
- Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease.Neurology. 1984; 34: 939-944
- Diagnostic and Statistical Manual of Mental Disorders.4th ed. American Psychiatric Association, Washington, DC1994
- Subjective memory impairment. A review of its definitions indicates the need for a comprehensive set of standardised and validated criteria.Eur. Psychiatry. 2008; 23: 321-330
- Subjective cognitive impairment.Curr. Opin. Psychiatry. 2012; 25: 445-450
- Questionnaire-based diagnosis of REM sleep behavior disorder in Parkinson's disease.Mov. Disord. 2013; 28: 1146-1149
- Assessment of autonomic dysfunction in Parkinson's disease: the SCOPA-AUT.Mov. Disord. 2004; 19: 1306-1312
- Seoul Neuropsychological Screening Battery.Human Consulting Co., Incheon2003
- Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome.Clin. Auton. Res. 2011; 21: 69-72
- Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy.Clin. Auton. Res. 1996; 6: 125-126
- Association between supine hypertension and orthostatic hypotension in autonomic failure.Hypertension. 2003; 42: 136-142
- Orthostatic and supine blood pressures are associated with white matter hyperintensities in Parkinson disease.J. Mov. Disord. 2013; 6: 23-27
- Causes and consequences of a non-dipping blood pressure profile.Neth. J. Med. 2007; 65: 127-131
- 2007 Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).Eur. Heart J. 2007; 28: 1462-1536
- Nighttime blood pressure and white matter hyperintensities in patients with Parkinson disease.Chronobiol. Int. 2013; 30: 811-817
- Autonomic dysfunction in dementia with Lewy bodies.J. Neurol. 2003; 250: 530-533
- Value of 123I-MIBG radioactivity in the differential diagnosis of DLB from AD.Neurology. 2006; 66: 1850-1854
- Frequency and case identification of dementia with Lewy bodies using the revised consensus criteria.Dement. Geriatr. Cogn. Disord. 2008; 26: 445-452
- Staging of brain pathology related to sporadic Parkinson's disease.Neurobiol. Aging. 2003; 24: 197-211
- Sleepiness in Parkinson's disease.Parkinsonism Relat. Disord. 2009; 15: S101-S104
- Incidental Lewy body disease restricted to the heart and stellate ganglia.Mov. Disord. 2009; 24: 2299-2301
- Multiple organ involvement by alpha-synuclein pathology in Lewy body disorders.Mov. Disord. 2014; 29: 1010-1018
- Prodromal dementia with Lewy bodies.Geriatr. Gerontol. Int. 2015; 15: 817-826
- Dementia with Lewy bodies: early diagnostic challenges.Psychogeriatrics. 2013; 13: 128-138
- MIBG myocardial scintigraphy in pre-motor Parkinson's disease: a review.Parkinsonism Relat. Disord. 2014; 20: 267-273
- Cardiac 123I-MIBG uptake is reduced more markedly in patients with REM sleep behavior disorder than in those with early stage Parkinson's disease.Parkinsonism Relat. Disord. 2010; 16: 252-255
Article info
Publication history
Published online: July 17, 2015
Accepted:
July 16,
2015
Received in revised form:
July 13,
2015
Received:
June 12,
2015
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
