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Orbital and Dorsolateral Frontal Perfusion Defect Associated With Behavioral Response to Cholinesterase Inhibitor Therapy in Alzheimer's Disease

Received August 4, 1999; revised October 26, 1999; accepted November 19, 1999. From the Departments of Neurology, Nuclear Medicine Harbor/UCLA, Laboratory of Neuro Imaging, Alzheimer's Disease Center, and Department of Psychiatry and Biobehavioral Science, UCLA School of Medicine, Los Angeles, California. Address correspondence to Dr. Mega, Laboratory of Neuro Imaging, Department of Neurology, UCLA School of Medicine, 710 Westwood Plaza, Los Angeles, CA 90095-1769.

The authors retrospectively explored the behavioral and functional imaging profile of Alzheimer's disease (AD) patients who respond to cholinesterase inhibitor therapy by using the Neuropsychiatric Inventory (NPI) and baseline [^99mTc]HMPAO SPECT. Thirty AD patients were divided into three groups (Responders, Nonresponders, and Unchanged) based on their behavioral response to donepezil. Responders had significantly (P0.01) more pretreatment irritability, disinhibition (P0.05), and euphoria (P=0.05) than Nonresponders and significantly lower lateral orbital frontal (P<0.00001) and dorsolateral frontal (P0.0005) perfusion bilaterally. A pretreatment orbitofrontal syndrome may predict behavioral response to cholinesterase inhibitor therapy in AD.

Key Words: Alzheimer's Disease • Donepezil • SPECT Studies

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