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Misch MR, Mitchell S, Francis PL, Sherborn K, Meradje K, McNeely AA, Honjo K, Zhao J, Scott CJ, Caldwell CB, Ehrlich L, Shammi P, MacIntosh BJ, Bilbao JM, Lang AE, Black SE, Masellis M. Differentiating between visual hallucination-free dementia with Lewy bodies and corticobasal syndrome on the basis of neuropsychology and perfusion single-photon emission computed tomography. ALZHEIMERS RESEARCH & THERAPY 2014; 6:71. [PMID: 25484929 PMCID: PMC4256921 DOI: 10.1186/s13195-014-0071-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/08/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Dementia with Lewy bodies (DLB) and Corticobasal Syndrome (CBS) are atypical parkinsonian disorders with fronto-subcortical and posterior cognitive dysfunction as common features. While visual hallucinations are a good predictor of Lewy body pathology and are rare in CBS, they are not exhibited in all cases of DLB. Given the clinical overlap between these disorders, neuropsychological and imaging markers may aid in distinguishing these entities. METHODS Prospectively recruited case-control cohorts of CBS (n =31) and visual hallucination-free DLB (n =30), completed neuropsychological and neuropsychiatric measures as well as brain perfusion single-photon emission computed tomography and structural magnetic resonance imaging (MRI). Perfusion data were available for forty-two controls. Behavioural, perfusion, and cortical volume and thickness measures were compared between the groups to identify features that serve to differentiate them. RESULTS The Lewy body with no hallucinations group performed more poorly on measures of episodic memory compared to the corticobasal group, including the delayed and cued recall portions of the California Verbal Learning Test (F (1, 42) =23.1, P <0.001 and F (1, 42) =14.0, P =0.001 respectively) and the delayed visual reproduction of the Wechsler Memory Scale-Revised (F (1, 36) =9.7, P =0.004). The Lewy body group also demonstrated reduced perfusion in the left occipital pole compared to the corticobasal group (F (1,57) =7.4, P =0.009). At autopsy, the Lewy body cases all demonstrated mixed dementia with Lewy bodies, Alzheimer's disease and small vessel arteriosclerosis, while the corticobasal cases demonstrated classical corticobasal degeneration in five, dementia with agyrophilic grains + corticobasal degeneration + cerebral amyloid angiopathy in one, Progressive Supranuclear Palsy in two, and Frontotemporal Lobar Degeneration-Ubiquitin/TAR DNA-binding protein 43 proteinopathy in one. MRI measures were not significantly different between the patient groups. CONCLUSIONS Reduced perfusion in the left occipital region and worse episodic memory performance may help to distinguish between DLB cases who have never manifested with visual hallucinations and CBS at earlier stages of the disease. Development of reliable neuropsychological and imaging markers that improve diagnostic accuracy will become increasingly important as disease modifying therapies become available.
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Affiliation(s)
- Michael R Misch
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Sara Mitchell
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Philip L Francis
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Kayla Sherborn
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Katayoun Meradje
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Alicia A McNeely
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Kie Honjo
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Jiali Zhao
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Christopher Jm Scott
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Curtis B Caldwell
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Lisa Ehrlich
- Department of Nuclear Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Prathiba Shammi
- Neuropsychology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Juan M Bilbao
- Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Department of Medicine (Neurology), Brain Sciences Research Program, Sunnybrook Health Sciences, Centre University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Department of Medicine (Neurology), Brain Sciences Research Program, Sunnybrook Health Sciences, Centre University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Cognition & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Neurogenetics Section, Centre for Addiction and Mental Health, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
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Could clinical profile influence CSF biomarkers in early-onset Alzheimer disease? Alzheimer Dis Assoc Disord 2011; 24:278-83. [PMID: 20473135 DOI: 10.1097/wad.0b013e3181d712d9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In common forms of Alzheimer disease (AD), anterograde memory impairment is the first deficit to occur. However, the disease, especially in its presenile forms, may also manifest itself through initial deficits that are predominantly of a nonmemory type. These distinct clinical profiles, which reflect the distinct topography of the underlying pathologic processes, may also differ in terms of their cerebrospinal fluid (CSF) markers. The aim of this study was to assess the levels of total tau, phosphorylated tau, and amyloid-beta 42 peptide in the CSF of "atypical" (nonmemory) early-onset AD patients. CSF biomarkers were evaluated in 22 atypical patients, and compared with those from a group of 13 "typical" patients, with a memory onset form of the disease. Our results show that independently of age, disease duration, education level, and clinical severity indices, patients with an atypical onset have significantly higher levels of total tau in the CSF (P=0.023). These findings indicate that an assessment of CSF biomarkers may be of particular use in the clinical diagnosis of "atypical-onset" forms of early-onset AD in which the initial symptoms involve language and visuospatial abilities rather than memory. In addition, they highlight the heterogeneity of pathologic processes in AD, suggesting more intense degeneration in the forms of the disease that primarily involve neocortical structures.
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Kreisler A, Defebvre L, Duhamel A, Lecouffe P, Dujardin K, Steinling M, Pasquier F, Destée A. [Classification of parkinsonian syndromes via factorial discriminant analysis of brain SPECT data]. Rev Neurol (Paris) 2009; 165:440-8. [PMID: 19150099 DOI: 10.1016/j.neurol.2008.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 10/10/2008] [Accepted: 11/17/2008] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The objective was to assess the value of single photon emission computerized tomography (SPECT) and factorial discriminant analysis (FDA) in the differential diagnosis of Parkinson's disease (PD), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). PATIENTS AND METHODS Sixty-two patients with clinical diagnoses of either CBD, PSP or PD were studied using brain HmPaO-SPECT. Thirteen pairs of regions of interest (ROIs) were drawn on the slices located 50mm and 90mm above the canthomeatal plane. Twenty-six uptake indices and 13 asymmetry indices were determined. FDA was performed in order to determine whether or not the patients could be classified into the correct clinical group on the basis of SPECT data alone. The most discriminant parameters were used to generate two predictive scores, which were tested in a second group of 15 patients. RESULTS FDA of all 39 variables correctly classified all the patients. A subset of 10 variables was used to build predictive scores, which correctly classified 90% of PD patients, 100% of PSP patients and 86% of CBD patients. When tested in the validation group of 15 patients, these predictive scores correctly classified 87% of the individuals. The frontal medial, temporoparietal and parietal regions were the most discriminant. CONCLUSION Using SPECT data alone, this study enabled us to distinguish between PD, PSP and CBD in patients with clear clinical presentations of the diseases in question. This novel, statistical approach provides reliable information. However, a prospective study dealing with de novo parkinsonian syndromes will be necessary.
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Affiliation(s)
- A Kreisler
- EA 2683, service de neurologie et pathologie du mouvement, hôpital Roger Salengro, CHU de Lille, 59037 Lille cedex, France.
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Juh R, Pae CU, Kim TS, Lee CU, Choe B, Suh T. Cerebral glucose metabolism in corticobasal degeneration comparison with progressive supranuclear palsy using statistical mapping analysis. Neurosci Lett 2005; 383:22-7. [PMID: 15936506 DOI: 10.1016/j.neulet.2005.03.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Revised: 03/18/2005] [Accepted: 03/21/2005] [Indexed: 10/25/2022]
Abstract
This study measured the cerebral glucose metabolism in patients suffering from corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP). The aim was to determine if there is a different metabolic pattern using (18)F-labeled 2-deoxyglucose ((18)F-FDG) positron emission tomography (PET). The regional cerebral glucose metabolism was examined in 8 patients diagnosed clinically with CBD (mean age 69.6 +/- 7.8 years; male/female: 5/3), 8 patients with probable PSP (mean age 67.8 +/- 4.5 years; male/female: 4/4) and 22 healthy controls. The regional cerebral glucose metabolism between the three groups was compared using statistical parametric mapping (SPM) with a voxel-by-voxel approach (p < 0.001, 200-voxel level). Compared with the normal controls, asymmetry in the regional glucose metabolism was observed in the parietal, frontal and cingulate in the CBD patients. In the PSP patients, the glucose metabolism was lower in the orbitofrontal, middle frontal, cingulate, thalamus and mid-brain than their age matched normal controls. A comparison of the two patient groups demonstrated relative hypometabolism in the thalamus, the mid-brain in the PSP patients and the parietal lobe in CBD patients. These results suggest that when making a differential diagnosis of CBD and PSP, voxel-based analysis of the (18)F-FDG PET images using a SPM might be a useful tool in clinical examinations.
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Affiliation(s)
- Rahyeong Juh
- Department of Biomedical Engineering, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seocho-Gu, Seoul
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Kreisler A, Defebvre L, Lecouffe P, Duhamel A, Charpentier P, Steinling M, Destée A. Corticobasal degeneration and Parkinson's disease assessed by HmPaO SPECT: The utility of factorial discriminant analysis. Mov Disord 2005; 20:1431-8. [PMID: 16007659 DOI: 10.1002/mds.20611] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The diagnosis of corticobasal degeneration (CBD) is difficult despite the existence of some typical clinical features. Single photon emission computerized tomography (SPECT) in CBD presents an original pattern (with asymmetric hypoperfusion in pre- and retrorolandic regions) that could facilitate the differential diagnosis of CBD relative to the other degenerative parkinsonian syndromes. The objective of our study was to compare the regional cerebral blood flow measurements studied by SPECT in both CBD and Parkinson's disease (PD) using a multivariate procedure. Twenty-one patients with probable CBD and 20 patients with probable PD underwent brain (99m)Tc HmPaO SPECT. We used factorial discriminant analysis (FDA) to study the relative fixation of 26 regions of interest (ROIs) drawn on two transverse slices, together with the asymmetry indexes of 13 pairs of ROIs. FDA performed using the full set of parameters classified all the patients correctly. In order to classify the patients more easily, a predictive score using a selection of parameters was established. The most discriminating ROIs were the temporoinsular, temporoparietal, and frontal medial regions. We believe that this semiautomatic classification may be a precious tool for reinforcing the current clinical differential diagnosis of CBD and PD.
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Affiliation(s)
- Alexandre Kreisler
- Department of Neurology, Regional and University Hospital, Lille, France
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Abstract
PURPOSE OF REVIEW Physicians are becoming more astute at diagnosing the various parkinsonian syndromes but in clinical practice it is still often difficult to make the correct diagnosis. This review discusses new evidence that may aid physicians in correctly identifying parkinsonian syndromes. RECENT FINDINGS We will review the newest developments in the areas of clinical features, electrophysiologic tests, autonomic tests, neuropsychologic tests, imaging, and biochemical markers which may be of value in differentiating these syndromes. SUMMARY Accurate diagnosis of the parkinsonian syndromes has important implications for patients, in terms of both prognosis and management. Investigations reported during the last year provide new insight into the distinguishing features of these syndromes and may help clinicians and researchers define these disorders more precisely.
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Affiliation(s)
- Jodi Kashmere
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
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