Alzheimer's disease versus dementia with Lewy bodies: Cerebral metabolic distinction with autopsy confirmation

Authors

  • Satoshi Minoshima MD, PhD,

    Corresponding author
    1. Department of Internal Medicine, University of Michigan Medical School, Geriatrics Research, Education Clinical Center, Ann Arbor, MI
    • Department of Radiology, University of Washington, Health Sciences Building NW040J, 1959 North East Pacific Street, Box 356004, Seattle, WA 98195-6004
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  • Norman L. Foster MD,

    1. Department of Neurology, University of Michigan Medical School, Geriatrics Research, Education Clinical Center, Ann Arbor, MI
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  • Anders A. F. Sima MD, PhD,

    1. Department of Internal Medicine, University of Michigan Medical School, Geriatrics Research, Education Clinical Center, Ann Arbor, MI
    2. Departments of Pathology and Neurology, Wayne State University School of Medicine, Detroit, MI
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  • Kirk A. Frey MD, PhD,

    1. Department of Internal Medicine, University of Michigan Medical School, Geriatrics Research, Education Clinical Center, Ann Arbor, MI
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  • Roger L. Albin MD,

    1. Department of Neurology, University of Michigan Medical School, Geriatrics Research, Education Clinical Center, Ann Arbor, MI
    2. VAMC, Ann Arbor, MI
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  • David E. Kuhl MD

    1. Department of Internal Medicine, University of Michigan Medical School, Geriatrics Research, Education Clinical Center, Ann Arbor, MI
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Abstract

Seeking antemortem markers to distinguish Dementia with Lewy bodies (DLB) and Alzheimer's disease (AD), we examined brain glucose metabolism of DLB and AD. Eleven DLB patients (7 Lewy body variant of AD [LBVAD] and 4 pure diffuse Lewy body disease [DLBD]) who had antemortem position emission tomography imaging and autopsy confirmation were compared to 10 autopsy-confirmed pure AD patients. In addition, 53 patients with clinically-diagnosed probable AD, 13 of whom later fulfilled clinical diagnoses of DLB, were examined. Autopsy-confirmed AD and DLB patients showed significant metabolic reductions involving parietotemporal association, posterior cingulate, and frontal association cortices. Only DLB patients showed significant metabolic reductions in the occipital cortex, particularly in the primary visual cortex (LBVAD −23% and DLBD −29% vs AD −8%), which distinguished DLB versus AD with 90% sensitivity and 80% specificity. Multivariate analysis revealed that occipital metabolic changes in DLB were independent from those in the adjacent parietotemporal cortices. Analysis of clinically-diagnosed probable AD patients showed a significantly higher frequency of primary visual metabolic reduction among patients who fulfilled later clinical criteria for DLB. In these patients, occipital hypometabolism preceded some clinical features of DLB. Occipital hypometabolism is a potential antemortem marker to distinguish DLB versus AD.

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