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John T. O'Brien, DM, MRCPysch; Sean Colloby, MPhil; John Fenwick, PhD; E. David Williams, PhD; Michael Firbank, PhD; David Burn, MD; Dag Aarsland, MD; Ian G. McKeith, MD

Arch Neurol. 2004;61:919-925.

Background  Dementia with Lewy bodies (DLB) is a common form of late-life dementia that can be difficult to differentiate from other disorders, especially Alzheimer disease (AD), during life. At autopsy the striatal dopaminergic transporter is reduced.

Objectives  To examine the extent and pattern of dopamine transporter loss using iodine I 123–radiolabeled 2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT) with single-photon emission computed tomography (SPECT) in DLBs compared with other dementias and to assess its potential to enhance a differential diagnosis.

Design  Cohort study comparing FP-CIT with criterion standard of consensus clinical diagnosis.

Setting  General hospital.

Participants  One hundred sixty-four older subjects (33 healthy older control subjects, 34 with NINCDS/ADRDA [National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association]-confirmed AD, 23 with consensus guideline–confirmed DLB, 38 with United Kingdom's Parkinson Disease Society Brain Bank–confirmed Parkinson disease [PD], and 36 with PD and dementia).

Interventions  Injection of ¹²³I-2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl) nortropane with SPECT scan performed at 4 hours.

Main Outcome Measures  Visual ratings of scans and region of interest analysis.

Results  Significant reductions (P<.001) in FP-CIT binding occurred in the caudate and anterior and posterior putamens in subjects with DLB compared with subjects with AD and controls. Transporter loss in DLBs was of similar magnitude to that seen in PD, but with a flatter rostrocaudal (caudate-putamen) gradient (P = .001), while the greatest loss in all 3 areas was seen in those who had PD and dementia. Both region of interest analysis and visual ratings provided good separation between DLBs and AD (region of interest: sensitivity, 78%; specificity, 94%; positive predictive value, 90%) but not among subjects with DLB, PD, and PD with dementia.

Conclusions  Dopamine transporter loss can be detected in vivo using FP-CIT SPECT in DLB. Further studies, especially of subjects with DLB without PD, are required to fully establish use in clinical practice.

From the Institute for Ageing and Health, Newcastle University, Wolfson Research Centre (Drs O'Brien, Colloby, and McKeith), the Regional Medical Physics Department (Drs Fenwick and Firbank) and the Department of Neurology (Dr Burn), Newcastle General Hospital, Newcastle upon Tyne, England; the Regional Medical Physics Department, Sunderland Royal Hospital, Sunderland, England (Dr Williams); and Section of Geriatric Psychiatry, Rogaland Central Hospital, Stavanger, Norway (Dr Aarsland).
Dr Fenwick is deceased.

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