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J. and neuropathologic diagnoses were applied with the use of standard international criteria. == Results: == Fifty-five patients (33 with DLB and 22 with Alzheimer disease) were included. Against autopsy diagnosis, 123I-FP-CIT had a balanced diagnostic reliability of 86% (sensitivity 80%, specificity 92%) compared with clinical diagnosis, which had an reliability of 79% (sensitivity 87%, specificity 72%). Among patients with DLB, 10% (3 patients) fulfilled pathologic criteria for Lewy body disease but had normal123I-FP-CIT imaging. == Findings: == This large autopsy analysis of123I-FP-CIT imaging in dementia demonstrates that it is a valid and accurate biomarker intended for DLB, and the high specificity compared with clinical diagnosis (20% higher) is clinically important. The results need to be replicated with patients recruited from a wider range of settings, including movement disorder clinics and Tandospirone general practice. While an abnormal123I-FP-CIT scan strongly supports Tandospirone Lewy body disease, a normal check out does not exclude DLB with minimal brainstem involvement. == Classification of evidence: == This study provides Class I evidence that123I-FP-CIT dopaminergic neuroimaging accurately identifies patients with DLB. Early identification and accurate diagnosis of Tandospirone dementia are priorities because disease-modifying treatments need to be administered at the earliest stage. Accurate diagnosis is more hard during earlier phases of disease, and the need to use biomarkers to improve accuracy is correspondingly more pressing and included in recent diagnostic criteria. 1, 2For example, dementia with Lewy bodies (DLB) is the second commonest cause of degenerative dementia after Alzheimer disease (AD). 3Diagnostic criteria for DLB have large accuracy in specialist centers (sensitivity and specificity both > 80%), 4although case detection in many centers is less accurate. Dopaminergic neurons in the substantia nigra pars compacta project to the striatum (the nigrostriatal pathway). Their loss is associated with the presence of -synuclein aggregates (Lewy body and Lewy neurites), which are a core neuropathologic feature of DLB and Parkinson disease (PD). 4Autopsy studies report a loss of dopamine transporters associated with loss of nigrostriatal neurons, 5which can be assessed with imaging. Such imaging, using PET and SPECT ligands, is abnormal in PD, multiple system atrophy, corticobasal degeneration (CBD), 6progressive supranuclear palsy, 6frontotemporal lobar degeneration (FTLD), 7and DLB. 8Dopaminergic neuroimaging is a biomarker included as a suggestive feature in the consensus diagnostic criteria for DLB, 4and a review of123I-N-fluoropropyl-2b-carbomethoxy-3b-(4-iodophenyl) Tandospirone nortropane (123I-FP-CIT) SPECT studies, with clinical diagnosis used because the standard, reported a sensitivity of 78% and specificity of 90% for differentiating AD from DLB. 9 Although123I-FP-CIT imaging has good accuracy intended for DLB in degenerative dementia, its validation has rested mainly on comparisons with a consensus clinical diagnosis. 10The gold standard for biomarker validation is autopsy, but only 2 small studies have evaluated123I-FP-CIT against neuropathology in DLB. One Tandospirone examined 20 patients (8 with DLB) and found that123I-FP-CIT had a sensitivity of 88% and specificity of 100%. 11The other investigated neuronal loss and pathology in 23 cases (7 with DLB), reporting an association between neuronal density in the substantia nigra and reduced uptake on123I-FP-CIT. 12There is therefore a need to validate123I-FP-CIT diagnostic reliability in autopsy-confirmed DLB. Here, we report such a validation using brain cells from the Newcastle Brain Cells Resource in 55 patients with dementia who had123I-FP-CIT SPECT imaging in research studies during life. PGC1A == METHODS == The primary purpose of this study was to assess the diagnostic accuracy of123I-FP-CIT dopaminergic imaging in people with neurodegenerative dementia. This study provides Class I evidence that123I-FP-CIT dopaminergic neuroimaging accurately identifies patients with DLB. == Patients and clinical diagnosis. == Patients > 60 years aged (at clinical assessment) in the Newcastle Brain Tissue Source who had had123I-FP-CIT imaging in the context of a dementia were included in this study. We did not include patients with PD or healthy controls. == Standard protocol approvals, registrations, and patient consents. == Clinical research studies were approved by.