Abstract
Despite some differences in clinical presentation, it is often difficult to differentiate between dementia with Lewy bodies (DLB), clinical Alzheimer’s dementia (AD) and Parkinson’s disease dementia. However, differentiation can be crucial, especially as patients with DLB characteristically have a hypersensitivity to most antiemetic and neuroleptic drugs as they affect the cholinergic and dopaminergic system, potentially leading to life-threatening catatonia, loss of cognitive function and muscle rigidity. The aim of this study is to evaluate if resting state (RS) functional MRI (fMRI) can be used in routine practice on a 1.5 T scanner to differentiate between AD and DLB on an individual basis. We age- and gender-matched a known DLB patient with an AD patient and a human control (HC). Individual independent component analysis was carried out. Region of interest seeds were chosen from the midcingulate and insula regions. Functional connectivity from insula to midcingulate and within the midcingulate network (part of the Salience network) was lower in DLB than AD or HC. RS-fMRI on a 1.5 T scanner, in a routine clinical setting, detected abnormal functional connectivity patterns and allowed differentiation of DLB and AD in a routine clinical setting. This is the first evaluation of RS-fMRI in a routine clinical setting. It shows that incorporating RS-fMRI into the clinical scanning protocol can assist in early diagnosis and likely assist in monitoring the natural history of the disease or disease modifying treatments.
Highlights
Despite some differences in the clinical presentation, it is often difficult to differentiate between dementia with Lewy bodies (DLB) and clinical Alzheimer’s dementia (AD) or Parkinson’s disease dementia.[1,2]A prominent example is that of the actor Robin Williams
With his first symptoms occurring in October 2013, he eventually suffered from paranoia, delusions, severe insomnia, memory loss, and high cortisol levels indicating stress, before he committed suicide in August 2014.3 Originally diagnosed with Parkinson’s disease, his autopsy revealed that he had been suffering from DLB, explaining the underlying cause for his Parkinsonism, depression and memory loss
The DLB patient had the highest scores on clinical dementia rating (CDR) global (1) and sum of boxes (5) assessment, showing a mild severity stage of dementia
Summary
A prominent example is that of the actor Robin Williams With his first symptoms occurring in October 2013 (sudden spikes in anxiety, constipation, urinary difficulty, heartburn, insomnia, a poor sense of smell, stress, and a slight tremor in his left hand), he eventually suffered from paranoia, delusions, severe insomnia, memory loss, and high cortisol levels indicating stress, before he committed suicide in August 2014.3 Originally diagnosed with Parkinson’s disease, his autopsy revealed that he had been suffering from DLB, explaining the underlying cause for his Parkinsonism, depression and memory loss. Differentiation is important as patients with DLB characteristically have a hypersensitivity to most antiemetic and neuroleptic drugs. These affect the cholinergic and dopaminergic system, potentially leading to life-threatening catatonia, loss of cognitive function and muscle rigidity. Some antidepressants and over-the-counter drug cold remedies may cause acute confusion, delusions, and hallucinations.[2]
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