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P1‐078: Alzheimer's Disease (AD) and Lewy Bodies Dementia (LBD) differential diagnosis: A 123 Ioflupane SPECT study
Author(s) -
Nuvoli Susanna,
Nieddu Antonio,
Rotondo Anthony,
Salvo Renata,
Chessa Francesca,
Spanu Angela,
Madeddu Giuseppe
Publication year - 2009
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2009.04.082
Subject(s) - putamen , caudate nucleus , dementia , dementia with lewy bodies , nuclear medicine , differential diagnosis , medicine , spect imaging , cognitive impairment , psychology , disease , pathology
Background: Amyloid imaging have been utilized to detect the amyloid deposition in the brain. It has been reported that Alzheimer’s disease (AD) and some of MCI patients show deposition by the CPiB-PET. We have reported that there were some PiB negative dementia patients who were clinically diagnosed as AD. In this study, we evaluated the characteristics of these PiB negative patients. Methods: We examined PiB-PET study for 44 dementia patients who suffered cognitive decline or memory disturbance. They were clinically diagnosed as AD with neurological and neuropsycological evaluations, laboratory tests. PiB binding was calculated using the Logan graphical analysis method to yield regional distribution volume ratio (DVR) with cerebellum as reference. The PiB-negative 10 patients (3 males and 7 females, 75.1 6 2.4 years old) were compared with 34 PiB-positive patients (13 males and 21 females, 73.3 6 7.4 years old). Cerebrospinal fluid (CSF) Ab40, 42, tau, p-tau levels were measured. MRI images were obtained in all patients to compare their brain morphology. Results: All patients were finally confirmed as AD with their neuropsycological features and met NINCDS-ADRDA criteria. There were no PiB negative patients who have ApoE 4 genotype. The CSF P-tau and tau levels were significantly decreased, and the CSF Ab1-42 levels was increased in PiB negative patients. We divided the PiB negative patients into four groups with the results of the CSF biomarkers, FDG-PET and brain MRI. Group 1 contained 4 patients who showed the unilateral atrophy of the medial temporal lobe. In group 2 patients, we found the atrophy and hypo glucose metabolisms in their frontal lobe. Group 3 includes only 1 patient who showed the increase of CSF p-tau level as AD patients. We have 2 patients in group 4, and they showed no apparent features by the brain MRI and FDG-PET images. Conclusions: These results suggest that clinically diagnosed AD patients may include the non-AD type dementia (PiB negative dementia). Because neuropsychological features of these patients were consistent with AD patients, it is useful to separate these patients into different types of dementia utilizing PiB-PET, FDG-PET, brain MRI and CSF biomarkers for effective treatment.