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Diagnostic Accuracy of Dopaminergic Imaging in Prodromal Dementia with Lewy Bodies

Lookup NU author(s): Professor Alan Thomas, Dr Paul Donaghy, Gemma Roberts, Dr Sean Colloby, Nicola Barnett, Dr George Petrides, Dr James Lloyd, Kirsty Olsen, Dr John-Paul Taylor, Professor Ian McKeith, Professor John O'Brien

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

Background Dopaminergic imaging has high diagnostic accuracy for dementia with Lewy bodies (DLB) at the dementia stage. We report the first investigation of dopaminergic imaging at the prodromal stage. Methods We recruited 75 patients over 60 with Mild Cognitive Impairment (MCI), 33 with probable MCI with Lewy body disease (MCI-LB), 15 with possible MCI-LB and 27 with MCI with Alzheimer’s disease (MCI-AD). All underwent detailed clinical, neurological and neuropsychological assessments and FP-CIT dopaminergic imaging. FP-CIT scans were blindly rated by a consensus panel and classified as normal or abnormal. Results The sensitivity of visually rated FP-CIT imaging to detect combined possible or probable MCI-LB was 54.2% (95% confidence interval 39.2 to 68.6), with a specificity of 89.0% (95% confidence interval 70.8 to 97.6) and a likelihood ratio for MCI-LB of 4.9, indicating that FP-CIT may be a clinically important test in MCI where any characteristic symptoms of Lewy body disease are present. The sensitivity in probable MCI-LB was 61.0% (95% CI 42.5 to 77.4) and in possible MCI-LB was 40.0% (95% CI 16.4 to 67.7). Conclusions Dopaminergic imaging had high specificity at the pre-dementia stage and gave a clinically important increase in diagnostic confidence and so should be considered in all patients with MCI who have any of the diagnostic symptoms of DLB. As expected the sensitivity was lower in MCI-LB than in established DLB, although over 50% still had an abnormal scan. Accurate diagnosis of LB disease is important to enable early optimal treatment for Lewy body symptoms.


Publication metadata

Author(s): Thomas A, Donaghy P, Roberts G, Colloby SJ, Barnett NA, Petrides G, Lloyd J, Olsen K, Taylor J-P, McKeith I, O'Brien JT

Publication type: Article

Publication status: Published

Journal: Psychological Medicine

Year: 2018

Pages: epub ahead of print

Online publication date: 25/04/2018

Acceptance date: 27/03/2018

ISSN (print): 0033-2917

ISSN (electronic): 1469-8978

Publisher: Cambridge University Press

URL: https://doi.org/10.1017/S0033291718000995

DOI: 10.1017/S0033291718000995


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