Progression of dopaminergic degeneration in dementia with Lewy bodies and Parkinson's disease with and without dementia assessed using 123I-FP-CIT SPECT

Purpose: The objective of this study was to investigate the rate of progression of nigrostriatal dopaminergic loss in subjects with dementia with Lewy bodies (DLB), Parkinson's disease (PD) and PD with dementia (PDD) using serial I-123-FP-CIT SPECT imaging. We hypothesised that striatal rates of decline in patients would be greater than in controls, and that DLB and PDD would show similar rates, reflecting the similarity in neurobiological mechanisms of dopaminergic loss between the two disorders. Methods: We studied 20 patients with DLB, 20 with PD, 15 with PDD and 22 healthy age-matched controls. Semi-automated region of interest (ROI) analysis was performed on both baseline and repeat scans for each subject and mean striatal uptake ratios ( caudate, anterior and posterior putamen) were calculated. Results: Rates of decline in striatal binding between groups were assessed using ANCOVA. Significant differences between patients and controls were observed in caudate ( DLB, PD, PDD, p <= 0.01), anterior putamen ( DLB, PDD, p <= 0.05; PD, p= 0.07) and posterior putamen ( DLB, PD, PDD, p< 0.006). Rates of decline were similar between DLB, PD and PDD. Conclusion: In conclusion, this is the first study to show that significant progressive dopaminergic loss occurs in DLB and PDD using serial I-123-FP-CIT SPECT. Dementia severity and motor impairment were correlated with decline, suggesting that dopaminergic loss may play an important role in cognitive as well as motor features.