Differentiation Between Dementia With Lewy Bodies And Alzheimer's Disease Using Voxel-Based Morphometry Of Structural
Hiroshi Matsuda1, Kota Yokoyama2, Noriko Sato2
1Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
Background:
The differential diagnosis of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) is particularly important because DLB patients respond better to cholinesterase inhibitors but sometimes exhibit sensitivity to neuroleptics, which may cause worsening of clinical status. Antemortem voxel-based morphometry (VBM) using structural MRI has previously revealed that patients with DLB have normal hippocampal volume, but atrophy in the dorsal mesopontine area.
Objectives:
The aim of this multicenter study was to determine whether VBM of the brain stem in addition to that of medial temporal lobe structures improves the differential diagnosis of AD and DLB.
Methods:
We retrospectively chose 624 patients who were clinically diagnosed with either DLB (239 patients) or AD (385 patients) from 10 institutes using different MR scanners with different magnetic field strengths. In all cases, VBM was performed on 3D T1-weighted images. The degree of local atrophy was calculated using Z-score by comparison with a database of normal volumes of interest (VOIs) in medial temporal lobe (MTL) and the dorsal brain stem (DBS). The discrimination of DLB and AD was evaluated using Z-score values in these two VOIs. MRI data from 414 patients were used as the training data set to determine the classification criteria, with the MRI data from the remaining 210 patients used as the test data set.
Results:
The DLB and AD patients did not differ with respect to mean age or Mini-Mental State Examination scores. Z-index scores showed that there was significantly more atrophy in MTL of AD patients, compared to DLB patients and in DBS of DLB patients, compared to AD patients. The discrimination accuracies of VBM were 63.3% in the test data set and 73.4% in the training data set.
Conclusion:
VBM of DBS in addition to that of MTL improves the differentiation of DLB and AD.
Insights
Accurately differentiating dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) is crucial. Voxel-based morphometry (VBM) of the dorsal brain stem (DBS) and medial temporal lobe (MTL) significantly improves diagnostic accuracy.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Distinguishing dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) is clinically significant due to differing treatment responses and sensitivities.
- Previous voxel-based morphometry (VBM) studies indicated normal hippocampal volume in DLB but atrophy in the dorsal mesopontine area.
- Accurate differential diagnosis impacts patient management, particularly regarding cholinesterase inhibitors and neuroleptic sensitivity in DLB.
Purpose of the Study:
- To evaluate if VBM of the brain stem, alongside medial temporal lobe structures, enhances the differential diagnosis between AD and DLB.
- To assess the diagnostic utility of combining VBM data from medial temporal lobe (MTL) and dorsal brain stem (DBS) regions.
- To improve the accuracy of distinguishing AD and DLB using neuroimaging biomarkers.
Main Methods:
- A multicenter retrospective study involving 624 patients (385 AD, 239 DLB) diagnosed clinically.
- Voxel-based morphometry (VBM) was performed on 3D T1-weighted MRI scans using different field strengths.
- Local atrophy was quantified using Z-scores comparing medial temporal lobe (MTL) and dorsal brain stem (DBS) volumes against normal databases. Data were split into training (414 patients) and testing (210 patients) sets.
Main Results:
- No significant differences in age or Mini-Mental State Examination scores between DLB and AD groups.
- AD patients showed significantly more MTL atrophy than DLB patients; DLB patients exhibited significantly more DBS atrophy than AD patients.
- VBM achieved discrimination accuracies of 73.4% in the training set and 63.3% in the test set.
Conclusions:
- Integrating VBM analysis of the dorsal brain stem (DBS) with medial temporal lobe (MTL) structures improves the differentiation between DLB and AD.
- Regional brain atrophy patterns identified by VBM serve as valuable biomarkers for distinguishing these neurodegenerative diseases.
- This combined VBM approach offers a more robust method for the differential diagnosis of AD and DLB.
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