Institute for Ageing and Health, Newcastle University, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
Int J Geriatr Psychiatry. 2012 May;27(5):443-53. doi: 10.1002/gps.2749. Epub 2011 Jul 1.
Dementia with Lewy bodies (DLB) shares common clinical, neuropsychological and pathological features with other dementia subtypes, such as Alzheimer's disease (AD), making it difficult to differentiate in clinical practice. Despite the development of consensus diagnostic criteria, many cases are missed, and biomarkers to assist with diagnosis would represent important advances. Our aim was to review the literature to identify potential biomarkers that may distinguish DLB from other dementia subtypes, especially AD.
The literature search was performed using Medline up to October 2010 for imaging studies [single-photon emission computed tomography (SPECT), positron emission tomography (PET), magnetic resonance imaging (MRI) and amyloid imaging] and cerebrospinal fluid (CSF) markers in DLB. Individual articles were examined for additional references. The abstracts of the identified articles were read to determine the most relevant papers, which became the basis for this review.
The most robust evidence available was for striatal dopamine transporter activity visualised by (123) I-labelled N-(3-fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl)nortropane ((123) I-FP-CIT) SPECT. Several other imaging techniques have also reported promising results, such as [(18) F]fluorodopa PET, which assesses nigrostriatal integrity; [(18) F]fluorodeoxyglucose PET, which assesses metabolic deficits; and meta-iodobenzylguanidine imaging, which assesses sympathetic cardiac denervation. Data from studies using CSF measures of amyloid and tau, occipital hypoperfusion on SPECT and preservation of medial temporal lobe structures on MRI suggest that they may offer less diagnostic discrimination.
Several potential biomarkers have shown good diagnostic accuracy for DLB, but apart from FP-CIT SPECT, there is now a need for larger clinical multi-site studies, as well as for studies with pathological verification of diagnosis, before their use could be recommended for routine clinical practice.
路易体痴呆（DLB）与其他痴呆亚型（如阿尔茨海默病，AD）具有共同的临床、神经心理学和病理学特征，这使得在临床实践中难以区分。尽管已经制定了共识诊断标准，但仍有许多病例被漏诊，而有助于诊断的生物标志物将是重要的进展。我们的目的是综述文献，以确定可能将 DLB 与其他痴呆亚型（特别是 AD）区分开来的潜在生物标志物。
我们使用 Medline 数据库检索了截至 2010 年 10 月的影像学研究（单光子发射计算机断层扫描[SPECT]、正电子发射断层扫描[PET]、磁共振成像[MRI]和淀粉样蛋白成像）和脑脊液（CSF）标志物在 DLB 中的应用。查阅了个别文章以获取更多参考文献。阅读所确定文章的摘要，以确定最相关的论文，这些论文成为本综述的基础。
目前最可靠的证据是通过（123）I-标记 N-（3-氟丙基）-2β-羰基-3β-（4-碘苯基）-nortropane（（123）I-FP-CIT）SPECT 对纹状体多巴胺转运体活性进行可视化。其他几种成像技术也报告了有希望的结果，例如评估黑质纹状体完整性的（18）F-氟多巴 PET；评估代谢缺陷的（18）F-氟脱氧葡萄糖 PET；以及评估交感神经心脏去神经支配的 meta-碘苄基胍成像。使用 CSF 中淀粉样蛋白和 tau 标志物、SPECT 中的枕叶灌注不足以及 MRI 中内侧颞叶结构的保留进行研究的数据表明，它们可能提供的诊断区分度较低。
有几种潜在的生物标志物已显示出对 DLB 的良好诊断准确性，但除了 FP-CIT SPECT 之外，现在还需要更大规模的临床多中心研究，以及具有病理诊断验证的研究，然后才能推荐将其用于常规临床实践。
