Performance of 123I-Ioflupane SPECT Striatal Binding in Dementia with Lewy Bodies

Authors

Emily F. Maly
Frank P. DiFilippo
Brittany Lapin
Yadi Li
Sarah Berman
Andrea C. Bozoki
Jori E. Fleisher
James E. Galvin
David J. Irwin
Carol F. Lippa, Thomas Jefferson UniversityFollow
Irene Litvan
Debby W. Tsuang
Cyrus P. Zabetian
Angela S. Taylor
Lynn M. Bekris
Oscar L. Lopez
Douglas Galasko
James B. Leverenz

Document Type

Article

Publication Date

9-16-2025

Comments

This article is the author's final published version in Alzheimer's and Dementia, Volume 21, Issue 9, September 2025, Article number e70596.

The published version is available at https://doi.org/10.1002/alz.70596. Copyright © 2025 The Author(s).

Abstract

INTRODUCTION: We aimed to determine whether ¹²³I-ioflupane single-photon emission computed tomography (SPECT) striatal binding ratio (SBR) correlated with parkinsonian motor symptoms in dementia with Lewy bodies (DLB) and if SBR predicts worsening of parkinsonism over time.

METHODS: A retrospective cohort study of the U.S. Dementia with Lewy Bodies Consortium dataset including individuals with DLB with baseline ¹²³I-ioflupane SPECT analyzed with DaTQUANT and baseline and 24-month Movement Disorder Society Unified Parkinson's Disease Rating Scale–Part III (MDS-UPDRS-III). A subset had cerebrospinal fluid α-synuclein seed amplification assay (SAA) evaluation.

RESULTS: Baseline mean SBRs were significant predictors of baseline and 24-month MDS-UPDRS-III scores, although they did not predict meaningful worsening over time. SAA positivity was associated with lower SBRs; Z score cut-off values are provided.

DISCUSSION: In suspected DLB, ¹²³I-ioflupane SPECT, at diagnosis, could be used to confirm underlying dopamine deficiency; it does not predict meaningful worsening of motor parkinsonism. More severe dopamine deficiency increases confidence in presence of synucleinopathy.

HIGHLIGHTS: ¹²³I-ioflupane single-photon emission computed tomography (SPECT) can confirm underlying dopamine deficiency. Striatal binding ratio (SBR) Z scores predicted 24-month Unified Parkinson's Disease Rating Scale–Part III (UPDRS-III) scores. SBR Z scores are not predictive of subsequent meaningful worsening of parkinsonism. More severe dopamine dysfunction on SPECT is associated with presence of seed amplification assay (SAA). SBR Z score cut-offs that indicate cerebrospinal fluid SAA positivity are provided. © 2025 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.

Recommended Citation

Maly, Emily F.; DiFilippo, Frank P.; Lapin, Brittany; Li, Yadi; Berman, Sarah; Bozoki, Andrea C.; Fleisher, Jori E.; Galvin, James E.; Irwin, David J.; Lippa, Carol F.; Litvan, Irene; Tsuang, Debby W.; Zabetian, Cyrus P.; Taylor, Angela S.; Bekris, Lynn M.; Lopez, Oscar L.; Galasko, Douglas; and Leverenz, James B., "Performance of 123I-Ioflupane SPECT Striatal Binding in Dementia with Lewy Bodies" (2025). Department of Neurology Faculty Papers. Paper 377.
https://jdc.jefferson.edu/neurologyfp/377

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

PubMed ID

40955476

Language

English