Depletion or preservation of cardiac sympathetic nerve - an autopsy-verified contrast in two cases of Alzheimer's disease with or without Lewy bodies

Abstract

We report autopsy findings of 2 patients with the clinical diagnosis of dementia with Lewy bodies (DLB) both with Alzheimer disease (AD) pathology. Lewy bodies and cardiac sympathetic nerve depletion were found in case 1, while these pathological changes were both absent in case 2 with pure AD pathology. This autopsy-verified contrast was detectable through reduced uptake of (123)I-metaiodobenzylguanidine cardiac scintigraphy as in case 1. Conversely, its preserved uptake, indicating preserved cardiac sympathetic nerve, may point to the absence of Lewy bodies, as in case 2, even though other clinical pictures are indistinguishable from DLB. (123)I-metaiodobenzylguanidine cardiac scintigraphy may be useful to distinguish clinically between pure AD and DLB.