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Neuroimaging for Lewy body disease (PD, PDD, DLB)
This is a review article on neuroimaging techniques for diagnosing Parkinson's Disease (PD), Parkinson's disease with dementia (PDD) and Dementia with Lewy Bodies (DLB). This is a very dense article with lots of citations. I've copied the abstract below.
The authors say: "Nevertheless, whilst PDD and DLB are therefore not necessarily the same disorder, the current consensus is that they may represent different points on the same and potentially continuous spectrum of Lewy body disease (LBD)." Note that this article uses the acronym LBD to refer to Lewy body disease, which is PD, PDD, and DLB.
When I first started the local Lewy Body Dementia support group, quite a lot was being written about myocardial scintigraphy with 123I-MIBG being used as a diagnostic tool for differentiating DLB from AD. I haven't heard much about this in a couple of years. This review article notes those earlier studies of myocardial scintigraphy, and points out that non-neurological diseases common in the elderly may prevent good data from this cardiac test.
This article concludes with the idea that we now have a way to image amyloid plaque pathology in Alzheimer's disease and wonders if this strategy can be applied to imaging alpha-synuclein pathology (or Lewy body pathology) in PD, PDD, and DLB.
Here's the abstract:
Brain Research Reviews. 2010 Jun 2. [Epub ahead of print]
Neuroimaging for Lewy body disease: Is the in vivo molecular imaging of alpha-synuclein neuropathology required and feasible?
Vernon AC, Ballard C, Modo M.
Kings College London, Institute of Psychiatry, Department of Neuroscience, Denmark Hill campus, London UK.
Alpha-synuclein aggregation is a neuropathological hallmark of many neurodegenerative diseases including Parkinson's Disease (PD), Parkinson's disease with dementia (PDD) and Dementia with Lewy Bodies (DLB), collectively termed the alpha-synucleinopathies.
Substantial advances in clinical criteria and neuroimaging technology over the last 20 years have allowed great strides in the detection and differential diagnosis of these disorders. Nevertheless, it is clear that whilst the array of different imaging modalities in clinical use allow for a robust diagnosis of alpha-synucleinopathy in comparison to healthy subjects, there is no clear diagnostic imaging marker that affords a reliable differential diagnosis between the different forms of Lewy body disease (LBD) or that could facilitate tracking of disease progression.
This has led to a call for a biomarker based on the pathological hallmarks of these diseases, namely alpha-synuclein-positive Lewy bodies (LBs). This potentially may be advantageous in terms of early disease detection, but may also be leveraged into a potential marker of disease progression.
We here aim to firstly review the current status of neuroimaging biomarkers in PD and related synucleinopathies. Secondly, we outline the rationale behind alpha-synuclein imaging as a potential novel biomarker as well as the potential benefits and limitations of this approach. Thirdly, we attempt to illustrate the likely technical hurdles to be overcome to permit successful in vivo imaging of alpha-synuclein pathology in the diseased brain. Our overriding aim is to provide a framework for discussion of how to address this major unmet clinical need.
Copyright Â© 2010. Published by Elsevier B.V.
PubMed ID#: 20685363 (see pubmed.gov for this abstract only)