J Korean Neurol Assoc > Volume 21(3); 2003 > Article

Journal of the Korean Neurological Association 2003;21(3): 261-266.

루이체치매의 임상 양상,약물 반응 및 뇌영상 소견

김재우 , 박경원 차재관 김상호 강도영

동아대학교 의과대학 신경과학교실,핵의학교실

"Clinical Features, Drug Responsiveness and Neuroimaging Findings in Dementia with Lewy Bodies"

Jae Woo Kim

Department of Neurology, Nuclear Medicine* College of Medicine, Dong-A University

Abstract

"Background: Dementia with Lewy bodies (DLB) is the second common degenerative dementia and has several char-acteristics including fluctuating cognition, visual hallucination and parkinsonism. We investigated clinical manifesta-tions, responsiveness to drugs and neuroimaging findings in DLB patients.
Methods: Ten probable DLB patients were included in this study. For responsiveness to drugs, we measured Unified Parkinson s Disease Rating Scale (UPDRS) of rest tremor, rigidity and bradykinesia (finger tapping and leg agility), and Korean version of mini-mental state examina-tion (K-MMSE) before and after administration of levodopa or cholinesterase inhibitors. Brain MRI, cerebral perfusion SPECT (Tc-99m HMPAO) and dopamine transporter SPECT (123I-IPT) were also performed. R e s u l t s: All patients were men and mean age of onset was 66.9 years (range from 58 to 80). All had fluctuating cognition and parkinsonism, and 7 had visual hallucination. Mean increment of K-MMSE after administration of cholinesterase inhibitors was 2.1 points. Levodopa reduced UPDRS scores of tremor, rigidity and bradykinesia by 0.4, 0.6 and 1.0 points, respectively. Cerebral perfusion SPECT using Tc-99m HMPAO showed hypoperfusion in occipital area as well as fronto-temporo-parietal areas. Dopamine transporter SPECT using 123I-IPT revealed reduced uptake comparable to Parkinson ’s dis -ease in the striatum.
Conclusions: DLB should be first considered as one of possible diagnoses in patients showing dementia in the early stage of parkinsonism. Responsiveness of parkinsonism to levodopa seems favorable. Cholinesterase inhibitors are thought promising in enhancing cognition in short term periods. It is suggested that occipi-tal hypoperfusion be a characteristic finding in DLB and be helpful in differentiating DLB from other degenerative dementias.Key Words: Dementia with Lewy bodies, Parkinsonism, Dopamine transporter, SPECT"