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Imaging in prodromal dementia with Lewy bodies: Where do we stand?

Lookup NU author(s): Dr Rory Durcan, Dr Paul Donaghy, Dr Curtis Osborne, Professor John-Paul TaylorORCiD, Professor Alan ThomasORCiD


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© 2019 John Wiley & Sons, Ltd. Objectives: The aim of this review was to provide an overview of the literature on imaging in prodromal dementia with Lewy bodies (DLB). Design: Systematic PubMed search and literature review. Results: Diagnostic classification of the prodromal DLB stage remains to be established but is likely to require imaging biomarkers to improve diagnostic accuracy. In subjects with mild cognitive impairment with Lewy body disease (MCI-LB) (here synonymous with prodromal DLB) and REM sleep behaviour disorder, a high risk condition for future conversion to a synucleinopathy, imaging modalities have assessed early structural brain changes, striatal dopaminergic integrity, metabolic brain, and cerebral perfusion alterations. It remains uncertain whether structural brain imaging can differentiate MCI-LB from mild cognitive impairment with Alzheimer disease (MCI-AD), but early right anterior insula thinning has been reported to occur in MCI-LB compared with MCI-AD. Dopaminergic deficits have been observed in a substantial proportion of MCI-LB subjects and have a high specificity for Lewy body disease at the pre-dementia stage. Cardiac sympathetic denervation, occipital hypometabolism, or hypoperfusion is less studied as this pre-dementia stage and it remains to be determined whether any imaging abnormalities antedate DLB. Conclusion: Imaging studies in prodromal DLB are still in their infancy but offer great potential to study early in vivo structural and functional biological alterations. Future work should focus on longitudinal multimodal imaging studies with postmortem validation of diagnosis in order to develop and then validate criteria for prodromal DLB.

Publication metadata

Author(s): Durcan R, Donaghy P, Osborne C, Taylor J-P, Thomas AJ

Publication type: Review

Publication status: Published

Journal: International Journal of Geriatric Psychiatry

Year: 2019

Volume: 34

Issue: 5

Pages: 635-646

Print publication date: 01/05/2019

Online publication date: 03/02/2019

Acceptance date: 28/01/2019

ISSN (print): 0885-6230

ISSN (electronic): 1099-1166

Publisher: John Wiley and Sons Ltd


DOI: 10.1002/gps.5071