A comparison of 99mTc-HMPAO SPET changes in dementia with Lewy bodies and Alzheimer's disease using statistical parametric mapping

Abstract. Differences in regional cerebral blood flow (rCBF) between subjects with Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and healthy volunteers were investigated using statistical parametric mapping (SPM99). Forty-eight AD, 23 DLB and 20 age-matched control subjects participated. Technetium-99m hexamethylpropylene amine oxime (HMPAO) brain single-photon emission tomography (SPET) scans were acquired for each subject using a single-headed rotating gamma camera (IGE CamStar XR/T). The SPET images were spatially normalised and group comparison was performed by SPM99. In addition, covariate analysis was undertaken on the standardised images taking the Mini Mental State Examination (MMSE) scores as a variable. Applying a height threshold of P≤0.001 uncorrected, significant perfusion deficits in the parietal and frontal regions of the brain were observed in both AD and DLB groups compared with the control subjects. In addition, significant temporoparietal perfusion deficits were identified in the AD subjects, whereas the DLB patients had deficits in the occipital region. Comparison of dementia groups (height threshold of P≤0.01 uncorrected) yielded hypoperfusion in both the parietal [Brodmann area (BA) 7] and occipital (BA 17, 18) regions of the brain in DLB compared with AD. Abnormalities in these areas, which included visual cortex and several areas involved in higher visual processing and visuospatial function, may be important in understanding the visual hallucinations and visuospatial deficits which are characteristic of DLB. Covariate analysis indicated group differences between AD and DLB in terms of a positive correlation between cognitive test score and temporoparietal blood flow. In conclusion, we found evidence of frontal and parietal hypoperfusion in both AD and DLB, while temporal perfusion deficits were observed exclusively in AD and parieto-occipital deficits in DLB.

[1]  D. Ffytche,et al.  The anatomy of conscious vision: an fMRI study of visual hallucinations , 1998, Nature Neuroscience.

[2]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[3]  D. Benson,et al.  The fluorodeoxyglucose 18F scan in Alzheimer's disease and multi-infarct dementia. , 1983, Archives of neurology.

[4]  R H Huesman,et al.  Regional Cerebral Metabolic Alterations in Dementia of the Alzheimer Type: Positron Emission Tomography with [1818] Fluorodeoxyglucose , 1983, Journal of computer assisted tomography.

[5]  R. Levy,et al.  The Lewy-Body Variant of Alzheimer's Disease , 1993, British Journal of Psychiatry.

[6]  C. Grady,et al.  Heterogeneous anterior‐posterior metabolic patterns in dementia of the Alzheimer type , 1988, Neurology.

[7]  K. Ishii,et al.  Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer's disease , 1998, Neurology.

[8]  L. Defebvre,et al.  Technetium HMPAO SPECT study in dementia with Lewy bodies, Alzheimer's disease and idiopathic Parkinson's disease. , 1999, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[9]  J L Lancaster,et al.  Automated Talairach Atlas labels for functional brain mapping , 2000, Human brain mapping.

[10]  P. Sharp,et al.  Application of iodine-123-labeled isopropylamphetamine imaging to the study of dementia. , 1986, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[11]  David E. Kuhl,et al.  Journal of Cerebral Blood Flow and Metabolism Cerebral Metabolic Relationships for Selected Brain Regions in Alzheimer's, Huntington's, and Parkinson's Diseases , 2022 .

[12]  Sarah H. Creem,et al.  Defining the cortical visual systems: "what", "where", and "how". , 2001, Acta psychologica.

[13]  S. Kinomura,et al.  Tc-99m HMPAO SPECT in the evaluation of Alzheimer’s disease: correlation between neuropsychiatric evaluation and CBF images , 1999, Journal of neurology, neurosurgery, and psychiatry.

[14]  Karl J. Friston,et al.  Statistical parametric mapping in functional neuroimaging: beyond PET and fMRI activation studies. , 1998, European journal of nuclear medicine.

[15]  Karl J. Friston,et al.  Statistical parametric maps in functional imaging: A general linear approach , 1994 .

[16]  J D Fenwick,et al.  Occipital hypoperfusion on SPECT in dementia with Lewy bodies but not AD , 2001, Neurology.

[17]  A. Swann,et al.  Prospective validation of Consensus criteria for the diagnosis of dementia with Lewy bodies , 2000, Neurology.

[18]  S. Kinomura,et al.  Parametric mapping of cerebral blood flow deficits in Alzheimer's disease: a SPECT study using HMPAO and image standardization technique. , 1999, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[19]  B L Holman,et al.  The scintigraphic appearance of Alzheimer's disease: a prospective study using technetium-99m-HMPAO SPECT. , 1992, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[20]  R. S. J. Frackowiak,et al.  The Activity in Human Areas V1/V2, V3, and V5 during the Perception of Coherent and Incoherent Motion , 1996, NeuroImage.

[21]  Mrc Psych,et al.  Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): Report of the consortium on DLB international workshop , 1996 .

[22]  Y Imahori,et al.  Aberrant plasticity in Alzheimer's disease. , 1999, Neuroreport.

[23]  E. Perry,et al.  Cholinergic Transmitter and Neurotrophic Activities in Lewy Body Dementia: Similarity to Parkinson's and Distinction from Alzheimer Disease , 1993, Alzheimer disease and associated disorders.

[24]  F. Huppert,et al.  CAMDEX: A Standardised Instrument for the Diagnosis of Mental Disorder in the Elderly with Special Reference to the Early Detection of Dementia , 1986, British Journal of Psychiatry.

[25]  Richard S. J. Frackowiak,et al.  Retinotopic Maps in Human Prestriate Visual Cortex: The Demarcation of Areas V2 and V3 , 1995, NeuroImage.

[26]  Karl J. Friston,et al.  Assessing the significance of focal activations using their spatial extent , 1994, Human brain mapping.

[27]  I G McKeith,et al.  MRI volumetric study of dementia with Lewy bodies , 2000, Neurology.

[28]  Nobuyuki Okamura,et al.  Glucose Hypometabolism and Neuropathological Correlates in Brains of Dementia with Lewy Bodies , 2000, Experimental Neurology.

[29]  Hiroaki Kazui,et al.  Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer's disease: a comparative study using positron emission tomography , 1997, Neuroscience Letters.

[30]  B. Sahakian,et al.  A study of regional cerebral blood flow and cognitive performance in Alzheimer's disease. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[31]  K. Ishii,et al.  Regional cerebral blood flow difference between dementia with Lewy bodies and AD , 1999, Neurology.

[32]  K. Ishii,et al.  Visual hallucinations and regional cerebral metabolism in dementia with Lewy bodies (DLB). , 1999, Neuroreport.

[33]  A. J. Collins,et al.  Introduction to Multivariate Analysis , 1982 .

[34]  S. Zeki,et al.  The position and topography of the human colour centre as revealed by functional magnetic resonance imaging. , 1997, Brain : a journal of neurology.

[35]  K Cheng,et al.  Human cortical regions activated by wide-field visual motion: an H2(15)O PET study. , 1995, Journal of neurophysiology.

[36]  J. Haxby,et al.  Positron emission tomography in Alzheimer's disease , 1986, Neurology.

[37]  R. Bronen,et al.  Comparison of technetium-99m-HMPAO and technetium-99m-ECD cerebral SPECT images in Alzheimer's disease. , 1996, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[38]  D. Neary,et al.  Single photon emission tomography using 99mTc-HM-PAO in the investigation of dementia. , 1987, Journal of neurology, neurosurgery, and psychiatry.