No abstract available.
Dementia ; Indans ; Lewy Bodies ; Piperidines ; Receptors, sigma

A case of Lewy body dementia in a 71 year-old male patient was reported and related articles were also reviewed. He has been ill with Parkinsonism since 1988, and referred to the neuropsychiatrist because of depression since 1989. Episodically he has experienced dizziness, falls and low blood pressure. Mild cognitive decline including memory, attention, language, and visuospatial ability accompanied by occasional fluctuation of consciousness, confusion, visual hallucination and disorientation was developed on February 9th in 2000. Such symptoms were repeated thereafter, and responded on donepezil in addition to the antiparkinsonian drugs.
Aged ; Consciousness ; Depression ; Dizziness ; Hallucinations ; Humans ; Hypotension ; Lewy Bodies* ; Lewy Body Disease* ; Male ; Memory ; Parkinsonian Disorders

OBJECTIVE: Donepezil is used to improve cognitive impairment of dementia with Lewy bodies (DLB). Visuo-spatial dysfunction is a well-known symptom of DLB. Non-verbal Raven’s Colored Progressive Matrices (RCPM) were used to assess both visual perception and reasoning ability in DLB subjects treated with donepezil. METHODS: Twenty-one DLB patients (mean age, 78.7±4.5 years) were enrolled. RCPM assessment was performed at the time of starting donepezil and within one year after starting donepezil. RESULTS: There were significant improvements of RCPM in the total scores between one year donepezil treatment (p=0.013), in both Set A score (p=0.002) and Set AB score (p=0.015), but trend in the Set B score (p=0.083). CONCLUSION: Donepezil is useful for improving visuo-spatial impairment in DLB, but not for problem-solving impairment.
Cholinesterase Inhibitors ; Cognition Disorders ; Dementia* ; Humans ; Lewy Bodies* ; Lewy Body Disease ; Spatial Processing ; Visual Perception

Metaiodobenzylguanidine (MIBG) is an analog of norepinephrine that accumulates in sympathetic nerve endings soon after intravenous administration. The degree of accumulation reflects the uptake, storage and release of transmitters by noradrenergic neurons. Myocardial imaging with ¹²³I labeled MIBG ( ¹²³I-MIBG) can be used to estimate the extent of local myocardial sympathetic nerve damage, which has been widely used in the diagnosis and treatment of various heart diseases. In recent years, numerous studies have been carried out on the application of ¹²³I-MIBG in the diagnosis of degenerative diseases of the nervous system (such as Parkinson's disease and dementia of Lewy body), and have made some achievements. The purpose of this review is to summarize the current clinical application of ¹²³I-MIBG myocardial imaging in the diagnosis of dementia with Lewy bodies, the problems in imaging technology and the possible research directions in the future, so as to provide valuable reference information for clinicians to reasonably and accurately apply this technology in the early diagnosis and discrimination of dementia.
Humans ; Lewy Bodies ; 3-Iodobenzylguanidine ; Lewy Body Disease/diagnostic imaging* ; Iodine Radioisotopes

Alzheimer Disease ; China ; Consensus ; Humans ; Lewy Bodies ; Lewy Body Disease/drug therapy*

BACKGROUND: Because patients with idiopathic Parkinson's disease (PD) may exhibit patterns of cognitive impairment, it is difficult to distinguish from patients with Parkinson's disease dementia (PDD). Recently, cardiac 123I-metaiodobenzylguanidine (MIBG) scinti-graphy has been used to help distinguish PD from atypical Parkinsonism. This study investigated the relations between cardiac 123I-MIBG scintigraphy and these diseases. METHODS: Cardiac 123I-MIBG scintigraphy was conducted on 18 patients with PD, 18 patients with PDD and 13 normal controls matched for age, disease duration and severity of symptoms. The heart to mediastinum (H/M) ratio was calculated. RESULTS: The mean values of H/M ratio were significantly lower for PDD and PD than for normal controls but there was no difference between the disease groups. CONCLUSION: Unfortunately, cardiac 123I-MIBG scintigraphy did not distinguish PDD from PD in our study. We suggest further research with larger study populations be done to clarify the use of cardiac 123I-MIBG scintigraphy in differentiating other Lewy body diseases from dementia with PD features.
Dementia ; Heart ; Humans ; Lewy Bodies ; Mediastinum ; Parkinson Disease ; Parkinsonian Disorders

¹²³I-meta-iodobenzylguanidine (MIBG) has become widely applied in Japan since its introduction to clinical cardiology and neurology practice in the 1990s. Neurological studies found decreased cardiac uptake of ¹²³I-MIBG in Lewy-body diseases including Parkinson's disease and dementia with Lewy bodies. Thus, cardiac MIBG uptake is now considered a biomarker of Lewy body diseases. Although scintigraphic images of ¹²³I-MIBG can be visually interpreted, an average count ratio of heart-to-mediastinum (H/M) has commonly served as a semi-quantitative marker of sympathetic activity. Since H/M ratios significantly vary according to acquisition and processing conditions, quality control should be appropriate, and quantitation should be standardized. The threshold H/M ratio for differentiating Lewy-body disease is 2.0-2.1, and was based on standardized H/M ratios to comparable values of medium-energy collimators. Parkinson's disease can be separated from various types of parkinsonian syndromes using cardiac ¹²³I-MIBG, whereas activity is decreased on images of Lewy-body diseases using both ¹²³I-ioflupane for the striatum and ¹²³I-MIBG. Despite being a simple index, the H/M ratio of ¹²³I-MIBG uptake is reproducible and can serve as an effective tool to support a diagnosis of Lewy-body diseases in neurological practice.
3-Iodobenzylguanidine ; Cardiology ; Dementia ; Diagnosis ; Japan ; Lewy Bodies ; Lewy Body Disease ; Neurology ; Nuclear Medicine ; Parkinson Disease ; Parkinsonian Disorders ; Quality Control

Parkinson's disease (PD) and related Lewy body diseases are characterized by deposition of alpha-synuclein aggregates in both the central nervous system and peripheral nervous system. Synucleinopathy lesions spread to larger brain areas as the disease progresses, and prion-like cell-to-cell transmission of aggregated alpha-synuclein is thought to be the underlying mechanism for this pathological spreading. LRRK2 is another protein linked to the pathogenesis of PD, and its presence in Lewy bodies has attracted much attention as to whether LRRK2 and alpha-synuclein interplay during the pathogenesis of PD. However, the relationship between these two crucial proteins still remains unclear. In this review article, we will discuss the current state of knowledge in terms of how these proteins cause the disease and provide the hypothetical mechanisms by which LRRK2 might modify the generation and progression of synucleinopathy.
alpha-Synuclein ; Brain ; Central Nervous System ; Lewy Bodies ; Parkinson Disease* ; Peripheral Nervous System

The dementia with Lewy bodies which was common next to the Alzheimer's dementia had been oftenly misdiagnozed as vascular dementia. The pathologic diagnosis of dementia with Lewy bodies was increasing with the development of immunocytochemical techniques, and it also drew much interest recently. The clinical criteria included core symptoms such as fluctuation of cognitive function, well-formed visual hallucination and extrapyramidal symptoms. For the pathologic criteria, presence of brainstem or cortical Lewy bodies were essential, besides of other pathology. However, it was difficult to obtain satisfactory consensus between investigators about the clinical and pathologic criteria of the dementia with Lewy bodies. There were several reports which suggested good response to the cholinesterase inhibitors.
Brain Stem ; Cholinesterase Inhibitors ; Consensus ; Dementia* ; Dementia, Vascular ; Diagnosis ; Hallucinations ; Humans ; Lewy Bodies* ; Pathology ; Research Personnel

Here the author reviews the clinical and pathologic characteristics of dementia with Lewy bodies (DLB). DLB took many years to crystallize into a recognizable clinico-pathologic entity. Based on sensitive immunostaining technique, DLB is now considered the second most commonest cause of neurodegenerative dementia in the elderly. It is part of the range of clinical presentations that share a neuritic pathology based on abnormal aggregation of the synaptic protein alpha-synuclein. Lewy body pathology is found from the brainstem to the cortex and, in many cases, associated with concurrent Alzheimer' disease pathology. A recent international consortium on DLB has resulted in revised criteria for the clinical and pathological diagnosis of DLB incorporating new information about the clinical features and improved methods for their assessment. Neuropathologic diagnosis now assigns a weight to both alpha-synuclein and Alzheimer tangle pathology. Accurate identification of patients is important because they have specific symptoms, impairments, and functional disabilities that differ from those of other dementing illness including Alzheimer's disease.
Aged ; alpha-Synuclein ; Alzheimer Disease ; Brain Stem ; Dementia* ; Diagnosis ; Humans ; Lewy Bodies* ; Pathology