Clinical-Imaging-Pathologic Analysis in Seven Patients with Dementia: Correlations with Ioflupane SPECT Findings (P6.236)

Objective: To assess the clinicopathologic correlations in those with dementia who have undergone ioflupane SPECT. Background: Decreased striatonigral uptake on ioflupane SPECT imaging in patients with dementia is presumed to reflect underlying Lewy body disease (LBD) based on limited clinicopathologic data from Europe. Methods: Data was analyzed on all subjects enrolled in the Mayo Alzheimer’s Disease Research Center who were diagnosed with a dementia syndrome, had undergone ioflupane SPECT imaging and underwent autopsy. Ioflupane SPECT was performed 1-25 (median 15) months prior to death; the findings were interpreted in a blinded manner, and were considered abnormal if there was unequivocally reduced uptake in one or both putamen based on visual inspection. Group comparisons for ioflupane SPECT findings between LBD and non-LBD pathologies were made using Fischer’s exact test. Results: Among 101 subjects who have undergone ioflupane SPECT imaging at our center, nine have died, of whom seven have undergone autopsy (all male). The median (range) for key features were: age of onset of cognitive decline: 60 (51-76) years; age of death: 70 (57-86) years; and duration of cognitive impairment: 9 (3-12) years. The clinical diagnosis, ioflupane SPECT findings, and neuropathologic findings for each case were as follows: Case 1-Alzheimer’s disease dementia (ADem)/normal/Alzheimer’s disease (AD); Case 2-corticobasal syndrome/normal/AD; Case 3-combined ADem and dementia with Lewy bodies (DLB)/normal/AD; Case 4-primary progressive aphasia/normal/frontotemporal lobar degeneration; Case 5-DLB/abnormal/LBD; Case 6-DLB/abnormal/LBD; Case 7-DLB/abnormal/LBD. Abnormal ioflupane SPECT was seen in all 3 cases with underlying LBD, while all 4 non-LBD pathology cases had a normal scan (p=0.03). Conclusions: In this small series of patients with various dementia syndromes, an abnormal ioflupane SPECT was strongly associated with underlying LBD. These findings support the potential utility of ioflupane SPECT imaging in predicting LBD pathology in those with a dementia syndrome. Disclosure: Dr. Boeve has received personal compensation for activities with Isis Pharmaceuticals. Dr. Boeve has received research support from GE Healthcare and FORUM Pharmaceuticals. Dr. Lowe has received personal compensation for activities with Bayer Pharmaceuticals as a consultant. Dr. Kantarci has received personal compensation for activities with Takeda and Novartis. Dr. Parisi has nothing to disclose. Dr. Dickson has nothing to disclose. Dr. Ferman has nothing to disclose. Dr. Jones has nothing to disclose. Dr. Graff-Radford has nothing to disclose. Dr. Savica has nothing to disclose. Dr. Machulda has nothing to disclose. Dr. Fields has nothing to disclose. Dr. Dheel has nothing to disclose. Dr. Allen has nothing to disclose. Dr. Drubach has received research support from Allon Therapeutics. Dr. St. Louis has nothing to disclose. Dr. Silber has nothing to disclose. Dr. Jack has received personal compensation for activities with Janssen Research & Development, LLC by providing consulting services. Dr. Jack has received research support from the National Institutes of Health (R01-AG011378, RO1-AG041851, RO1-AG037551. Dr. Knopman has received personal compensation for activities with Lundbeck Pharmaceuticals. Dr. Knopman has received personal compensation in an editorial capacity for Neurology. Dr. Knopman has received research support from Lilly Pharmaceuticals and Ta Dr. Ronald Petersen received personal compensation from Pfizer, Inc., Janssen Alzheimer9s Immunotherapy. Merck, inc. Roche, Inc. Genentech, Inc. Biogen, Inc. Eli Lilly and Co. as a consultant or speaker.