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DaT-SPECT scans show declining dopamine transporter binding in Lewy Body Disease (LBD) patients over time. This imaging biomarker is crucial for diagnosing LBD, even in early stages like mild cognitive impairment (MCI) and isolated REM sleep behavior disorder (iRBD).

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Area of Science:

  • Neurology
  • Radiology
  • Pathology

Background:

  • Dementia with Lewy Bodies (DLB) is often misdiagnosed as Alzheimer's Disease (AD) due to overlapping pathologies.
  • Autopsy confirms DLB, but longitudinal DaT-SPECT findings in autopsy-confirmed DLB are not well-characterized.
  • Previous research identified DaTQUANT z-score of the putamen as a key discriminator for Lewy Body Disease (LBD) pathology.

Purpose of the Study:

  • To characterize the time-course changes in DaT-SPECT findings in autopsy-confirmed LBD patients.
  • To evaluate DaT-SPECT's utility in clinical trials targeting LBD.
  • To assess DaTQUANT's diagnostic accuracy across different LBD stages.

Main Methods:

  • Analysis of longitudinal DaT-SPECT scans (two or more) from eight autopsy-confirmed LBD patients.
  • Utilized DaTQUANT 2.0 software to analyze nigrostriatal dopamine transporter (DaT) binding and age-adjusted z-scores.
  • Correlated imaging findings with clinical diagnoses (DLB, MCI, iRBD) and autopsy results.

Main Results:

  • All patients showed DaTQUANT putamen z-scores below -1.0 at initial scans, including those with MCI and iRBD.
  • DLB patients initially presented with z-scores below -1.55, with most below -2.0.
  • All patients exhibited DaTQUANT putamen z-scores below -2.0 by their last scan, indicating progressive decline in DaT binding.

Conclusions:

  • DaTQUANT, with a putamen z-score cutoff of -1, accurately identifies LBD pathology, including in early MCI and iRBD stages.
  • Nigrostriatal DaT binding demonstrates a progressive decline over time in LBD patients.
  • DaT-SPECT provides a valuable, non-invasive tool for tracking LBD progression and aiding diagnosis.