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Cholinesterase inhibitor use does not significantly influence the ability of 123I-FP-CIT imaging to distinguish Alzheimer’s disease from dementia with Lewy bodies
  1. John-Paul Taylor1,
  2. Sean J Colloby1,
  3. Ian G McKeith1,
  4. David J Burn1,
  5. David Williams2,
  6. Jim Patterson3,
  7. John T O’Brien1
  1. 1
    Institute for Ageing and Health, Newcastle upon Tyne, UK
  2. 2
    Sunderland Royal Hospital, Sunderland, UK
  3. 3
    Southern General Hospital, Glasgow, UK
  1. Dr John-Paul Taylor, Institute for Ageing and Health, Wolfson Research Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK; john-paul.taylor{at}ncl.ac.uk

Abstract

Background: 123I-labelled 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) imaging is a diagnostic tool to help differentiate dementia with Lewy bodies (DLB) from Alzheimer’s disease (AD). However, in animals, cholinesterase inhibitors (ChEi) have been reported to reduce radioligand binding to the striatal dopamine transporter. As ChEi are frequently used in people with dementia, it is important to determine whether their use affects 123I-FP-CIT uptake in the striatum.

Objective: To clarify whether chronic ChEi therapy modulates striatal dopamine transporter binding measured by 123I-FP-CIT in patients with AD, DLB and Parkinson’s disease with dementia (PDD).

Design: Cross sectional study in 99 patients with AD (nine on ChEi, 25 not on ChEi), DLB (nine on ChEi, 19 not on ChEi) and PDD (six on ChEi, 31 not on ChEi) comparing 123I-FP-CIT striatal binding (caudate, anterior and posterior putamen) in patients receiving compared with those not receiving ChEi, correcting for key clinical variables including diagnosis, age, sex, Mini-Mental State Examination score, severity of parkinsonism and concurrent antidepressant use.

Results: As previously described, 123I-FP-CIT striatal uptake was lower in DLB and PDD subjects compared with those with AD. Median duration of ChEi use was 180 days. 123I-FP-CIT uptake was not significantly reduced in subjects receiving ChEi compared those not receiving ChEi (mean percentage reduction: AD 4.3%; DLB 0.7%; PDD 6.1%; p = 0.40). ChEi use did not differentially affect striatal 123FP-CIT uptake between patient groups (p = 0.83).

Conclusions: Use of ChEi does not significantly influence the ability of 123I-FP-CIT imaging to distinguish AD from DLB.

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Footnotes

  • Competing interests: John O’Brien, Ian McKeith and Jim Patterson have acted as consultants for GE Healthcare. David Burn has received honoraria from Novartis and GE Healthcare.

  • Abbreviations:
    AD
    Alzheimer’s disease
    ChEi
    cholinesterase inhibitors
    DAT
    dopamine transporter
    DLB
    dementia with Lewy bodies
    123I-FP-CIT
    123I-labelled 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane
    PDD
    Parkinson’s disease with dementia
    PET
    positron emission tomography
    ROIs
    regions of interest
    SPECT
    single photon emission computed tomography
    UPDRS III
    Unified Parkinson’s Disease Rating Scale, subsection III

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