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Review
. 2014 Apr 9;6(2):18.
doi: 10.1186/alzrt248. eCollection 2014.

Neuroimaging characteristics of dementia with Lewy bodies

Elijah Mak  1 , Li Su  1 , Guy B Williams  2 , John T O'Brien  1
Affiliations
Review

Neuroimaging characteristics of dementia with Lewy bodies

Elijah Mak et al. Alzheimers Res Ther. .

Abstract

This review summarises the findings and applications from neuroimaging studies in dementia with Lewy bodies (DLB), highlighting key differences between DLB and other subtypes of dementia. We also discuss the increasingly important role of imaging biomarkers in differential diagnosis and outline promising areas for future research in DLB. DLB shares common clinical, neuropsychological and pathological features with Parkinson's disease dementia and other dementia subtypes, such as Alzheimer's disease. Despite the development of consensus diagnostic criteria, the sensitivity for differential diagnosis of DLB in clinical practice remains low and many DLB patients will be misdiagnosed. The importance of developing accurate imaging markers in dementia is highlighted by the potential for treatments targeting specific molecular abnormalities as well as the responsiveness to cholinesterase inhibitors and marked neuroleptic sensitivity of DLB. We review various brain imaging techniques that have been applied to investigate DLB, including the characteristic nigrostriatal degeneration in DLB using positron emission tomography (PET) and single-photon emission computed tomography (SPECT) tracers. Dopamine transporter loss has proven to reliably differentiate DLB from other dementias and has been incorporated into the revised clinical diagnostic criteria for DLB. To date, this remains the 'gold standard' for diagnostic imaging of DLB. Regional cerebral blood flow, 18 F-fluorodeoxygluclose-PET and SPECT have also identified marked deficits in the occipital regions with relative sparing of the medial temporal lobe when compared to Alzheimer's disease. In addition, structural, diffusion, and functional magnetic resonance imaging techniques have shown alterations in structure, white matter integrity, and functional activity in DLB. We argue that the multimodal identification of DLB-specific biomarkers has the potential to improve ante-mortem diagnosis and contribute to our understanding of the pathological background of DLB and its progression.

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Figures

Figure 1
Figure 1
Comparison of FP-CIT scans between Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). In the DLB group, reduced uptake is evident in the caudate while more extensive loss is found in the putamen.
Figure 2
Figure 2
Preservation of medial temporal lobe in dementia with Lewy bodies compared to Alzheimer’s disease. (a) A 76-year-old female with Alzheimer’s disease (AD). (b) A 72-year-old male with AD. (c) A 75-year-old female with AD. (d) A 73 year old male with dementia with Lewy bodies.
See this image and copyright information in PMC

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