This Norwegian review article was recently published. The authors performed a literature search, looking for biomarkers to help differentiate DLB from AD. The results included: "The best evidence was for scintigraphy of the striatal dopamine transporter system using FP-CIT SPECT. Several small scintigraphy studies of cardiovascular autonomic function using metaiodobenzylguanidine SPECT have reported promising results." (Note that metaiodobenzylguanidine = MIBG. We've seen plenty of reports on scinitgraphy showing decreased cardiac uptake of MIBG in patients with a DLB clinical diagnosis.)

The full abstract follows.

Robin



Dementia and Geriatric Cognitive Disorders. 2008 Jan 17;25(3):195-205 [Epub ahead of print]

Early Discriminatory Diagnosis of Dementia with Lewy Bodies. The Emerging Role of CSF and Imaging Biomarkers.

Aarsland D, Kurz M, Beyer M, Bronnick K, Piepenstock Nore S, Ballard C.
Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.

Background: The clinical diagnostic criteria for dementia with Lewy bodies (DLB) have a low sensitivity, and there are no generally accepted biomarkers to distinguish DLB from other dementias. Our aim was to identify biomarkers that may differentiate DLB from Alzheimer's disease (AD).

Method: We performed a systematic literature search for studies of EEG, imaging techniques and genetic and CSF markers that provide sensitivity and specificity in the identification of DLB.

Results: The best evidence was for scintigraphy of the striatal dopamine transporter system using FP-CIT SPECT. Several small scintigraphy studies of cardiovascular autonomic function using metaiodobenzylguanidine SPECT have reported promising results. Studies exploring innovative techniques based on CSF have reported interesting findings for the combination of amyloid beta (abeta) isoforms as well as alpha-synuclein, and there are interesting results emerging from preliminary studies applying proteomic techniques. Data from studies using structural MRI, perfusion SPECT, genetics and EEG studies show differences between DLB and AD but only at a group level.

Conclusion: Several potential biomarkers for the differential diagnosis of probable DLB and AD have shown good diagnostic accuracy in the research setting. Data from large multicentre studies and from studies with autopsy confirmation exist for scintigraphy of the dopamine transporter system. Future studies should explore its value in possible DLB and for clinical management and health economics.

PubMed ID#: 18204253 (see pubmed.gov for the abstract only)