Motor Dysfunction Questionnaire and Dopamine Transporter Imaging Composite Scale Improve Differentiating Dementia With Lewy Bodies From Alzheimer's Disease With Motor Dysfunction.

Pai-Yi Chiu,Shey-Lin Wu,Cheng-Yu Wei,Guang-Uei Hung

doi:10.3389/fnagi.2021.709215

Abstract

Objective: Characteristic parkinsonism is the major comorbidity of dementia with Lewy bodies (DLB). We aimed to differentiate DLB from Alzheimer's disease (AD) with motor dysfunction using a composite scale with a characteristic motor dysfunction questionnaire (MDQ) and dopamine transporter (DAT) imaging. It could help detect DLB easily in healthcare settings without movement disorder specialists.Methods: This is a two-phase study. In the design phase, seven questions were selected and composed of a novel MDQ. In the test phase, all participants with DLB, AD, or non-dementia (ND) control completed dementia and parkinsonism survey, the novel designed questionnaire, DAT imaging, and composite scales of MDQ and DAT. The cutoff scores of the MDQ, semiquantitative analysis of the striatal–background ratio (SBR) and visual rating of DAT, and the composite scale of MDQ and DAT for discriminating DLB from AD or ND were derived and compared.Results: A total of 277 participants were included in this study (126 with DLB, 86 with AD, and 65 with ND). Compared with the AD or ND groups, the DLB group showed a significantly higher frequency in all seven items in the MDQ and a significantly lower SBR. For discrimination of DLB from non-DLB with MDQ, SBR, and composite scale, the cutoff scores of 3/2, 1.37/1.38, and 6/5 were suggested for the diagnosis of DLB with the sensitivities/specificities of 0.91/0.72, 0.91/0.80, and 0.87/0.93, respectively. The composite scale significantly improved the accuracy of discrimination compared with either the MDQ or SBR.Conclusion: This study showed that the novel designed simple questionnaire was a practical screening tool and had similar power to DAT scanning to detect DLB. The questionnaire can be applied in clinical practice and population studies for screening DLB. In addition, the composite scale of MDQ and DAT imaging further improved the diagnostic accuracy, indicating the superiority of the dual-model diagnostic tool.

Highlights

Dopamine transporter (DAT) imaging is an indicative biomarker for diagnosing dementia with Lewy bodies (DLB)
To narrow down the differences, this study aims to compare the different presentations of parkinsonism to those with Alzheimer’s disease (AD) as observed by the caregivers of patients with DLB, and to design a simple motor dysfunction questionnaire (MDQ)
Along with other common motor symptoms observed in patients with brain disorders, the original 13 questions were compared between the Parkinson’s disease (PD)/DLB and AD groups

Summary

Introduction

Dopamine transporter (DAT) imaging is an indicative biomarker for diagnosing dementia with Lewy bodies (DLB). A recent systematic analysis showed that the sensitivity and specificity for the differentiation of DLB from other brain disorders were 0.86 and 0.81 and 0.93 and 0.75 for visual and semiquantitative assessments of DAT-Single Photon Emission Computed Tomography (DAT-SPECT), respectively (Nihashi et al, 2020). There is still a lack of tracers that target αsynuclein, and DAT has become the most important biomarker for the diagnosis of DLB. Clinical diagnosis of DLB is mainly based on consensus criteria, and the core clinical features help detect and differentiate DLB from other dementia syndromes. For the clinical detection of DLB, Galvin (2015) provided a simple risk score composed of 10 questions associated with core/supportive clinical features

Methods

Results

Discussion

Conclusion