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From the Department of Neurology and Neurobiology of Aging (M.Y., M.N.-S., Y.M., M.Y.) and Biotracer Medicine (J.T., K.Y., K.N.), Kanazawa University Graduate School of Medical Science, Kanazawa, Japan; and the Department of Neurology and Center for Neuroscience (M.Y.), University of California at Davis.
Address correspondence and reprint requests to Dr. Mitsuhiro Yoshita, Department of Neurology and Center for Neuroscience, University of California at Davis, 1544 Newton Court, Davis, CA 95616; e-mail: myoshita{at}ucdavis.edu
Objective: To evaluate the diagnostic reliability of cardiac iodine-123 metaiodobenzylguanidine (123I-MIBG) radioactivity in discriminating dementia with Lewy bodies (DLB) from Alzheimer disease (AD) regardless of parkinsonism.
Background: The diagnosis of DLB may be confounded by the absence of parkinsonism. This highlights the need to improve the accuracy of antemortem diagnosis of DLB without parkinsonism.
Methods: Cardiac sympathetic denervation was examined using myocardial 123I-MIBG scintigraphy in 37 patients with DLB, 42 patients with AD, and 10 normal elderly controls. The DLB patients consisted of seven patients without parkinsonism (DLB/P–) and 30 patients with parkinsonism (DLB/P+) at the time of the study.
Results: The heart-to-mediastinum uptake ratio (H/M ratio) of myocardial MIBG uptake was decreased in both the DLB groups vs the AD group (p < 0.0001) and control group (p < 0.0001). The washout rate (WR) was higher in the DLB group than in the control group (p < 0.0001) and AD group (p < 0.0001). No differences were found between the AD and control groups or between the DLB/P+ and DLB/P– groups in either the early or delayed H/M ratio or WR. In discriminating between DLB and AD, regardless of parkinsonism, the delayed H/M ratio had a sensitivity of 100%, a specificity of 100%, and a positive predictive value of 100% at a cutoff value of 1.68.
Conclusions: 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.
This work was partially supported by the grant for the 21st Century COE Program (on Innovative Brain Science for Development, Learning and Memory) and the grant for the Knowledge Cluster Initiative (High-Tech Sensing and Knowledge Handling Technology [Brain Technology]).
Disclosure: The authors report no conflicts of interest.
Received August 1, 2005. Accepted in final form March 13, 2006.
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