Background: Dopaminergic imaging is an established biomarker for dementia with Lewy bodies, but
its diagnostic accuracy at the mild cognitive impairment stage remains uncertain.
Aims: To provide robust prospective evidence of the diagnostic accuracy of dopaminergic imaging at
the mild cognitive impairment stage to either support ...
Background: Dopaminergic imaging is an established biomarker for dementia with Lewy bodies, but
its diagnostic accuracy at the mild cognitive impairment stage remains uncertain.
Aims: To provide robust prospective evidence of the diagnostic accuracy of dopaminergic imaging at
the mild cognitive impairment stage to either support or refute its inclusion as a biomarker for the
diagnosis of mild cognitive impairment with Lewy bodies.
Methods: We conducted a prospective diagnostic accuracy study of baseline dopaminergic imaging
with 123-I-FP-CIT SPECT in 144 patients with mild cognitive impairment (MCI). Images were rated as
normal or abnormal by a panel of experts with access to striatal binding ratio results. Follow-up
consensus diagnosis based on the presence of core features of Lewy body disease was used as the
reference standard.
Results: At latest assessment (mean 2 years) 61 patients had probable MCI with Lewy bodies, 26
possible MCI with Lewy bodies and 57 MCI due to Alzheimer’s disease. The sensitivity of baseline FPCIT visual rating for probable MCI with Lewy bodies was 66% (95% CI 52 to 77%), specificity 88% (76 to
95%) and accuracy 76% (68 to 84%), with positive likelihood ratio 5.3.
Conclusions: It is over five times as likely for an abnormal scan to be found in probable MCI with Lewy
bodies than MCI due to Alzheimer’s disease. Dopaminergic imaging appears to be useful at the mild
cognitive impairment stage, in cases where Lewy body disease is suspected clinically.
