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Objective: To evaluate the diagnostic reliability of cardiac iodine-123 metaiodobenzylguanidine (¹²³I-MIBG) radioactivity in discriminating dementia with Lewy bodies (DLB) from Alzheimer disease (AD) regardless of parkinsonism.

Background: The diagnosis of DLB may be confounded by the absence of parkinsonism. This highlights the need to improve the accuracy of antemortem diagnosis of DLB without parkinsonism.

Methods: Cardiac sympathetic denervation was examined using myocardial ¹²³I-MIBG scintigraphy in 37 patients with DLB, 42 patients with AD, and 10 normal elderly controls. The DLB patients consisted of seven patients without parkinsonism (DLB/P−) and 30 patients with parkinsonism (DLB/P+) at the time of the study.

Results: The heart-to-mediastinum uptake ratio (H/M ratio) of myocardial MIBG uptake was decreased in both the DLB groups vs the AD group (p < 0.0001) and …