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October 11, 2022; 99 (15) Clinical/Scientific Note

Neuroimaging Biomarkers in a Patient With Probable Psychiatric-Onset Prodromal Dementia With Lewy Bodies

Daniele Urso, Valentina Gnoni, Roberto De Blasi, Antonio Anastasia, Dag Aarsland, View ORCID ProfileKallo Chaudhuri Ray, Giancarlo Logroscino
First published August 11, 2022, DOI: https://doi.org/10.1212/WNL.0000000000201166
Daniele Urso
From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione “Card. G. Panico”, Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy.
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Valentina Gnoni
From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione “Card. G. Panico”, Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy.
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Roberto De Blasi
From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione “Card. G. Panico”, Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy.
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Antonio Anastasia
From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione “Card. G. Panico”, Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy.
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Dag Aarsland
From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione “Card. G. Panico”, Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy.
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Kallo Chaudhuri Ray
From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione “Card. G. Panico”, Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy.
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  • ORCID record for Kallo Chaudhuri Ray
Giancarlo Logroscino
From the Center for Neurodegenerative Diseases and the Aging Brain (D.U., V.G., G.L.), Department of Clinical Research in Neurology, University of Bari “Aldo Moro”, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy; Department of Neurosciences (D.U., V.G., D.A., K.R.C.), King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom; Department of Diagnostic Imaging (R.D.B., A.A.), Pia Fondazione di Culto e Religione “Card. G. Panico”, Tricase, Italy; and Department of Basic Medicine (G.L.), Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy.
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Citation
Neuroimaging Biomarkers in a Patient With Probable Psychiatric-Onset Prodromal Dementia With Lewy Bodies
Daniele Urso, Valentina Gnoni, Roberto De Blasi, Antonio Anastasia, Dag Aarsland, Kallo Chaudhuri Ray, Giancarlo Logroscino
Neurology Oct 2022, 99 (15) 654-657; DOI: 10.1212/WNL.0000000000201166

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Abstract

Objectives Psychiatric-onset prodromal dementia with Lewy bodies (DLBs) is a recently proposed clinical entity characterized by psychiatric presentation that may predate clinical dementia by many years. It is not yet clear how to identify patients with prominent late-onset psychiatric symptoms who may have underlying Lewy body disease. In this article, we describe how neuroimaging can assist in the identification of this condition.

Methods A 77-year-old man presented with late-onset psychosis. He underwent an extensive clinical and neuropsychological evaluation. These included brain MRI with arterial spin labeling (ASL) which quantifies perfusion. [123I] FP-CIT SPECT and I-metaiodobenzylguanidine scintigraphy assessed striatal dopaminergic and cardiac adrenergic integrity, respectively.

Results Clinical evaluation revealed a history of REM sleep behavior disorder and parkinsonism induced by antipsychotics. The patient's cognitive function was normal. Conventional MRI showed parieto-occipital atrophy, and posterior hypoperfusion was revealed by ASL-MRI. Of note, the “cingulate island sign” was present. [123I]FP-CIT SPECT and I-metaiodobenzylguanidine endorsed the suspicion of α-synucleinopathy. The patient fulfils the recently proposed key features of psychiatric-onset prodromal DLB.

Discussion Prodromal DLB is an emerging concept. Biomarkers have not been yet established. We propose that nuclear imaging and advanced MRI technics showing posterior hypoperfusion and the presence of the “cingulate island sign” could be promising biomarker candidates.

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Linda Hershey, MD, PhD, FAAN.

  • Received February 9, 2022.
  • Accepted in final form July 11, 2022.
  • © 2022 American Academy of Neurology
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