Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Nov;71(5):583–588. doi: 10.1136/jnnp.71.5.583

A clinical role for [123I]MIBG myocardial scintigraphy in the distinction between dementia of the Alzheimer's-type and dementia with Lewy bodies

M Yoshita 1, J Taki 1, M Yamada 1
PMCID: PMC1737586  PMID: 11606666

Abstract

OBJECTIVE—Scintigraphy with [123I]metaiodobenzyl guanidine ([123I]MIBG) enables the quantification of postganglionic sympathetic cardiac innervation. Recently, myocardial [123I]MIBG scintigraphy has been found to be useful in distinguishing Parkinson's disease, a Lewy body disease, from other akinetic rigid syndromes. Some patients initially diagnosed with dementia of the Alzheimer's type (DAT) are discovered to have an alternative disease such as dementia with Lewy bodies (DLB), despite the application of stringent diagnostic criteria. In the present study, examinations were performed to clarify the usefulness of myocardial [123I]MIBG scintigraphy in improving the differential diagnosis between patients with DLB and DAT.
METHODS—Fourteen patients with DLB and 14 patients with DAT underwent scintigraphy with [123I]MIBG, combined with orthostatic tests and cardiac examinations.
RESULTS—In all patients with DLB, the heart to mediastinum (H/M) ratio of MIBG uptake was pathologically impaired in both early and delayed images, independently of the duration of disease and autonomic failure. All patients with DAT had successful MIBG uptake in the heart regardless of duration of disease and autonomic failure. Orthostatic hypotension was seen in four patients with DAT and 13 patients with DLB.
CONCLUSIONS—[123I]MIBG myocardial scintigraphy might detect early disturbances of the sympathetic nervous system in DLB and might provide useful diagnostic information to discriminate DLB from DAT. The distinction between DLB and DAT may be improved by greater emphasis on cardiac sympathetic disturbances.



Full Text

The Full Text of this article is available as a PDF (236.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Algotsson A., Viitanen M., Winblad B., Solders G. Autonomic dysfunction in Alzheimer's disease. Acta Neurol Scand. 1995 Jan;91(1):14–18. doi: 10.1111/j.1600-0404.1995.tb05836.x. [DOI] [PubMed] [Google Scholar]
  2. Ando Y., Obayashi K., Tanaka Y., Tsuji T., Uchino M., Takahashi M., Ando M. Radiolabelled meta-iodobenzylguanidine in assessment of autonomic dysfunction. Lancet. 1994 Apr 16;343(8903):984–985. doi: 10.1016/s0140-6736(94)90113-9. [DOI] [PubMed] [Google Scholar]
  3. Braune S., Reinhardt M., Schnitzer R., Riedel A., Lücking C. H. Cardiac uptake of [123I]MIBG separates Parkinson's disease from multiple system atrophy. Neurology. 1999 Sep 22;53(5):1020–1025. doi: 10.1212/wnl.53.5.1020. [DOI] [PubMed] [Google Scholar]
  4. Burns A., Luthert P., Levy R., Jacoby R., Lantos P. Accuracy of clinical diagnosis of Alzheimer's disease. BMJ. 1990 Nov 3;301(6759):1026–1026. doi: 10.1136/bmj.301.6759.1026. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dae M. W., O'Connell J. W., Botvinick E. H., Ahearn T., Yee E., Huberty J. P., Mori H., Chin M. C., Hattner R. S., Herre J. M. Scintigraphic assessment of regional cardiac adrenergic innervation. Circulation. 1989 Mar;79(3):634–644. doi: 10.1161/01.cir.79.3.634. [DOI] [PubMed] [Google Scholar]
  6. Ganguly P. K., Beamish R. E., Dhalla K. S., Innes I. R., Dhalla N. S. Norepinephrine storage, distribution, and release in diabetic cardiomyopathy. Am J Physiol. 1987 Jun;252(6 Pt 1):E734–E739. doi: 10.1152/ajpendo.1987.252.6.E734. [DOI] [PubMed] [Google Scholar]
  7. Gill J. S., Hunter G. J., Gane G., Camm A. J. Heterogeneity of the human myocardial sympathetic innervation: in vivo demonstration by iodine 123-labeled meta-iodobenzylguanidine scintigraphy. Am Heart J. 1993 Aug;126(2):390–398. doi: 10.1016/0002-8703(93)91056-k. [DOI] [PubMed] [Google Scholar]
  8. Gill J. S., Hunter G. J., Gane J., Ward D. E., Camm A. J. Asymmetry of cardiac [123I] meta-iodobenzyl-guanidine scans in patients with ventricular tachycardia and a "clinically normal" heart. Br Heart J. 1993 Jan;69(1):6–13. doi: 10.1136/hrt.69.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hachinski V. C., Iliff L. D., Zilhka E., Du Boulay G. H., McAllister V. L., Marshall J., Russell R. W., Symon L. Cerebral blood flow in dementia. Arch Neurol. 1975 Sep;32(9):632–637. doi: 10.1001/archneur.1975.00490510088009. [DOI] [PubMed] [Google Scholar]
  10. Hakusui S., Yasuda T., Yanagi T., Tohyama J., Hasegawa Y., Koike Y., Hirayama M., Takahashi A. A radiological analysis of heart sympathetic functions with meta-[123I]iodobenzylguanidine in neurological patients with autonomic failure. J Auton Nerv Syst. 1994 Sep;49(1):81–84. doi: 10.1016/0165-1838(94)90023-x. [DOI] [PubMed] [Google Scholar]
  11. Hely M. A., Reid W. G., Halliday G. M., McRitchie D. A., Leicester J., Joffe R., Brooks W., Broe G. A., Morris J. G. Diffuse Lewy body disease: clinical features in nine cases without coexistent Alzheimer's disease. J Neurol Neurosurg Psychiatry. 1996 May;60(5):531–538. doi: 10.1136/jnnp.60.5.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ishii T. Distribution of Alzheimer's neurofibrillary changes in the brain stem and hypothalamus of senile dementia. Acta Neuropathol. 1966 Mar 4;6(2):181–187. doi: 10.1007/BF00686763. [DOI] [PubMed] [Google Scholar]
  13. Kuzuhara S., Yoshimura M. Clinical and neuropathological aspects of diffuse Lewy body disease in the elderly. Adv Neurol. 1993;60:464–469. [PubMed] [Google Scholar]
  14. Langston J. W., Forno L. S. The hypothalamus in Parkinson disease. Ann Neurol. 1978 Feb;3(2):129–133. doi: 10.1002/ana.410030207. [DOI] [PubMed] [Google Scholar]
  15. Liberini P., Valerio A., Memo M., Spano P. F. Lewy-body dementia and responsiveness to cholinesterase inhibitors: a paradigm for heterogeneity of Alzheimer's disease? Trends Pharmacol Sci. 1996 Apr;17(4):155–160. doi: 10.1016/0165-6147(96)81592-6. [DOI] [PubMed] [Google Scholar]
  16. Lipsitz L. A. Orthostatic hypotension in the elderly. N Engl J Med. 1989 Oct 5;321(14):952–957. doi: 10.1056/NEJM198910053211407. [DOI] [PubMed] [Google Scholar]
  17. Litvan I., MacIntyre A., Goetz C. G., Wenning G. K., Jellinger K., Verny M., Bartko J. J., Jankovic J., McKee A., Brandel J. P. Accuracy of the clinical diagnoses of Lewy body disease, Parkinson disease, and dementia with Lewy bodies: a clinicopathologic study. Arch Neurol. 1998 Jul;55(7):969–978. doi: 10.1001/archneur.55.7.969. [DOI] [PubMed] [Google Scholar]
  18. Lopez O. L., Litvan I., Catt K. E., Stowe R., Klunk W., Kaufer D. I., Becker J. T., DeKosky S. T. Accuracy of four clinical diagnostic criteria for the diagnosis of neurodegenerative dementias. Neurology. 1999 Oct 12;53(6):1292–1299. doi: 10.1212/wnl.53.6.1292. [DOI] [PubMed] [Google Scholar]
  19. McKeith I. G., Fairbairn A. F., Perry R. H., Thompson P. The clinical diagnosis and misdiagnosis of senile dementia of Lewy body type (SDLT). Br J Psychiatry. 1994 Sep;165(3):324–332. doi: 10.1192/bjp.165.3.324. [DOI] [PubMed] [Google Scholar]
  20. McKeith I. G., Galasko D., Kosaka K., Perry E. K., Dickson D. W., Hansen L. A., Salmon D. P., Lowe J., Mirra S. S., Byrne E. J. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology. 1996 Nov;47(5):1113–1124. doi: 10.1212/wnl.47.5.1113. [DOI] [PubMed] [Google Scholar]
  21. McKeith I. G., Perry E. K., Perry R. H. Report of the second dementia with Lewy body international workshop: diagnosis and treatment. Consortium on Dementia with Lewy Bodies. Neurology. 1999 Sep 22;53(5):902–905. doi: 10.1212/wnl.53.5.902. [DOI] [PubMed] [Google Scholar]
  22. McKeith I., Fairbairn A., Perry R., Thompson P., Perry E. Neuroleptic sensitivity in patients with senile dementia of Lewy body type. BMJ. 1992 Sep 19;305(6855):673–678. doi: 10.1136/bmj.305.6855.673. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan E. M. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984 Jul;34(7):939–944. doi: 10.1212/wnl.34.7.939. [DOI] [PubMed] [Google Scholar]
  24. Merlet P., Valette H., Dubois-Randé J. L., Moyse D., Duboc D., Dove P., Bourguignon M. H., Benvenuti C., Duval A. M., Agostini D. Prognostic value of cardiac metaiodobenzylguanidine imaging in patients with heart failure. J Nucl Med. 1992 Apr;33(4):471–477. [PubMed] [Google Scholar]
  25. Minardo J. D., Tuli M. M., Mock B. H., Weiner R. E., Pride H. P., Wellman H. N., Zipes D. P. Scintigraphic and electrophysiological evidence of canine myocardial sympathetic denervation and reinnervation produced by myocardial infarction or phenol application. Circulation. 1988 Oct;78(4):1008–1019. doi: 10.1161/01.cir.78.4.1008. [DOI] [PubMed] [Google Scholar]
  26. Morris J. C., Drazner M., Fulling K., Grant E. A., Goldring J. Clinical and pathological aspects of parkinsonism in Alzheimer's disease. A role for extranigral factors? Arch Neurol. 1989 Jun;46(6):651–657. doi: 10.1001/archneur.1989.00520420071025. [DOI] [PubMed] [Google Scholar]
  27. Mäntysaari M., Kuikka J., Mustonen J., Tahvanainen K., Vanninen E., Länsimies E., Uusitupa M. Noninvasive detection of cardiac sympathetic nervous dysfunction in diabetic patients using [123I]metaiodobenzylguanidine. Diabetes. 1992 Sep;41(9):1069–1075. doi: 10.2337/diab.41.9.1069. [DOI] [PubMed] [Google Scholar]
  28. Nakajima K., Taki J., Tonami N., Hisada K. Decreased 123I-MIBG uptake and increased clearance in various cardiac diseases. Nucl Med Commun. 1994 May;15(5):317–323. doi: 10.1097/00006231-199405000-00003. [DOI] [PubMed] [Google Scholar]
  29. Olichney J. M., Galasko D., Salmon D. P., Hofstetter C. R., Hansen L. A., Katzman R., Thal L. J. Cognitive decline is faster in Lewy body variant than in Alzheimer's disease. Neurology. 1998 Aug;51(2):351–357. doi: 10.1212/wnl.51.2.351. [DOI] [PubMed] [Google Scholar]
  30. Papka M., Rubio A., Schiffer R. B. A review of Lewy body disease, an emerging concept of cortical dementia. J Neuropsychiatry Clin Neurosci. 1998 Summer;10(3):267–279. doi: 10.1176/jnp.10.3.267. [DOI] [PubMed] [Google Scholar]
  31. Rajput A. H., Rozdilsky B. Dysautonomia in Parkinsonism: a clinicopathological study. J Neurol Neurosurg Psychiatry. 1976 Nov;39(11):1092–1100. doi: 10.1136/jnnp.39.11.1092. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Sisson J. C., Shapiro B., Meyers L., Mallette S., Mangner T. J., Wieland D. M., Glowniak J. V., Sherman P., Beierwaltes W. H. Metaiodobenzylguanidine to map scintigraphically the adrenergic nervous system in man. J Nucl Med. 1987 Oct;28(10):1625–1636. [PubMed] [Google Scholar]
  33. Solanki K. K., Bomanji J., Moyes J., Mather S. J., Trainer P. J., Britton K. E. A pharmacological guide to medicines which interfere with the biodistribution of radiolabelled meta-iodobenzylguanidine (MIBG). Nucl Med Commun. 1992 Jul;13(7):513–521. doi: 10.1097/00006231-199207000-00006. [DOI] [PubMed] [Google Scholar]
  34. Stanton M. S., Tuli M. M., Radtke N. L., Heger J. J., Miles W. M., Mock B. H., Burt R. W., Wellman H. N., Zipes D. P. Regional sympathetic denervation after myocardial infarction in humans detected noninvasively using I-123-metaiodobenzylguanidine. J Am Coll Cardiol. 1989 Nov 15;14(6):1519–1526. doi: 10.1016/0735-1097(89)90391-4. [DOI] [PubMed] [Google Scholar]
  35. Takano H., Yoshimura N. [Markedly decreased cardiac uptake with 123I-MIBG scintigraphy in a case of pure progressive autonomic failure]. Rinsho Shinkeigaku. 1993 Jul;33(7):784–786. [PubMed] [Google Scholar]
  36. Takatsu H., Nishida H., Matsuo H., Watanabe S., Nagashima K., Wada H., Noda T., Nishigaki K., Fujiwara H. Cardiac sympathetic denervation from the early stage of Parkinson's disease: clinical and experimental studies with radiolabeled MIBG. J Nucl Med. 2000 Jan;41(1):71–77. [PubMed] [Google Scholar]
  37. Tobes M. C., Jaques S., Jr, Wieland D. M., Sisson J. C. Effect of uptake-one inhibitors on the uptake of norepinephrine and metaiodobenzylguanidine. J Nucl Med. 1985 Aug;26(8):897–907. [PubMed] [Google Scholar]
  38. Wakabayashi K., Takahashi H. Neuropathology of autonomic nervous system in Parkinson's disease. Eur Neurol. 1997;38 (Suppl 2):2–7. doi: 10.1159/000113469. [DOI] [PubMed] [Google Scholar]
  39. Wieland D. M., Brown L. E., Rogers W. L., Worthington K. C., Wu J. L., Clinthorne N. H., Otto C. A., Swanson D. P., Beierwaltes W. H. Myocardial imaging with a radioiodinated norepinephrine storage analog. J Nucl Med. 1981 Jan;22(1):22–31. [PubMed] [Google Scholar]
  40. Yates C. M., Ritchie I. M., Simpson J., Maloney A. F., Gordon A. Noradrenaline in Alzheimer-type dementia and Down syndrome. Lancet. 1981 Jul 4;2(8236):39–40. doi: 10.1016/s0140-6736(81)90269-5. [DOI] [PubMed] [Google Scholar]
  41. Yoshita M. Differentiation of idiopathic Parkinson's disease from striatonigral degeneration and progressive supranuclear palsy using iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. J Neurol Sci. 1998 Feb 18;155(1):60–67. doi: 10.1016/s0022-510x(97)00278-5. [DOI] [PubMed] [Google Scholar]
  42. Yoshita M., Hayashi M., Hirai S. Decreased myocardial accumulation of 123I-meta-iodobenzyl guanidine in Parkinson's disease. Nucl Med Commun. 1998 Feb;19(2):137–142. doi: 10.1097/00006231-199802000-00007. [DOI] [PubMed] [Google Scholar]
  43. den HARTOG JAGER W. A., BETHLEM J. The distribution of Lewy bodies in the central and autonomic nervous systems in idiopathic paralysis agitans. J Neurol Neurosurg Psychiatry. 1960 Nov;23:283–290. doi: 10.1136/jnnp.23.4.283. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES