Differential diagnosis of MCI with Lewy bodies and MCI due to Alzheimer's disease by visual assessment of occipital hypoperfusion on SPECT images.

PURPOSE: Predicting progression of mild cognitive impairment (MCI) to Alzheimer's disease (AD) or dementia with Lewy bodies (DLB) is important. We evaluated morphological and functional differences between MCI with Lewy bodies (MCI-LB) and MCI due to AD (MCI-AD), and a method for differentiating between these conditions using brain MRI and brain perfusion SPECT. METHODS: A continuous series of 101 subjects, who had visited our memory clinic and met the definition of MCI, were enrolled retrospectively. They were consisted of 60 MCI-LB and 41 MCI-AD subjects. Relative cerebral blood flow (rCBF) on SPECT images and relative brain atrophy on MRI images were evaluated. We performed voxel-based analysis and visually inspected brain perfusion SPECT images for regional brain atrophy, occipital hypoperfusion and the cingulate island sign (CIS), for differential diagnosis of MCI-LB and MCI-AD. RESULTS: MRI showed no significant differences in regional atrophy between the MCI-LB and MCI-AD groups. In MCI-LB subjects, occipital rCBF was significantly decreased compared with MCI-AD subjects (p < 0.01, family wise error [FWE]-corrected). Visual inspection of occipital hypoperfusion had sensitivity, specificity, and accuracy values of 100%, 73.2% and 89.1%, respectively, for differentiating MCI-LB and MCI-AD. Occipital hypoperfusion was offered higher diagnostic utility than the CIS. CONCLUSIONS: The occipital lobe was the region with significantly decreased rCBF in MCI-LB compared with MCI-AD subjects. Occipital hypoperfusion on brain perfusion SPECT may be a more useful imaging biomarker than the CIS for visually differentiating MCI-LB and MCI-AD.

Correlation between noise pareidolia test scores for visual hallucinations and regional cerebral blood flow in dementia with Lewy bodies.

OBJECTIVE: This study aimed at investigating the correlation between recurrent visual hallucinations (VHs) and regional cerebral blood flow (rCBF) in patients with dementia with Lewy bodies (DLB). METHODS: In 147 DLB patients, the correlation between noise pareidolia scores and rCBF in brain perfusion single photon emission computed tomography (SPECT) was evaluated. The 147 subjects comprised 52 probable and 95 possible DLB patients, of whom 107 did not have visual hallucinations and 40 had visual hallucinations. Brain perfusion SPECT was then performed, and memory impairment was assessed using the Mini-Mental State Examination (MMSE), while the optical illusion "pareidolia" (the tendency to see a specific image in a random visual pattern) was evaluated using noise pareidolia test. The correlations between rCBF and MMSE or noise pareidolia scores were then analyzed. RESULTS: The rCBF and MMSE scores were positively correlated, and rCBF was correlated with MMSE scores in a region that was consistent with a previously reported memory-related site. There was no correlation between noise pareidolia scores and occipital CBF, but there were weak correlations between noise pareidolia scores and rCBF in the bilateral frontal lobes (Brodmann area [BA]8 and BA9), left cingulate cortex (BA31), and left angular and supramarginal gyri (BA39 and BA40) in DLB patients. CONCLUSION: Weak correlation was found between noise pareidolia scores and rCBF in several sites (BA8, BA9, BA31, BA39 and BA40) other than in occipital lobe. These findings suggest that DLB hallucinations may be manifested by more complex brain network disorders, rather than by primary visual cortex disorders alone.

Choto-san versus placebo for patients with dementia: systematic review and meta-analysis.

BACKGROUND: Choto-san is a traditional medicine used for hypertension and headaches in Japan and China. Some studies have shown its effectiveness in the treatment of dementia. The present review aimed to assess the effectiveness and acceptability of Choto-san in the treatment of adults with cognitive impairment. METHODS: We included randomized controlled trials comparing Choto-san with placebo for patients with dementia or mild cognitive impairment. RESULTS: Three randomized controlled trials evaluating 219 participants were included. Two were studies on vascular dementia, and the other was on Alzheimer's dementia. There was no difference between Choto-san and placebo in terms of short-term dichotomous judgement of improvement, but Choto-san was more effective than placebo in terms of short-term improvement of cognitive function as measured by continuous outcomes. Also, dropouts judged it to be acceptable. However, the results were imprecise and/or heterogeneous. The number of participants included in the analysis was small (n = 199 in the primary analysis) and sometimes inconsistent, as indicated by the large I 2 (72% in the primary analysis). CONCLUSION: Low-quality evidence was suggestive of Choto-san's efficacy for vascular dementia, but the present results may be overestimated. Studies with a larger sample size and conducted over longer periods should be performed. Regardless, Choto-san can be one of the choices for the treatment of vascular dementia as it is well tolerated.

Slow Progression of Cognitive Dysfunction of Alzheimer's Disease in Sexagenarian Women with Schizophrenia.

Although both schizophrenia (SCZ) and Alzheimer's disease (AD) are among the most common psychiatric diseases, the interaction of these two is not well-understood. We investigated three women with SCZ who developed AD in their 60s. The patients presented with cognitive dysfunction such as loss of recent memory, which was confirmed by both clinical observations and neuropsychological tests. Their magnetic resonance and functional imaging findings were consistent with AD. Their brain atrophy advanced significantly during a 6-year observation period. However, their global cognitive function did not deteriorate significantly during this period. Although the cognitive reserve model might account for this discrepancy, our results suggest some interactions between the neuropathology of SCZ and AD and warrant further research.

Myocardial scintigraphy may predict the conversion to probable dementia with Lewy bodies.

OBJECTIVE: To compare the usefulness of brain perfusion SPECT and (123)I-metaiodobenzylguanidine ((123)I-MIBG) in predicting the conversion of possible dementia with Lewy bodies (DLB) to probable DLB. METHODS: We examined 94 patients with possible DLB based on the Consensus Criteria for the Clinical Diagnosis of DLB by N-Isopropyl-p-(123)I-iodoamphetamine ((123)I-IMP) brain perfusion SPECT and (123)I-MIBG myocardial scintigraphy. After 1 year of follow-up, 33 of 94 patients met the criteria for probable DLB. (123)I-IMP brain perfusion SPECT and (123)I-MIBG myocardial scintigraphy were tested as predictors of the conversion from possible DLB to probable DLB. A receiver operating characteristic (ROC) analysis was performed. RESULTS: The areas under the ROC curves for SPECT for predicting the conversion to probable DLB from possible DLB based on the occipital/cerebellum and occipital/striatum cortex ratios of blood flow counts were 0.591 and 0.585, respectively. The areas under the ROC curves for (123)I-MIBG based on the early heart to mediastinum (H/M) ratio, delayed H/M ratio, and washout rate were 0.935, 0.936, and 0.884, respectively. CONCLUSION: (123)I-MIBG myocardial scintigraphy is a good predictor of the future conversion of possible DLB to probable DLB.

Automatic volumetry of the cerebrospinal fluid space in idiopathic normal pressure hydrocephalus.

OBJECTIVES: To measure the cerebrospinal fluid (CSF) space volume in idiopathic normal pressure hydrocephalus (INPH), we developed a software that allows us to automatically measure the regional CSF space and compared the volumes of the ventricle systems (VS), Sylvian fissures (SF) and sulci at high convexity and midline (SHM) among INPH patients, Alzheimer's disease (AD) patients and healthy volunteers (HVs). METHODS: Fifteen INPH patients, 15 AD patients and 15 HVs were retrospectively selected for this study. 3D-T1 MR images were obtained. We improved upon an automatic gray matter volume system to measure CSF spaces, adopting new regions for the template of INPH-characteristic CSF spaces and measured them. The VS, SF and SHM volumes were calculated relative to the intracranial volume. RESULTS: The relative SHM volume of the INPH group (0.0237 ± 0.0064) was the smallest among the 3 groups (AD: 0.0477 ± 0.0109, HV: 0.0542 ± 0.0045). The VS (0.0499 ± 0.0135) and SF (0.0187 ± 0.0037) volumes of the INPH group were significantly larger than those of the AD (VS: 0.0311 ± 0.0075, SF: 0.0146 ± 0.0026) and HV groups (VS: 0.0167 ± 0.0065, SF: 0.0111 ± 0.017). CONCLUSION: Automatic volume measurement can be used to delineate the characteristic changes in CSF space in patients with INPH and is useful in the diagnosis of INPH.

Neuropsychological profile of dementia with Lewy bodies.

Dementia with Lewy bodies (DLB) accounts for 10-25% of all dementia cases in clinical populations and is considered to be the second most common degenerative dementia in elderly people after Alzheimer's disease (AD). Dementia with Lewy bodies is characterized by the presence of cognitive, psychiatric, and motor symptoms. Although the neuropsychological profiles of patients with DLB often differ from those of patients with AD, the diagnostic sensitivity, specificity, and predictive values of these profiles remain largely unknown. The present paper reviews the neuropsychological profiling of DLB and attempts the neuropsychological differentiation of DLB from AD.

The neuropsychological profile in dementia with Lewy bodies and Alzheimer's disease.

OBJECTIVE: To demonstrate the exact nature of the cognitive profile of dementia with Lewy bodies (DLB) on standardized neuropsychological tests including the Wechsler Adult Intelligence Scale--Revised (WAIS-R) and the Wechsler Memory Scale--Revised (WMS-R). DESIGN: We examined the WAIS-R and the WMS-R of 26 patients with probable DLB (based on the Consensus Criteria for the clinical diagnosis of DLB) and of 78 patients with probable Alzheimer's disease (AD) (based on criteria of the National Institute for Neurological and Communicative Disorders and Stroke-Alzheimer's disease and Related Disorders Association) who were matched to the patients with DLB 3:1 by Mini-Mental State Examination score. RESULTS: The DLB group scored significantly lower on the Block Design, Object Assembly and Digit Symbol of WAIS-R and significantly higher on the Logical Memory I, Verbal Paired Associates I, Logical Memory II, Visual Paired Associates II, Verbal Paired Associates II and Visual Reproduction II of WMS-R (p < 0.0016 to p < 0.0001). In a comparison between the DLB group and the AD group, a logistic regression analysis revealed that the weighted sum score of the Object Assembly and the Logical Memory II may differentiate DLB from AD with a sensitivity of 0.81 [95% Confidence Intervals (CI) = 0.66-0.96] and a specificity of 0.76 (95% CI = 0.66-0.85). CONCLUSIONS: The WAIS-R and the WMS-R can help to differentiate DLB from AD.

Hemispatial visual defect in Alzheimer's disease.

We describe a 56-year-old woman with Alzheimer's disease with left hemispatial neglect and left homonymous hemianopsia with macular sparing considered a manifestation of Alzheimer's disease resulting from severe degenerative change in the right primary visual cortex. Hemispatial neglect normally results from brain damage to the right cerebral hemisphere. Homonymous hemianopsia is commonly the result of localized brain disease, especially cerebral infarction or hemorrhage. To our knowledge, a patient with Alzheimer's disease showing hemispatial neglect and homonymous hemianopsia with macular sparing has not previously been reported.