Many patients with dementia with Lewy bodies (DLB) have overlapping Alzheimer's disease (AD)-related pathology, which may contribute to white matter (WM) diffusivity alterations on diffusion tensor imaging (DTI). Consecutive patients with DLB (n = 30), age- and sex-matched AD patients (n = 30), and cognitively normal controls (n = 60) were recruited. All subjects underwent DTI, 18F 2-fluoro-deoxy-d-glucose, and (11)C Pittsburgh compound B positron emission tomography scans. DLB patients had reduced fractional anisotropy (FA) in the parietooccipital WM but not elsewhere compared with cognitively normal controls, and elevated FA in parahippocampal WM compared with AD patients, which persisted after controlling for β-amyloid load in DLB. The pattern of WM FA alterations on DTI was consistent with the more diffuse posterior parietal and occipital glucose hypometabolism of 2-fluoro-deoxy-d-glucose positron emission tomography in the cortex. DLB is characterized by a loss of parietooccipital WM integrity, independent of concomitant AD-related β-amyloid load. Cortical glucose hypometabolism accompanies WM FA alterations with a concordant pattern of gray and WM involvement in the parietooccipital lobes in DLB.

Department of Health Sciences Research Mayo Clinic Rochester MN USA

Department of Information Technology Mayo Clinic Rochester MN USA

Department of Neurology Mayo Clinic Rochester MN USA

Department of Psychiatry and Psychology Mayo Clinic Jacksonville FL USA

Department of Psychiatry and Psychology Mayo Clinic Rochester MN USA

Department of Radiology Mayo Clinic Rochester MN USA

Department of Radiology Mayo Clinic Rochester MN USA; Department of Neurology Charles University Prague 2nd Faculty of Medicine and Motol University Hospital Prague The Czech Republic; International Clinical Research Center St Anne's University Hospital Brno Brno The Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Brno The Czech Republic; Department of Psychiatry and Psychology Mayo Clinic Scottsdale AZ USA; Department of Neurology Mayo Clinic Scottsdale AZ USA

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Cerebrovascular disease, neurodegeneration, and clinical phenotype in dementia with Lewy bodies