Walker Z, Costa D C, Walker R W H, Shaw K, Gacinovic S, Stevens T, Livingston G, Ince P, McKeith I G, Katona C L E
University College London, UK.
J Neurol Neurosurg Psychiatry. 2002 Aug;73(2):134-40. doi: 10.1136/jnnp.73.2.134.
Dementia with Lewy bodies (DLB) is one of the main differential diagnoses of Alzheimer's disease (AD). Key pathological features of patients with DLB are not only the presence of cerebral cortical neuronal loss, with Lewy bodies in surviving neurones, but also loss of nigrostriatal dopaminergic neurones, similar to that of Parkinson's disease (PD). In DLB there is 40-70% loss of striatal dopamine.
To determine if detection of this dopaminergic degeneration can help to distinguish DLB from AD during life.
The integrity of the nigrostriatal metabolism in 27 patients with DLB, 17 with AD, 19 drug naive patients with PD, and 16 controls was assessed using a dopaminergic presynaptic ligand, (123)I-labelled 2beta-carbomethoxy-3beta-(4-iodophenyl)-N-(3-fluoropropyl)nortropane (FP-CIT), and single photon emission tomography (SPET). A SPET scan was carried out with a single slice, brain dedicated tomograph (SME 810) 3.5 hours after intravenous injection of 185 MBq FP-CIT. With occipital cortex used as a radioactivity uptake reference, ratios for the caudate nucleus and the anterior and posterior putamen of both hemispheres were calculated. All scans were also rated by a simple visual method.
Both DLB and PD patients had significantly lower uptake of radioactivity than patients with AD (p<0.001) and controls (p<0.001) in the caudate nucleus and the anterior and posterior putamen.
FP-CIT SPET provides a means of distinguishing DLB from AD during life.
路易体痴呆（DLB）是阿尔茨海默病（AD）的主要鉴别诊断之一。DLB患者的关键病理特征不仅包括大脑皮质神经元丧失，存活神经元中出现路易小体，还包括黑质纹状体多巴胺能神经元丧失，这与帕金森病（PD）相似。在DLB中，纹状体多巴胺丧失40%-70%。
确定检测这种多巴胺能变性是否有助于在生前将DLB与AD区分开来。
使用多巴胺能突触前配体（123）I标记的2β-甲氧基羰基-3β-（4-碘苯基）-N-（3-氟丙基）去甲托烷（FP-CIT）和单光子发射断层扫描（SPET）评估27例DLB患者、17例AD患者、19例未用过药的PD患者和16例对照者黑质纹状体代谢的完整性。静脉注射185MBq FP-CIT 3.5小时后，使用单切片脑专用断层扫描仪（SME 810）进行SPET扫描。以枕叶皮质作为放射性摄取参考，计算双侧尾状核以及前、后壳核的比值。所有扫描还采用简单的视觉方法进行评分。
DLB和PD患者尾状核以及前、后壳核的放射性摄取均显著低于AD患者（p<0.001）和对照者（p<0.001）。
FP-CIT SPET提供了一种在生前将DLB与AD区分开来的方法。
