精神医学49巻7号

2007年07月発行

特集 レビー小体型認知症をめぐって

レビー小体型認知症の脳画像・心筋シンチ

著者： 吉田光宏¹ 山田正仁²

所属機関： ¹金沢大学医学部附属病院神経内科 ²金沢大学大学院医学系研究科 脳老化・神経病態学(神経内科学)

ページ範囲：P.699 - P.705

はじめに

　レビー小体型認知症（DLB）の中核症状は，しばしばアルツハイマー病（AD），脳血管性認知症（VaD）や認知症を伴うパーキンソン病（PDD）と重複することがあり，時に鑑別診断が困難なことがある。診断基準としては，第1回のDLBの国際ワークショップの報告として出版されたもの²¹⁾がこれまで用いられていたが，この診断基準では，特異度は高いが，感度が低い点が問題となっていた¹⁹⁾。この点を鑑み，第3回のDLB/PDDの国際ワークショップにおいて診断基準が改訂され2005年のNeurology誌に発表されたものが，最新の診断基準となっている²⁰⁾。画像診断が，DLBと他の認知症を鑑別するうえで有用であることが，この最新の診断基準でも認められている。本稿ではDLBの画像診断について概説する。

参考文献

1) Barber R, Gholkar A, Scheltens P, et al：Medial temporal lobe atrophy on MRI in dementia with Lewy bodies. Neurology 52：1153-1158, 1999

2) Barker RA：Getting to the heart of dementia. J Neurol Neurosurg Psychiatry 71：574-575, 2001

3) Bozzali M, Falini A, Cercignani M, et al：Brain tissue damage in dementia with Lewy bodies：An in vivo diffusion tensor MRI study. Brain 128：1595-1604, 2005

4) Burton EJ, McKeith IG, Burn DJ, et al：Cerebral atrophy in Parkinson's disease with and without dementia：A comparison with Alzheimer's disease, dementia with Lewy bodies and controls. Brain 127：791-800, 2004

I-beta-CIT single-photon emission tomography in dementia of the Alzheimer-type and diffuse Lewy body disease. Eur J Nucl Med 24：320-325, 1997

6) Geser F, Wenning GK, Poewe W, et al：How to diagnose dementia with Lewy bodies：State of the art. Mov Disord 20(Suppl 12)S11-20, 2005

7) Gilman S, Koeppe RA, Little R, et al：Striatal monoamine terminals in Lewy body dementia and Alzheimer's disease. Ann Neurol 55：774-780, 2004

I-MIBG心筋シンチグラフィによる心臓交感神経機能の検討．臨床神経学 34：402-404，1994

I-metaiodobenzylguanidine myocardial scintigraphy in the diagnosis of Lewy body disease in patients with dementia in a memory clinic. Dement Geriatr Cogn Disord 22：379-384, 2006

10) Hanyu H, Shimizu S, Tanaka Y, et al：MR features of the substantia innominata and therapeutic implications in dementias. Neurobiol Aging 28：548-554, 2007

11) Hashimoto M, Kitagaki H, Imamura T, et al：Medial temporal and whole-brain atrophy in dementia with Lewy bodies：A volumetric MRI study. Neurology 51：357-362, 1998

12) Herholz K：PET studies in dementia. Ann Nucl Med 17：79-89, 2003

13) Higuchi M, Tashiro M, Arai H, et al：Glucose hypometabolism and neuropathological correlates in brains of dementia with Lewy bodies. Exp Neurol 162：247-256, 2000

14) Hu XS, Okamura N, Arai H, et al：18F-fluorodopa PET study of striatal dopamine uptake in the diagnosis of dementia with Lewy bodies. Neurology 55：1575-1577, 2000

15) Ishii K, Imamura T, Sasaki M, et al：Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer's disease. Neurology 51：125-130, 1998

16) Ishii K, Yamaji S, Kitagaki H, et al：Regional cerebral blood flow difference between dementia with Lewy bodies and AD. Neurology 53：413-416, 1999

17) Lippa CF, Smith TW, Swearer JM：Alzheimer's disease and Lewy body disease：A comparative clinicopathological study. Ann Neurol 35：81-88, 1994

18) Lobotesis K, Fenwick JD, Phipps A, et al：Occipital hypoperfusion on SPECT in dementia with Lewy bodies but not AD. Neurology 56：643-649, 2001

19) McKeith I, Mintzer J, Aarsland D, et al：Dementia with Lewy bodies. Lancet Neurol 3：19-28, 2004

20) McKeith IG, Dickson DW, Lowe J, et al：Diagnosis and management of dementia with Lewy bodies：Third report of the DLB Consortium. Neurology 65：1863-1872, 2005

21) McKeith IG, Galasko D, Kosaka K, et al：Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies(DLB)：Report of the consortium on DLB international workshop. Neurology 47：1113-1124, 1996

22) Minoshima S, Foster NL, Sima AA, et al：Alzheimer's disease versus dementia with Lewy bodies：Cerebral metabolic distinction with autopsy confirmation. Ann Neurol 50：358-365, 2001

I-MIBG scintigraphy in idiopathic REM sleep behavior disorder. Neurology 67：2236-2238, 2006

24) Molina JA, Garcia-Segura JM, Benito-Leon J, et al：Proton magnetic resonance spectroscopy in dementia with Lewy bodies. Eur Neurol 48：158-163, 2002

25) O'Brien JT, Colloby S, Fenwick J, et al：Dopamine transporter loss visualized with FP-CIT SPECT in the differential diagnosis of dementia with Lewy bodies. Arch Neurol 61：919-925, 2004

I-QNB SPECT demonstrates loss of cholinergic muscarinic receptors in Alzheimer's disease, but occipital increases in dementia with Lewy bodies and Parkinson's disease dementia, in The 9th International Conference on Alzheimer's Disease and Related Disorders. pp2-147, 2004

27) O'Brien JT, Paling S, Barber R, et al：Progressive brain atrophy on serial MRI in dementia with Lewy bodies, AD, and vascular dementia. Neurology 56：1386-1388, 2001

28) Small GW：Neuroimaging as a diagnostic tool in dementia with Lewy bodies. Dement Geriatr Cogn Disord 17(Suppl 1)：25-31, 2004

29) Spiegel J, Mollers MO, Jost WH, et al：FP-CIT and MIBG scintigraphy in early Parkinson's disease. Mov Disord 20：552-561, 2005

30) Tam CW, Burton EJ, McKeith IG, et al：Temporal lobe atrophy on MRI in Parkinson disease with dementia：A comparison with Alzheimer disease and dementia with Lewy bodies. Neurology 64：861-865, 2005

Tc-HMPAO single-photon emission computed tomography study of Lewy body disease. J Neurol 244：349-359, 1997

32) Whitwell JL, Weigand SD, Shiung MM, et al：Focal atrophy in dementia with Lewy bodies on MRI：A distinct pattern from Alzheimer's disease. Brain 130：708-719, 2007

33) Wieland DM, Wu J, Brown LE, et al：Radiolabeled adrenergi neuron-blocking agents：Adrenomedullary imaging with［131I］iodobenzylguanidine. J Nucl Med 21：349-353, 1980

34) Yoshita M, Taki J, Yamada M：A clinical role for［(123)I］MIBG myocardial scintigraphy in the distinction between dementia of the Alzheimer's-type and dementia with Lewy bodies. J Neurol Neurosurg Psychiatry 71：583-588, 2001

I-MIBG radioactivity in the differential diagnosis of DLB from AD. Neurology 66：1850-1854, 2006

36) Yoshita M, Yamada M：Occipital cerebral hypoperfusion and cardiac sympathetic dysfunction in dementia with Lewy bodies and dementia of the Alzheimer's type. Neurology 60：A208, 2003

37) 吉田光宏，山田正仁：レビー小体型痴呆の画像診断．Cognition Dementia 4：40-45，2005