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Rebecca J. Cordery, BSc, MRCP; Philippa J. Tyrrell, MD, FRCP; Peter L. Lantos, MD, PhD, DSc, FRCPath; Martin N. Rossor, MD, FRCP

Arch Neurol. 2001;58:505-508.

Objective  To report a case initially fulfilling the clinical criteria for probable Alzheimer disease, although later clinical features suggested dementia with Lewy bodies. Oxygen 15–labeled positron emission tomograms revealed a pattern of hypometabolism characteristic of Alzheimer disease. At post mortem, there was no evidence of the pathological features of Alzheimer disease, but diffuse cortical Lewy bodies were seen in the pigmented brainstem nuclei and cerebral cortex.

Design  A case report.

Setting  Tertiary referral center.

Patient  A 65-year-old white man presented with a 3-year history of memory loss and language difficulties.

Results  Oxygen 15–labeled positron emission tomograms revealed hypometabolism in the frontal, temporal, and parietal lobes, more severe on the left than right. Metabolism in the left caudate was just outside the 95% reference range. Occipital metabolism was normal.

Conclusions  Positron emission tomographic studies have been reported to show occipital hypometabolism in dementia with Lewy bodies, in addition to the characteristic posterior bitemporal biparietal pattern of Alzheimer disease. We suggest that although this finding may favor a diagnosis of dementia with Lewy bodies, it is not necessary for diagnosis.

From the Dementia Research Group, Department of Clinical Neurology, Institute of Neurology and Division of Neurosciences, Imperial College School of Medicine (Drs Cordery and Rossor), the Medical Research Council Cyclotron Unit, Hammersmith Hospital (Dr Tyrrell), and the Department of Neuropathology, Institute of Psychiatry (Dr Lantos), London, England. Dr Tyrrell is now with the Department of Geriatric Medicine, Hope Hospital, Salford, England.

Corresponding author and reprints: Martin N. Rossor, MD, FRCP, Dementia Research Group, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, England (e-mail mrossor{at}dementia.ion.ucl.ac.uk).

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