Dementia with Lewy bodies: Basis of cingulate island sign

Jonathan Graff-Radford, Melissa E Murray, Val Lowe, Bradley F Boeve, Tanis Jill Ferman, Scott A. Przybelski, Timothy G. Lesnick, Matthew L. Senjem, Jeffrey L. Gunter, Glenn E. Smith, David S Knopman, Clifford R Jr. Jack, Dennis W Dickson, Ronald Carl Petersen, Kejal M Kantarci

Research output: Contribution to journalArticle

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Abstract

Objectives: To investigate clinical, imaging, and pathologic associations of the cingulate island sign (CIS) in dementia with Lewy bodies (DLB). Methods: We retrospectively identified and compared patients with a clinical diagnosis of DLB (n 5 39); patients with Alzheimer disease (AD) matched by age, sex, and education (n 5 39); and cognitively normal controls (n 5 78) who underwent 18F-fluorodeoxyglucose (FDG) and C11 Pittsburgh compound B (PiB)-PET scans. Among these patients, we studied those who came to autopsy and underwent Braak neurofibrillary tangle (NFT) staging (n 5 10). Results: Patients with a clinical diagnosis of DLB had a higher ratio of posterior cingulate to precuneus plus cuneus metabolism, cingulate island sign (CIS), on FDG-PET than patients with AD (p , 0.001), a finding independent of b-amyloid load on PiB-PET (p 5 0.56). Patients with CIS positivity on visual assessment of FDG-PET fit into the group of high- or intermediate-probability DLB pathology and received clinical diagnosis of DLB, not AD. Higher CIS ratio correlated with lower Braak NFT stage (r 5 20.96; p , 0.001). Conclusions: Our study found that CIS on FDG-PET is not associated with fibrillar b-amyloid deposition but indicates lower Braak NFT stage in patients with DLB. Identifying biomarkers that measure relative contributions of underlying pathologies to dementia is critical as neurotherapeutics move toward targeted treatments.

Original languageEnglish (US)
Pages (from-to)801-809
Number of pages9
JournalNeurology
Volume83
Issue number9
DOIs
StatePublished - 2014

Fingerprint

Lewy Body Disease
Islands
Neurofibrillary Tangles
Alzheimer Disease
Amyloid
Occipital Lobe
Parietal Lobe
Clinical Pathology
Sex Education
Gyrus Cinguli
Fluorodeoxyglucose F18
Positron-Emission Tomography
Dementia
Autopsy
Biomarkers
Pathology

ASJC Scopus subject areas

  • Clinical Neurology
  • Medicine(all)

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Dementia with Lewy bodies : Basis of cingulate island sign. / Graff-Radford, Jonathan; Murray, Melissa E; Lowe, Val; Boeve, Bradley F; Ferman, Tanis Jill; Przybelski, Scott A.; Lesnick, Timothy G.; Senjem, Matthew L.; Gunter, Jeffrey L.; Smith, Glenn E.; Knopman, David S; Jack, Clifford R Jr.; Dickson, Dennis W; Petersen, Ronald Carl; Kantarci, Kejal M.

In: Neurology, Vol. 83, No. 9, 2014, p. 801-809.

Research output: Contribution to journalArticle

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abstract = "Objectives: To investigate clinical, imaging, and pathologic associations of the cingulate island sign (CIS) in dementia with Lewy bodies (DLB). Methods: We retrospectively identified and compared patients with a clinical diagnosis of DLB (n 5 39); patients with Alzheimer disease (AD) matched by age, sex, and education (n 5 39); and cognitively normal controls (n 5 78) who underwent 18F-fluorodeoxyglucose (FDG) and C11 Pittsburgh compound B (PiB)-PET scans. Among these patients, we studied those who came to autopsy and underwent Braak neurofibrillary tangle (NFT) staging (n 5 10). Results: Patients with a clinical diagnosis of DLB had a higher ratio of posterior cingulate to precuneus plus cuneus metabolism, cingulate island sign (CIS), on FDG-PET than patients with AD (p , 0.001), a finding independent of b-amyloid load on PiB-PET (p 5 0.56). Patients with CIS positivity on visual assessment of FDG-PET fit into the group of high- or intermediate-probability DLB pathology and received clinical diagnosis of DLB, not AD. Higher CIS ratio correlated with lower Braak NFT stage (r 5 20.96; p , 0.001). Conclusions: Our study found that CIS on FDG-PET is not associated with fibrillar b-amyloid deposition but indicates lower Braak NFT stage in patients with DLB. Identifying biomarkers that measure relative contributions of underlying pathologies to dementia is critical as neurotherapeutics move toward targeted treatments.",
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T2 - Basis of cingulate island sign

AU - Graff-Radford, Jonathan

AU - Murray, Melissa E

AU - Lowe, Val

AU - Boeve, Bradley F

AU - Ferman, Tanis Jill

AU - Przybelski, Scott A.

AU - Lesnick, Timothy G.

AU - Senjem, Matthew L.

AU - Gunter, Jeffrey L.

AU - Smith, Glenn E.

AU - Knopman, David S

AU - Jack, Clifford R Jr.

AU - Dickson, Dennis W

AU - Petersen, Ronald Carl

AU - Kantarci, Kejal M

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N2 - Objectives: To investigate clinical, imaging, and pathologic associations of the cingulate island sign (CIS) in dementia with Lewy bodies (DLB). Methods: We retrospectively identified and compared patients with a clinical diagnosis of DLB (n 5 39); patients with Alzheimer disease (AD) matched by age, sex, and education (n 5 39); and cognitively normal controls (n 5 78) who underwent 18F-fluorodeoxyglucose (FDG) and C11 Pittsburgh compound B (PiB)-PET scans. Among these patients, we studied those who came to autopsy and underwent Braak neurofibrillary tangle (NFT) staging (n 5 10). Results: Patients with a clinical diagnosis of DLB had a higher ratio of posterior cingulate to precuneus plus cuneus metabolism, cingulate island sign (CIS), on FDG-PET than patients with AD (p , 0.001), a finding independent of b-amyloid load on PiB-PET (p 5 0.56). Patients with CIS positivity on visual assessment of FDG-PET fit into the group of high- or intermediate-probability DLB pathology and received clinical diagnosis of DLB, not AD. Higher CIS ratio correlated with lower Braak NFT stage (r 5 20.96; p , 0.001). Conclusions: Our study found that CIS on FDG-PET is not associated with fibrillar b-amyloid deposition but indicates lower Braak NFT stage in patients with DLB. Identifying biomarkers that measure relative contributions of underlying pathologies to dementia is critical as neurotherapeutics move toward targeted treatments.

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