Early discriminatory diagnosis of dementia with Lewy bodies. The emerging role of CSF and imaging biomarkers.
BACKGROUND
The clinical diagnostic criteria for dementia with Lewy bodies (DLB) have a low sensitivity, and there are no generally accepted biomarkers to distinguish DLB from other dementias. Our aim was to identify biomarkers that may differentiate DLB from Alzheimer's disease (AD).


METHODS
We performed a systematic literature search for studies of EEG, imaging techniques and genetic and CSF markers that provide sensitivity and specificity in the identification of DLB.


RESULTS
The best evidence was for scintigraphy of the striatal dopamine transporter system using FP-CIT SPECT. Several small scintigraphy studies of cardiovascular autonomic function using metaiodobenzylguanidine SPECT have reported promising results. Studies exploring innovative techniques based on CSF have reported interesting findings for the combination of amyloid beta (abeta) isoforms as well as alpha-synuclein, and there are interesting results emerging from preliminary studies applying proteomic techniques. Data from studies using structural MRI, perfusion SPECT, genetics and EEG studies show differences between DLB and AD but only at a group level.


CONCLUSIONS
Several potential biomarkers for the differential diagnosis of probable DLB and AD have shown good diagnostic accuracy in the research setting. Data from large multicentre studies and from studies with autopsy confirmation exist for scintigraphy of the dopamine transporter system. Future studies should explore its value in possible DLB and for clinical management and health economics.
Aarsland
Dag
D
Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway. daarsland@gmail.com
Kurz
Martin
M
Beyer
Mona
M
Bronnick
Kolbjørn
K
Piepenstock Nore
Sabine
S
Ballard
Clive
C
D000368:Aged; D000544:Alzheimer Disease / Q000134:cerebrospinal fluid / Q000175:diagnosis; D015415:Biomarkers; D003072:Cognition Disorders / Q000175:diagnosis; D003937:Diagnosis, Differential; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism; D042241:Early Diagnosis; D004569:Electroencephalography; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D020961:Lewy Body Disease / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D009483:Neuropsychological Tests; D010766:Phosphorylation; D049268:Positron-Emission Tomography; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes / Q000493:pharmacokinetics; D025801:Ubiquitin / Q000378:metabolism; D051844:alpha-Synuclein / Q000378:metabolism
D015415:Biomarkers; D050483:Dopamine Plasma Membrane Transport Proteins; D007457:Iodine Radioisotopes; D014326:Tropanes; D025801:Ubiquitin; D051844:alpha-Synuclein; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane