title: Dementia with Lewy bodies: basis of cingulate island sign.
abstract: OBJECTIVE
  To investigate clinical, imaging, and pathologic associations of the cingulate island sign (CIS) in dementia with Lewy bodies (DLB).
  
  
  METHODS
  We retrospectively identified and compared patients with a clinical diagnosis of DLB (n=39); patients with Alzheimer disease (AD) matched by age, sex, and education (n=39); and cognitively normal controls (n=78) who underwent 18F-fluorodeoxyglucose (FDG) and C11 Pittsburgh compound B (PiB)-PET scans. Among these patients, we studied those who came to autopsy and underwent Braak neurofibrillary tangle (NFT) staging (n=10).
  
  
  RESULTS
  Patients with a clinical diagnosis of DLB had a higher ratio of posterior cingulate to precuneus plus cuneus metabolism, cingulate island sign (CIS), on FDG-PET than patients with AD (p<0.001), a finding independent of β-amyloid load on PiB-PET (p=0.56). Patients with CIS positivity on visual assessment of FDG-PET fit into the group of high- or intermediate-probability DLB pathology and received clinical diagnosis of DLB, not AD. Higher CIS ratio correlated with lower Braak NFT stage (r=-0.96; p<0.001).
  
  
  CONCLUSIONS
  Our study found that CIS on FDG-PET is not associated with fibrillar β-amyloid deposition but indicates lower Braak NFT stage in patients with DLB. Identifying biomarkers that measure relative contributions of underlying pathologies to dementia is critical as neurotherapeutics move toward targeted treatments.
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Jonathan
authors: J
authors: Graff-Radford
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Melissa E
authors: ME
authors: Murray
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Val J
authors: VJ
authors: Lowe
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Bradley F
authors: BF
authors: Boeve
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Tanis J
authors: TJ
authors: Ferman
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Scott A
authors: SA
authors: Przybelski
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Timothy G
authors: TG
authors: Lesnick
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Matthew L
authors: ML
authors: Senjem
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Jeffrey L
authors: JL
authors: Gunter
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Glenn E
authors: GE
authors: Smith
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: David S
authors: DS
authors: Knopman
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Clifford R
authors: CR
authors: Jack
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Dennis W
authors: DW
authors: Dickson
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL.
authors: Ronald C
authors: RC
authors: Petersen
authors: From the Departments of Neurology (J.G.-R., B.F.B., D.S.K., R.C.P.) and Radiology (V.J.L., C.R.J., K.K.), Division of Biomedical Statistics and Informatics (S.A.P., T.G.L.), and Departments of Information Technology (M.L.S., J.L.G.) and Psychiatry and Psychology (G.E.S.), Mayo Clinic, Rochester, MN; and Departments of Pathology and Laboratory Medicine (M.E.M., D.W.D.) and Psychiatry and Psychology (T.J.F.), Mayo Clinic, Jacksonville, FL. kantarci.kejal@mayo.edu.
authors: Kejal
authors: K
authors: Kantarci
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D020961:Lewy Body Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D016874:Neurofibrillary Tangles / Q000473:pathology; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18