Talks：

DLB and RBD -- current update and challenges

Name：

邱百誼(Pai-Yi Chiu)

Position：

Attending physician

Affiliation：

Department of Neurology, Show Chwan Memorial Hospital

Email：

paiyibox@gmail.com

Photo：

Research Interests：

Neuropsychiatry Dementia

Selected Publications：

◆ Chan PC, Wei CY, Hung GU, Chiu PY. Reduced vascular risk factors in Parkinson’s disease dementia and dementia with Lewy bodies compared to Alzheimer’s disease. Brain and Behavior 2018. DOI: 10.1002/brb3.916. ◆ Chiu PY, Hsien Hsu MH, Wang CW, Tsai CT, Pai MC. Visual hallucinations in Alzheimer's disease is significantly associated with clinical diagnostic features of dementia with Lewy bodies. PLoS One. 2017; DOI: 10.1371/journal.pone.0186886. ◆ Hung GU, Chiu PY. The Value of 99mTc-Trodat-1 SPECT for Discriminating Dementia with Lewy Bodies and Alzheimer’s disease. J Nucl Med 2017; 58 (supplement 1): 1279. ◆ Chiu PY, Wang CW, Tsai CT, Li SH, Lin CL, Lai TJ. Depression in dementia with Lewy bodies: A comparison with Alzheimer's disease. PLoS One. 2017; 12(6): e0179399. ◆ Chiu PY, Teng PR, Wei CY, Wang CW, Tsai CT. Gender difference in the association and presentation of visual hallucinations in dementia with Lewy bodies: a cross-sectional study. International Journal of Geriatric Psychiatry. 2017. DOI: 10.1002/gps.4706. ◆ Chiu PY, Tsai CT, MS, Chen PK, MD, Chen WJ, MS, Lai TJ. Neuropsychiatric symptoms in Parkinson’s disease dementia are more similar to Alzheimer’s disease than dementia with Lewy bodies: a case-control study. PLoS One. 2016; 11(4):e0153989.

Abstract：

The fourth consensus criteria for the diagnosis of dementia with Lewy bodies (DLB) has been published in June last year. The newer criteria have some important changes of the clinical features and indicative biomarkers for the clinical diagnosis of DLB. Compared with the previous consensus criteria, fluctuation of cognition, recurrent visual hallucinations, spontaneous parkinsonism, and decreased dopamine receptor uptake are not changed of their status. However, REM sleep behavior disorder (RBD), clinically or polysomnography (PSG) study proved, has been proposed as a core clinical diagnosis feature as well as an indicative biomarker based on the findings that RBD may increase the sensitivity and specificity for the clinical diagnosis of DLB. However, there is still no molecular imaging that targeting alpha synuclein which is regarded as the primary pathological abnormality of DLB. In recent years, [123I]meta-iodobenzylguanidine (MIBG) myocardial scintigraphy has been used for visual assessment of the sympathetic nerve terminals, based on the fact that MIBG, a noradrenaline storage analogue, shares the same metabolic pathways as noradrenaline. The decreased cardiac uptake of MIBG in LBD as well as iRBD reflects the postganglionic cardiac sympathetic denervation. MIBG cardiac scintigraphy has been also proposed as a method to differentiate between DLB and AD. There are several other studies that support the evidence of MIBG imaging for the clinical differential diagnosis of DLB from other neurodegenerative disorders. Therefore, it becomes one of the indicative biomarkers for the diagnosis of DLB in the fourth consensus criteria. Since decreased cardiac uptake of MIBG in iRBD is also noted in few studies, the combination of mild cognitive impairment (MCI), RBD, and reduced MIBG uptake should have become the most important indicators for the prodromal detection of DLB. Effectiveness of the current medication for AD, such as acetylcholinesterase inhibitors or memantine, on DLB is still controversial. Fortunately, there are few countries agreed with the clinical use of donepezil in patients with DLB and we hope there will be more clinical researches to develop new technics for the diagnosis and new drugs for the treatment of DLB.