2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane and Hallucinations

To test the hypothesis that core and suggestive features in possible dementia with Lewy bodies (DLB) would vary in their ability to predict an abnormal dopamine transporter scan and therefore a follow-up diagnosis of probable DLB. A further objective was to assess the evolution of core and suggestive features in patients with possible DLB over time depending on the (123)I-FP-CIT SPECT scan result.. A total of 187 patients with possible DLB (dementia plus one core or one suggestive feature) were randomized to have dopamine transporter imaging or to follow-up without scan. DLB features were compared at baseline and at 6-month follow-up according to imaging results and follow-up diagnosis.. For the whole cohort, the baseline frequency of parkinsonism was 30%, fluctuations 29%, visual hallucinations 24%, and REM sleep behavior disorder 17%. Clinician-rated presence of parkinsonism at baseline was significantly (p = 0.001) more frequent and Unified Parkinson's Disease Rating Scale (UPDRS) score at baseline was significantly higher (p = 0.02) in patients with abnormal imaging. There was a significant increase in UPDRS score in the abnormal scan group over time (p < 0.01). There was relatively little evolution of the rest of the DLB features regardless of the imaging result.. In patients with possible DLB, apart from UPDRS score, there was no difference in the evolution of DLB clinical features over 6 months between cases with normal and abnormal imaging. Only parkinsonism and dopamine transporter imaging helped to differentiate DLB from non-DLB dementia.

Topics: Aged; Brain; Disease Progression; Europe; Female; Follow-Up Studies; Hallucinations; Humans; Lewy Body Disease; Male; Mental Status Schedule; Parkinsonian Disorders; Radiopharmaceuticals; REM Sleep Behavior Disorder; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon; Tropanes

The pathogenesis of visual hallucinations (VHs) in Parkinson's disease (PD) has been considered multifactorial. In the pathophysiology of VHs a combination of impaired visual processing and attention has been reported. Imaging studies evidenced a role of the primary visual system and visual association areas as well as a dysfunctional activation of frontal areas in the occurrence of VHs. Due to the functional connections between basal ganglia and frontal areas, a role of basal ganglia and of the fronto-striatal circuits in the pathogenesis of VHs may be postulated. Aim of this study is to unveil whether a presynaptic dopamine deficiency at baseline may predict the development of VHs.. A group of 18 non demented PD patients with VHs was matched with 18 non demented PD patients without VHs as regards age of onset of disease, disease duration and severity and levodopa equivalent dose. We retrospectively analyzed the (123)I-FP CIT SPECT performed on the two groups at the onset of their disease. The striatal uptake values in the two groups were examined, in order to evaluate nigrostriatal differences between the groups with different behavioral phenotype.. The group of patients with VHs had a significant reduction (p < 0.05) in right caudate uptake values at baseline when compared with patients without VHs. No significant differences were found between the groups regarding left caudate and putaminal uptake values.. The frontal impairment reported in PD patients with VHs may be due to a right caudate dysfunction, as it is connected to the frontal brain areas via neuronal loops.

Topics: Aged; Caudate Nucleus; Denervation; Dopamine; Dopaminergic Neurons; Female; Hallucinations; Humans; Iodine Radioisotopes; Levodopa; Male; Middle Aged; Parkinson Disease; Retrospective Studies; Tomography, Emission-Computed, Single-Photon; Tropanes

To explore the presenting and early symptoms of dementia with Lewy bodies (DLB).. Patients with mild dementia fulfilling diagnostic criteria for DLB (n = 61) and Alzheimer's disease (AD) (n = 109) were recruited from outpatient dementia clinics in western Norway. At diagnosis, caregivers were asked which symptom had been the presenting symptom of dementia.. Caregivers reported that memory impairment was the most common presenting symptom in DLB (57%), followed by visual hallucinations (44%), depression (34%), problem solving difficulties (33%), gait problems (28%), and tremor/stiffness (25%). In contrast, 99% of AD carers reported impaired memory as a presenting symptom, whereas visual hallucinations were a presenting symptom in 3% of the AD cases.. DLB should be suspected in predementia cases with visual hallucinations.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Caregivers; Cognition; Delirium; Depression; Diagnostic and Statistical Manual of Mental Disorders; Dopamine Plasma Membrane Transport Proteins; Educational Status; Female; Gait Disorders, Neurologic; Hallucinations; Humans; Lewy Body Disease; Male; Middle Aged; Neuropsychological Tests; Norway; Radiopharmaceuticals; Retrospective Studies; Surveys and Questionnaires; Tomography, Emission-Computed, Single-Photon; Tremor; Tropanes

Neuropsychiatric symptoms are frequent in dementia with Lewy bodies (DLB). Dopamine transporter (DAT) imaging with (123)I-labeled ligand N-delta-(fluoropropyl)-2 beta-carbomethoxy-3beta-(4-iodophenyl)tropene ((123)I-FP-CIT), which reliably measures midbrain dopaminergic dysfunction, has provided important evidence on the neurobiological substrate of some of these symptoms including apathy and depression. However, little is known on DAT levels and other distressing symptoms such as delusions and hallucinations. Therefore, (123)I-FP-CIT imaging was performed in 18 well-characterized patients with DLB, and striatal DAT levels were correlated with the frequency/severity ratings of several neuropsychiatric symptoms. A wide range of neuropsychiatric symptoms could be observed in the sample. Significant correlations were observed between decreased striatal DAT levels and visual hallucinations. Although there were no correlations between striatal DAT levels and other neuropsychiatric symptoms, when considering the putamen and the caudate nucleus separately, delusions, depression, and apathy were inversely correlated to decreased caudate DAT levels. The seresults provide intriguing evidence on the involvement of the mesocortical dopaminergic pathways in neuropsychiatric symptoms in DLB.

Topics: Aged; Caudate Nucleus; Delusions; Dopamine; Dopamine Plasma Membrane Transport Proteins; Female; Hallucinations; Humans; Image Processing, Computer-Assisted; Lewy Body Disease; Male; Middle Aged; Neostriatum; Neuropsychological Tests; Nucleus Accumbens; Parkinson Disease; Psychiatric Status Rating Scales; Putamen; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tropanes