Diffuse occipital hypometabolism on [18F]-FDG PET scans in patients with idiopathic REM sleep behavior disorder: Prodromal dementia with Lewy bodies?
Diffuse occipital hypometabolism on [18F]-FDG PET scans in patients with idiopathic REM sleep behavior disorder: Prodromal dementia with Lewy bodies?
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DOI：
10.1111/j.1479-8301.2010.00325.x
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发表时间：
2010-09-01
期刊：
影响因子：
2
通讯作者：
Sato, Kiyoshi
中科院分区：
文献类型：
--
作者：
Fujishiro, Hiroshige;Iseki, Eizo;Sato, Kiyoshi
背景资料：先前的纵向研究表明，遗忘性轻度认知障碍患者的[F-18]-氟-D-葡萄糖（FDG）正电子发射断层扫描（PET）扫描的特定模式可以预测阿尔茨海默病（AD）。然而，[F-18]-FDG PET扫描在路易体痴呆（DLB）前驱期患者中的特殊模式的意义尚不清楚。基于快速眼动（REM）睡眠行为障碍（RBD）通常先于DLB发作的普遍证据，[F-18]-9例报告复发性夜梦的非痴呆患者的FDG PET扫描-在我们的记忆诊所的行为进行了比较，使用三维立体定向表面投影（3D-SSP）图像的规范数据库。结果：4例DLB患者脑葡萄糖代谢率（CMRgIc）降低，主要分布在枕叶，是DLB患者的好发部位。在Bastast中，5例患者没有表现出这种枕叶代谢低下;相反，这5例患者在左前扣带回（Broadmann区（BA）24）、右额叶（BA 32）和右前颞叶（BA 38）表现出代谢低下，这些区域是帕金森病的优先受累区域，而不是DLB。左枕叶CMRgIc降低的程度与Bender Gestalt测试的分数相关，该测试反映了视觉空间能力，但与整体认知测量无关。所有患者显示心脏[I-123]-MIBG水平降低，符合潜在的Lewy体diseases.Conclusion：[F-18]-FDG PET扫描中的这些变化提高了CMRgIc减少的特定模式可能预测特发性RBD患者发生DLB的可能性。需要进一步的随访研究，特别是对弥漫性枕叶代谢低下的患者。
Background: Previous longitudinal studies have revealed that specific patterns on [F-18]-fluoro-D-glucose (FDG) positron emission tomography (PET) scans in patients with amnesic mild cognitive impairment can predict Alzheimer's disease (AD). However, the significance of particular patterns on [F-18]-FDG PET scans in prodromal patients with dementia with Lewy bodies (DLB) remains unclear.Methods: Based on the prevailing evidence that rapid eye movement (REM) sleep behavior disorder (RBD) often precedes the onset of DLB, [F-18]-FDG PET scans of nine non-demented patients reporting recurrent nocturnal dream-enactment behavior in our memory clinic were compared with the normative database using three-dimensional stereotactic surface projection (3D-SSP) images. All patients underwent clinical and neuropsychological examinations as well as cardiac [I-123]-metaiodobenzylguanidine ([I-123]-MIBG) scintigraphy.Results: Four patients were found to have diffuse areas of reduced cerebral metabolic rate of glucose (CMRgIc), predominantly in the occipital lobe, which is the preferentially affected region in DLB patients. In constrast, five patients showed no such occipital hypometabolism; instead, these five patients showed hypometabolism in the left anterior cingulate gyrus (Broadmann area (BA) 24), right frontal lobe (BA 32) and right anterior temporal lobe (BA 38), which are the preferentially affected regions in Parkinson's disease rather than DLB. The extent of the reduction in CMRgIc in the left occipital lobe was correlated with scores on the Bender Gestalt Test, which reflects visuospatial ability, but not with global cognitive measures. All patients showed reduced cardiac [I-123]-MIBG levels, consistent with underlying Lewy body disease.Conclusion: These variations in [F-18]-FDG PET scans raise the possibility that the specific pattern of CMRgIc reduction may predict developing DLB in patients with idiopathic RBD. Further follow-up studies are needed, particularly on patients with diffuse occipital hypometabolism.