Abstract
Setting
Dementia with Lewy bodies (DLB) remains poorly understood and frequently misdiagnosed, complicated by co-pathology with other dementia forms. DLB patients often present with autonomic dysfunction and peripheral Lewy body pathology alongside central lesions. Monoaminergic neurotransmitter systems seem an early target for DLB pathology, especially the noradrenergic system. Noradrenaline analogue 123I-metaiodobenzylguanidine (MIBG) is considered an indicative biomarker for peripheral noradrenergic sympathetic denervation.
Objectives
Our aim was to measure paired monoaminergic levels and MIBG scintigraphy values in DLB patients, exploring a possible link between noradrenergic neurotransmission and peripheral denervation.
Design
44 patients with a possible DLB diagnosis entered the study. Peripheral uptake of 123I-MIBG was determined by the heart-to-mediastinum (H/M) ratio, as a measure for noradrenergic sympathetic denervation. In cerebrospinal fluid (CSF), serum and plasma samples, monoamines ((nor)adrenaline ((N)A), 5-hydroxytryptamin (5-HT, serotonin), dopamine (DA)) and respective metabolites (3-methoxy-4-hydroxyphenylglycol (MHPG), 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3,4-dihydroxyphenylacetic acid (DOPAC)), were measured by means of reversed-phase ultrahigh-performance liquid chromatography with electrochemical detection.
Results
We found significant correlations between the H/M ratio and serum 5-HIAA, plasma 5-HT, plasma 5-HIAA/5-HT and plasma HVA/5-HIAA, but no further correlations with the noradrenergic system. CSF-serum MHPG, CSF-serum DOPAC, CSF-serum HVA, CSF-plasma MHPG, CSF plasma NA, CSF-plasma DOPAC, CSF-plasma MHPG/NA and CSF-plasma DOPAC/DA were significantly correlated.
Conclusions
These results show an association between the H/M ratio and serotonergic system, but not between peripheral noradrenergic denervation and circulating noradrenergic levels.
Dementia with Lewy bodies (DLB) remains poorly understood and frequently misdiagnosed, complicated by co-pathology with other dementia forms. DLB patients often present with autonomic dysfunction and peripheral Lewy body pathology alongside central lesions. Monoaminergic neurotransmitter systems seem an early target for DLB pathology, especially the noradrenergic system. Noradrenaline analogue 123I-metaiodobenzylguanidine (MIBG) is considered an indicative biomarker for peripheral noradrenergic sympathetic denervation.
Objectives
Our aim was to measure paired monoaminergic levels and MIBG scintigraphy values in DLB patients, exploring a possible link between noradrenergic neurotransmission and peripheral denervation.
Design
44 patients with a possible DLB diagnosis entered the study. Peripheral uptake of 123I-MIBG was determined by the heart-to-mediastinum (H/M) ratio, as a measure for noradrenergic sympathetic denervation. In cerebrospinal fluid (CSF), serum and plasma samples, monoamines ((nor)adrenaline ((N)A), 5-hydroxytryptamin (5-HT, serotonin), dopamine (DA)) and respective metabolites (3-methoxy-4-hydroxyphenylglycol (MHPG), 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3,4-dihydroxyphenylacetic acid (DOPAC)), were measured by means of reversed-phase ultrahigh-performance liquid chromatography with electrochemical detection.
Results
We found significant correlations between the H/M ratio and serum 5-HIAA, plasma 5-HT, plasma 5-HIAA/5-HT and plasma HVA/5-HIAA, but no further correlations with the noradrenergic system. CSF-serum MHPG, CSF-serum DOPAC, CSF-serum HVA, CSF-plasma MHPG, CSF plasma NA, CSF-plasma DOPAC, CSF-plasma MHPG/NA and CSF-plasma DOPAC/DA were significantly correlated.
Conclusions
These results show an association between the H/M ratio and serotonergic system, but not between peripheral noradrenergic denervation and circulating noradrenergic levels.
| Original language | English |
|---|---|
| Article number | 100346 |
| Number of pages | 8 |
| Journal | Clinical Parkinsonism & Related Disorders |
| Volume | 12 |
| DOIs | |
| Publication status | Published - 12 May 2025 |