Detection of Lewy body disease in patients with late-onset depression, anxiety and psychotic disorder with myocardial meta-iodobenzylguanidine scintigraphy.
OBJECTIVE
Lewy body disease (LBD) is comprised of a spectrum of diseases that includes Parkinson's disease (PD), PD dementia (PDD) and dementia with LBD (DLBD), an array of dementia, and motor symptoms. Low uptake of myocardial meta-iodobenzylguanidine (MIBG) validates diagnosis of LBD. Psychiatric symptoms sometimes precede atypical Parkinsonian syndromes in LBD. Of 34 patients with low MIBG uptake, late-onset depressive, anxiety, or psychotic symptoms were analyzed in term of clinical profiles.


METHODS
Thirty-four patients were classed into three groups according to three main symptoms, 11 patients with visual hallucination (VH), 13 with depression-anxiety (DA), and 10 with psychosis with cognitive disturbance (PCD). Cutoff values of heart-to-mediastinum (HM) ratio of MIBG were set at 1.78 in early phase or 1.68 in late phase.


RESULTS
Group VH patients showed a trend toward higher age at onset and occipital lobe hypoperfusion. Group DA patients lacked central and core features of DLBD and five of them showed frontal lobe hypoperfusion. Group PCD patients had the highest frequencies of suggestive symptoms and UPDRS scores and showed temporal lobe hypoperfusion. HM ratio was not associated with clinical profiles of three groups. Cognitive function was more severely disturbed in atypical Parkinsonian syndrome cases at an initial visit.


CONCLUSIONS
Group VH was considered to DLBD, and Group PCD was regarded as PDD or DLBD with early psychotic presentation. Group DA has a possibility of early depression or anxiety disorder of LBD although it lacked DLBD criteria. Atypical Parkinsonian syndromes are associated with cognitive disturbance irrespective of psychiatric profiles.
Kobayashi
Katsuji
K
Department of Psychiatry, Awazu Neuropsychiatric Sanatorium, 88 Yatano-machi, Komatsu-shi, Ishikawa-ken, 923-0342, Japan.
Sumiya
Hisashi
H
Nakano
Hiroyuki
H
Akiyama
Noriko
N
Urata
Katsumi
K
Koshino
Yoshifumi
Y
D019797:3-Iodobenzylguanidine; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000000981:diagnostic imaging; D003072:Cognition Disorders / Q000175:diagnosis; D003866:Depressive Disorder / Q000000981:diagnostic imaging; D005260:Female; D006212:Hallucinations / Q000175:diagnosis; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D020961:Lewy Body Disease / Q000000981:diagnostic imaging* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011618:Psychotic Disorders / Q000000981:diagnostic imaging; D019275:Radiopharmaceuticals
D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine