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Clinical Trial
. 2016 Sep 6;87(10):1045-51.
doi: 10.1212/WNL.0000000000003076. Epub 2016 Aug 10.

Evolution of clinical features in possible DLB depending on FP-CIT SPECT result

Zuzana Walker  1 , Emilio Moreno  2 , Alan Thomas  2 , Fraser Inglis  2 , Naji Tabet  2 , Tim Stevens  2 , Tim Whitfield  2 , Dag Aarsland  2 , Michael Rainer  2 , Alessandro Padovani  2 ; DaTSCAN DLB Phase 4 Study Group
Collaborators, Affiliations
Clinical Trial

Evolution of clinical features in possible DLB depending on FP-CIT SPECT result

Zuzana Walker et al. Neurology. .

Abstract

Objective: To test the hypothesis that core and suggestive features in possible dementia with Lewy bodies (DLB) would vary in their ability to predict an abnormal dopamine transporter scan and therefore a follow-up diagnosis of probable DLB. A further objective was to assess the evolution of core and suggestive features in patients with possible DLB over time depending on the (123)I-FP-CIT SPECT scan result.

Methods: A total of 187 patients with possible DLB (dementia plus one core or one suggestive feature) were randomized to have dopamine transporter imaging or to follow-up without scan. DLB features were compared at baseline and at 6-month follow-up according to imaging results and follow-up diagnosis.

Results: For the whole cohort, the baseline frequency of parkinsonism was 30%, fluctuations 29%, visual hallucinations 24%, and REM sleep behavior disorder 17%. Clinician-rated presence of parkinsonism at baseline was significantly (p = 0.001) more frequent and Unified Parkinson's Disease Rating Scale (UPDRS) score at baseline was significantly higher (p = 0.02) in patients with abnormal imaging. There was a significant increase in UPDRS score in the abnormal scan group over time (p < 0.01). There was relatively little evolution of the rest of the DLB features regardless of the imaging result.

Conclusions: In patients with possible DLB, apart from UPDRS score, there was no difference in the evolution of DLB clinical features over 6 months between cases with normal and abnormal imaging. Only parkinsonism and dopamine transporter imaging helped to differentiate DLB from non-DLB dementia.

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Figures

Figure 1
Figure 1. Percentage of abnormal and normal scans for each characteristic feature of dementia with Lewy bodies at baseline
RBD = REM sleep behavior disorder. Total number of patients with imaging = 111.
Figure 2
Figure 2. Baseline imaging results according to supportive dementia with Lewy bodies feature
MTL = medial temporal lobe.
Figure 3
Figure 3. Evolution of dementia with Lewy bodies features by imaging results
B = baseline; RBD = REM sleep behavior disorder; W8 = week 8; W24 = week 24. The p value is from Cochran-Armitage test.
See this image and copyright information in PMC

References

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    1. Walker Z, Moreno E, Thomas A, et al. . Clinical usefulness of dopamine transporter SPECT imaging with I-123-FP-CIT in patients with possible dementia with Lewy bodies: randomised study. Br J Psychiatry 2015;206:145–152. - PubMed
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