1
|
Yamada Y, Shinkawa K, Kobayashi M, Nemoto M, Ota M, Nemoto K, Arai T. Distinct eye movement patterns to complex scenes in Alzheimer's disease and Lewy body disease. Front Neurosci 2024; 18:1333894. [PMID: 38646608 PMCID: PMC11026598 DOI: 10.3389/fnins.2024.1333894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Background Alzheimer's disease (AD) and Lewy body disease (LBD), the two most common causes of neurodegenerative dementia with similar clinical manifestations, both show impaired visual attention and altered eye movements. However, prior studies have used structured tasks or restricted stimuli, limiting the insights into how eye movements alter and differ between AD and LBD in daily life. Objective We aimed to comprehensively characterize eye movements of AD and LBD patients on naturalistic complex scenes with broad categories of objects, which would provide a context closer to real-world free viewing, and to identify disease-specific patterns of altered eye movements. Methods We collected spontaneous viewing behaviors to 200 naturalistic complex scenes from patients with AD or LBD at the prodromal or dementia stage, as well as matched control participants. We then investigated eye movement patterns using a computational visual attention model with high-level image features of object properties and semantic information. Results Compared with matched controls, we identified two disease-specific altered patterns of eye movements: diminished visual exploration, which differentially correlates with cognitive impairment in AD and with motor impairment in LBD; and reduced gaze allocation to objects, attributed to a weaker attention bias toward high-level image features in AD and attributed to a greater image-center bias in LBD. Conclusion Our findings may help differentiate AD and LBD patients and comprehend their real-world visual behaviors to mitigate the widespread impact of impaired visual attention on daily activities.
Collapse
Affiliation(s)
- Yasunori Yamada
- Digital Health, IBM Research, Tokyo, Japan
- Department of Psychiatry, Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Masatomo Kobayashi
- Digital Health, IBM Research, Tokyo, Japan
- Department of Psychiatry, Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Miyuki Nemoto
- Department of Psychiatry, Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Miho Ota
- Department of Psychiatry, Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, Division of Clinical Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| |
Collapse
|
2
|
Fernando R, Thomas AJ, Hamilton CA, Durcan R, Barker S, Ciafone J, Barnett N, Olsen K, Firbank M, Roberts G, Lloyd J, Petrides G, Colloby S, Allan LM, McKeith IG, O'Brien JT, Taylor JP, Donaghy PC. Identifying parkinsonism in mild cognitive impairment. J Neurol Sci 2024; 458:122941. [PMID: 38422782 DOI: 10.1016/j.jns.2024.122941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Clinical parkinsonism is a core diagnostic feature for mild cognitive impairment with Lewy bodies (MCI-LB) but can be challenging to identify. A five-item scale derived from the Unified Parkinson's Disease Rating Scale (UPDRS) has been recommended for the assessment of parkinsonism in dementia. This study aimed to determine whether the five-item scale is effective to identify parkinsonism in MCI. METHODS Participants with MCI from two cohorts (n = 146) had a physical examination including the UPDRS and [123I]-FP-CIT SPECT striatal dopaminergic imaging. Participants were classified as having clinical parkinsonism (P+) or no parkinsonism (P-), and with abnormal striatal dopaminergic imaging (D+) or normal imaging (D-). The five-item scale was the sum of UPDRS tremor at rest, bradykinesia, action tremor, facial expression, and rigidity scores. The ability of the scale to differentiate P+D+ and P-D- participants was examined. RESULTS The five-item scale had an AUROC of 0.92 in Cohort 1, but the 7/8 cut-off defined for dementia had low sensitivity to identify P+D+ participants (sensitivity 25%, specificity 100%). Optimal sensitivity and specificity was obtained at a 3/4 cut-off (sensitivity 83%, specificity 88%). In Cohort 2, the five-item scale had an AUROC of 0.97, and the 3/4 cut-off derived from Cohort 1 showed sensitivity of 100% and a specificity of 82% to differentiate P+D+ from P-D- participants. The five-item scale was not effective in differentiating D+ from D- participants. CONCLUSIONS The five-item scale is effective to identify parkinsonism in MCI, but a lower threshold must be used in MCI compared with dementia.
Collapse
Affiliation(s)
- Rishira Fernando
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Newcastle University, UK; Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Sean Colloby
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Louise M Allan
- Centre for Research in Ageing and Cognitive Health, University of Exeter, UK
| | - Ian G McKeith
- Translational and Clinical Research Institute, Newcastle University, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, UK.
| |
Collapse
|
3
|
Chen TY, Chan PC, Tsai CF, Wei CY, Chiu PY. White matter hyperintensities in dementia with Lewy bodies are associated with poorer cognitive function and higher dementia stages. Front Aging Neurosci 2022; 14:935652. [PMID: 36092817 PMCID: PMC9459160 DOI: 10.3389/fnagi.2022.935652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose White matter hyperintensities (WMHs) are frequently found in elderly individuals with or without dementia. However, the association between WMHs and clinical presentations of dementia with Lewy bodies (DLB) has rarely been studied. Methods We conducted a retrospective analysis of patients with DLB registered in a dementia database. WMHs were rated visually using the Fazekas scale, and its associated factors including dementia severity, cognitive functions, neuropsychiatric symptoms, and core clinical features were compared among different Fazekas scores. Domains in the Clinical Dementia Rating (CDR), Cognitive abilities Screening Instruments (CASI), and Neuropsychiatric Inventory (NPI) were compared among different Fazekas groups after adjusting for age, sex, education, and disease duration. Results Among the 449 patients, 76, 207, 110, and 56 had Fazekas score of 0, 1, 2, and 3, respectively. There was a positive association between dementia severity and WMHs severity, and the mean sums of boxes of the Clinical Dementia Rating (CDR-SB) were 5.9, 7.8, 9.5, and 11.2 (f = 16.84, p < 0.001) for the Fazekas scale scores 0, 1, 2, and 3, respectively. There was a negative association between cognitive performance and WMHs severity, and the mean CASI were 57.7, 45.4, 4.06, and 33.4 (f = 14.22, p < 0.001) for the Fazekas scale scores 0, 1, 2, and 3, respectively. However, WMHs were not associated with the core clinical features of DLB. After adjustment, all cognitive domains in CDR increased as the Fazekas score increased. In addition, performance on all cognitive domains in CASI decreased as the Fazekas score increased (all p < 0.001). Among neuropsychiatric symptoms, delusions, euphoria, apathy, aberrant motor behavior, and sleep disorders were significantly worse in the higher Fazekas groups compared to those in the group with Fazekas score of 0 after adjustment. Conclusion WMHs in DLB might contribute to deterioration of cognitive function, neuropsychiatric symptoms, and dementia stages. However, core clinical features were not significantly influenced by WMHs in DLB.
Collapse
Affiliation(s)
- Tai-Yi Chen
- Department of Radiology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Po-Chi Chan
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ching-Fang Tsai
- Tainan Sin-Lau Hospital, The Presbyterian Church in Taiwan, Tainan, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Applied Mathematics, Tunghai University, Taichung, Taiwan
- *Correspondence: Pai-Yi Chiu,
| |
Collapse
|
4
|
Chen YT, Orimo S, Wei CY, Hung GU, Yang SY, Chiu PY. Synuclein Motor Dysfunction Composite Scale for the Discrimination of Dementia With Lewy Bodies From Alzheimer’s Disease. Front Aging Neurosci 2022; 14:920591. [PMID: 35663565 PMCID: PMC9161692 DOI: 10.3389/fnagi.2022.920591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background An abnormal increase of α-synuclein in the brain is the hallmark of dementia with Lewy bodies (DLB). However, the diagnostic power of plasma α-synuclein in DLB is not yet confirmed. Parkinsonism is highly associated with and is one of the core clinical features of DLB. We studied plasma α-synuclein and developed a novel tool that combined plasma α-synuclein level and Motor Dysfunction Questionnaire (MDQ), namely Synuclein Motor Dysfunction Composite Scale (SMDCS), for the clinical discrimination of DLB from Alzheimer’s disease (AD). Methods This cross-sectional study analyzed participants’ demographical data, plasma α-synuclein level, MDQ, structured clinical history questionnaire, neuropsychological and motor function tests, and neuroimaging studies. The power of plasma α-synuclein level, MDQ, and SMDCS for discriminating DLB from non-demented controls (NC) or AD were compared. Results Overall, 121 participants diagnosed as 58 DLB, 31 AD, and 31 NC were enrolled. Patients with DLB had significantly higher mean plasma α-synuclein level (0.24 ± 0.32 pg/ml) compared to the NC group (0.08 ± 0.05 pg/ml) and the AD group (0.08 ± 0.05 pg/ml). The DLB group demonstrated higher MDQ (2.95 ± 1.60) compared to the NC (0.42 ± 0.98) or AD (0.44 ± 0.99) groups. The sensitivity/specificity of plasma α-synuclein level, MDQ, and SMDCS for differentiating DLB from non-DLB were 0.80/0.64, 0.83/0.89, and 0.88/0.93, respectively. Conclusion Both plasma α-synuclein and MDQ were significantly higher in patients with DLB compared to the NC or AD groups. The novel SMDCS, significantly improved accuracy for the clinical differentiation of DLB from AD or NC.
Collapse
Affiliation(s)
- Ying-Tsung Chen
- Department of Psychiatry, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Psychiatry, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Satoshi Orimo
- Department of Neurology, Kamiyoga Setagaya Street Clinic, Tokyo, Japan
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | | | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Applied Mathematics, Tunghai University, Taichung, Taiwan
- *Correspondence: Pai-Yi Chiu,
| |
Collapse
|
5
|
Chiu PY, Wei CY, Hung GU, Wu SL. Motor Dysfunction Questionnaire and Dopamine Transporter Imaging Composite Scale Improve Differentiating Dementia With Lewy Bodies From Alzheimer's Disease With Motor Dysfunction. Front Aging Neurosci 2021; 13:709215. [PMID: 34456711 PMCID: PMC8385672 DOI: 10.3389/fnagi.2021.709215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/13/2021] [Indexed: 01/18/2023] Open
Abstract
Objective: Characteristic parkinsonism is the major comorbidity of dementia with Lewy bodies (DLB). We aimed to differentiate DLB from Alzheimer's disease (AD) with motor dysfunction using a composite scale with a characteristic motor dysfunction questionnaire (MDQ) and dopamine transporter (DAT) imaging. It could help detect DLB easily in healthcare settings without movement disorder specialists. Methods: This is a two-phase study. In the design phase, seven questions were selected and composed of a novel MDQ. In the test phase, all participants with DLB, AD, or non-dementia (ND) control completed dementia and parkinsonism survey, the novel designed questionnaire, DAT imaging, and composite scales of MDQ and DAT. The cutoff scores of the MDQ, semiquantitative analysis of the striatal–background ratio (SBR) and visual rating of DAT, and the composite scale of MDQ and DAT for discriminating DLB from AD or ND were derived and compared. Results: A total of 277 participants were included in this study (126 with DLB, 86 with AD, and 65 with ND). Compared with the AD or ND groups, the DLB group showed a significantly higher frequency in all seven items in the MDQ and a significantly lower SBR. For discrimination of DLB from non-DLB with MDQ, SBR, and composite scale, the cutoff scores of 3/2, 1.37/1.38, and 6/5 were suggested for the diagnosis of DLB with the sensitivities/specificities of 0.91/0.72, 0.91/0.80, and 0.87/0.93, respectively. The composite scale significantly improved the accuracy of discrimination compared with either the MDQ or SBR. Conclusion: This study showed that the novel designed simple questionnaire was a practical screening tool and had similar power to DAT scanning to detect DLB. The questionnaire can be applied in clinical practice and population studies for screening DLB. In addition, the composite scale of MDQ and DAT imaging further improved the diagnostic accuracy, indicating the superiority of the dual-model diagnostic tool.
Collapse
Affiliation(s)
- Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan.,Department of Nursing, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Shey-Lin Wu
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.,Department of Biomedical Sciences, Da-Yeh University,Changhua, Taiwan
| |
Collapse
|
6
|
O’Brien JT, Taylor JP, Thomas A, Bamford C, Vale L, Hill S, Allan L, Finch T, McNally R, Hayes L, Surendranathan A, Kane J, Chrysos AE, Bentley A, Barker S, Mason J, Burn D, McKeith I. Improving the diagnosis and management of Lewy body dementia: the DIAMOND-Lewy research programme including pilot cluster RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
Background
Lewy body dementia, comprising both dementia with Lewy bodies and Parkinson’s disease dementia, is the second commonest cause of neurodegenerative dementia. Existing evidence suggests that it is underdiagnosed and without a consistent approach to management.
Objectives
To improve the diagnosis and management of Lewy body dementia by (1) understanding current diagnostic practice for dementia with Lewy bodies and Parkinson’s disease dementia; (2) identifying barriers to and facilitators of diagnosis and management; (3) developing evidence-based assessment toolkits to improve diagnosis of dementia with Lewy bodies and Parkinson’s disease dementia; (4) producing a management toolkit to facilitate management; and (5) undertaking a pilot cluster randomised clinical trial.
Design
Work package 1 assessed clinical diagnostic rates from case notes for dementia with Lewy bodies and Parkinson’s disease dementia before and after (work package 1 repeated) introduction of an assessment toolkit. In work package 2, we developed a management toolkit for Lewy body dementia. In work package 3, we developed assessment toolkits for dementia with Lewy bodies and Parkinson’s disease dementia and piloted these and the management toolkit in a clinical service. In work package 4, we undertook a pilot study of 23 services in nine NHS trusts that were cluster randomised to receiving and using the management toolkit or standard care. Work package 5 comprised a series of qualitative studies, examining barriers to and facilitators of diagnosis and management.
Setting
Secondary care memory assessment and movement disorder services in England.
Interventions
Assessment toolkits for Lewy body dementia consisted of questions for diagnostic symptoms, and management toolkits comprised 161 guidance statements grouped under five symptom domains.
Review methods
The systematic reviews of pharmacological and non-pharmacological management were based on published literature, with meta-analysis when possible, following a search of several electronic databases and the grey literature using terms related to Lewy body dementia, without restriction on time or language.
Participants
Participants aged ≥ 50 years diagnosed with dementia with Lewy bodies or Parkinson’s disease dementia and, for work package 1 and work package 1 repeated, non-dementia with Lewy bodies and non-Parkinson’s disease dementia controls. The qualitative studies included people with Lewy body dementia, carers and professionals.
Main outcome measures
For work packages 1 and 1 repeated, diagnostic rates for dementia with Lewy bodies and Parkinson’s disease dementia as a proportion of all dementia or Parkinson’s disease. For work packages 2 and 3, the production of diagnostic and management toolkits. For work package 4, feasibility of undertaking a cluster randomised trial of the toolkits, measured by number of participants recruited and use of the toolkits, assessed qualitatively.
Results
Work package 1 – 4.6% of dementia cases in secondary care received a dementia with Lewy bodies diagnosis (with significant differences in diagnostic rates between services) and 9.7% of those with Parkinson’s disease had a diagnosis of Parkinson’s disease dementia. There was evidence of delays in diagnosis for both dementia with Lewy bodies and Parkinson’s disease dementia compared with control patients, and the costs of dementia with Lewy bodies and Parkinson’s disease dementia were also greater than those for matched controls (p < 0.01 for both). Work package 2 – we produced 252 statements regarding Lewy body dementia management and, following a Delphi process, 161 statements were included in a management toolkit. Work package 3 – piloting indicated that separate assessment toolkits for use in memory clinic and movement disorder services were preferred, but a single toolkit for Lewy body dementia management was suitable. Work package 4 – we were able to recruit Lewy body dementia patients to target and recruited 131 patients within 6 months (target n = 120), of whom > 80% were retained in the study at 6 months. Work package 5 – barriers to diagnosis and management of Lewy body dementia were complex. Managing Lewy body dementia often requires input from a range of specialties and, therefore, care pathways may be fragmented. Positive attitudes to diagnosing Lewy body dementia, working with a team with expertise in Lewy body dementia and opportunities for cross-specialty discussion of patients with complex needs facilitated diagnosis and management. The toolkits were generally well received, particularly the management toolkit. Implementation, however, varied, reflecting differences in attitudes, skills, time and local leadership. Work package 1 repeated – following introduction of the assessment toolkit, we found that 9.7% of dementia cases had dementia with Lewy bodies (a significant increase from baseline; p = 0.0019), but Parkinson’s disease dementia rates were similar (8.2%) to baseline.
Limitations
We included only two geographical regions and evidence informing the management toolkit was limited. Work package 4 was a pilot study and, therefore, we did not set out to assess the extent to which use of the management toolkit altered outcomes at the individual patient level. We noted implementation of the toolkits was variable. The increase in diagnostic rates in dementia with Lewy bodies following introduction of the assessment toolkits cannot be necessarily causally attributed to them.
Conclusions
Dementia with Lewy bodies and Parkinson’s disease dementia were diagnosed in secondary care NHS services, with a lower frequency (around half) than that expected from known prevalence rates. The introduction of assessment toolkits for dementia with Lewy bodies and Parkinson’s disease dementia was associated with increased diagnostic rates of dementia with Lewy bodies, but not Parkinson’s disease dementia. Qualitative studies indicated inherent complexities of the disease itself, with treatment requiring input from different specialties and the potential for fragmented services, a workforce with variable training and confidence in Lewy body dementia, and negative attitudes towards diagnosis. The cluster randomised pilot trial demonstrated that patients could be successfully recruited, and provided preliminary evidence that the toolkits could be implemented in clinical services.
Future work
The evidence base informing the management of Lewy body dementia is limited, especially for non-pharmacological interventions. More well-designed randomised controlled trials for both cognitive and non-cognitive symptoms are needed.
Trial registration
Current Controlled Trials ISRCTN11083027.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 7. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Allan
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Richard McNally
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Joseph Kane
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alexandros E Chrysos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Allison Bentley
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Sally Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - David Burn
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian McKeith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
7
|
Olivieri P, Lebouvier T, Hardouin JB, Courtemanche H, Le Dily S, Barbin L, Pallardy A, Derkinderen P, Boutoleau-Bretonnière C. LeSCoD: a new clinical scale for the detection of Lewy body disease in neurocognitive disorders. J Neurol 2021; 268:3886-3896. [PMID: 33830336 DOI: 10.1007/s00415-021-10539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dementia with Lewy bodies remains underdiagnosed in clinical practice mainly because of the low sensitivity of existing diagnostic criteria and a strong overlap with Alzheimer's pathology that can mask the Lewy phenotype. OBJECTIVE The objective of this study was therefore to develop and validate a new clinical scale designed to detect signs of Lewy body disease, called LeSCoD for Lewy body Screening scale in Cognitive Disorders. METHODS 128 patients who fulfilled the clinical criteria of dementia with Lewy bodies (DLB; n = 32), Alzheimer's disease (AD; n = 77) or both (n = 19) was prospectively enrolled. 18F-DOPA PET imaging and/or CSF biomarkers were available in some patients. LeSCoD scale was systematically administered and the potential correlation with 18F-DOPA PET imaging was evaluated in a subgroup of patients. RESULTS LeSCoD scale showed robust internal and external validity. We determined a cut-off of 10 above which the sensitivity and specificity for Lewy body disease diagnosis were 86% and 95%, respectively. The LeSCoD scale correlated with striatal dopamine uptake in 18F-DOPA PET. CONCLUSION LeSCoD scale is a simple and reliable tool for the evaluation of Lewy body disease in routine clinical practice, with a higher sensitivity and specificity than the existing criteria. It might be an alternative to the use of dopamine-specific imaging.
Collapse
Affiliation(s)
- Pauline Olivieri
- Department of Neurology of Memory and Language, GHU Paris Psychiatry and Neurosciences, Hôpital Sainte Anne, 75014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Thibaud Lebouvier
- University of Lille, Inserm U1172, CHU Lille, DISTALZ, Lille, France
| | - Jean-Benoît Hardouin
- UMR INSERM 1246-SPHERE "Methods in Patient-Centered Outcomes and Health Research", Université de Nantes, Université de Tours, Tours, France.,Unit of Methodology and Biostatistics, Université de Nantes, Nantes, France
| | - Hélène Courtemanche
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France.,INSERM CIC 04, Nantes, France
| | | | | | | | | | - Claire Boutoleau-Bretonnière
- Centre Mémoire Ressource et Recherche (CMRR), Department of Neurology, CHU Nantes, 44093, Nantes, France. .,INSERM CIC 04, Nantes, France. .,Claire Boutoleau-Bretonnière, Centre Mémoire Ressource et Recherche (CMRR), Centre Hospitalier Universitaire de Nantes Hôpital Laennec, Boulevard Jacques Monod, 44000, Nantes, France.
| |
Collapse
|
8
|
Malattia a corpi di Lewy. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
9
|
Jeppesen Kragh F, Bruun M, Budtz-Jørgensen E, Hjermind LE, Schubert R, Reilmann R, Nielsen JE, Hasselbalch SG. Quantitative Measurements of Motor Function in Alzheimer's Disease, Frontotemporal Dementia, and Dementia with Lewy Bodies: A Proof-of-Concept Study. Dement Geriatr Cogn Disord 2019; 46:168-179. [PMID: 30257254 DOI: 10.1159/000492860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/10/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study examines the efficacy of using quantitative measurements of motor dysfunction, compared to clinical ratings, in Alzheimer's disease (AD), frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB). METHODS In this cross-sectional study, 49 patients with a diagnosis of AD (n = 17), FTD (n = 19), or DLB (n = 13) were included and underwent cognitive testing, clinical motor evaluation, and quantitative motor tests: pronation/supination hand tapping, grasping and lifting, and finger and foot tapping. RESULTS Our results revealed significantly higher Q-Motor values in pronation/supination and in grip lift force assessment in AD, FTD, and DLB compared to healthy controls (HC). Q-Motor values detected significant differences between AD and HC, while clinical ratings did not. CONCLUSION Our results suggest that quantitative measurements provide more objective and sensitive measurements of motor dysfunction in dementia.
Collapse
Affiliation(s)
- Frederikke Jeppesen Kragh
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bruun
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Esben Budtz-Jørgensen
- Department of Public Health, Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Lena Elisabeth Hjermind
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Ralf Reilmann
- The George Huntington Institute, Münster, Germany.,Department of Clinical Radiology, University of Münster, Münster, Germany.,Department of Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Jørgen Erik Nielsen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen,
| |
Collapse
|
10
|
Génier Marchand D, Postuma RB, Escudier F, De Roy J, Pelletier A, Montplaisir J, Gagnon JF. How does dementia with Lewy bodies start? prodromal cognitive changes in REM sleep behavior disorder. Ann Neurol 2018; 83:1016-1026. [PMID: 29665124 DOI: 10.1002/ana.25239] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We describe the progression of cognitive decline and identify the predictive values of cognitive tests in three groups of REM sleep behavior disorder (RBD) patients classified at their last follow-up as having Parkinson's disease (PD), dementia with Lewy bodies (DLB), or still-idiopathic. METHODS Patients (n = 109) underwent polysomnographic, neurological, and neuropsychological assessments. We used linear mixed-model analyses to compare the progression of cognitive test performance between the three groups over a 3-year prodromal period, and performed linear regressions for a 6-year prodromal period. We compared the proportions of patients with clinically impaired performance (z scores < -1.5). DLB patients were pair-matched according to age, sex, and education to healthy controls (2:1 ratio), and receiver operating characteristic curves were performed to identify the psychometric properties of cognitive tests to predict dementia. RESULTS At follow-up, 38 patients (35%) developed a neurodegenerative disorder: 20 had PD and 18 DLB. Cognitive performance changes over time were strongly associated with later development of dementia. Clear deficits in attention and executive functions were observed 6 years before diagnosis. Verbal episodic learning and memory deficits started later, deviating from normal approximately 5 to 6 years and becoming clinically impaired at 1 to 2 years before diagnosis. Visuospatial abilities progressed variably, with inconsistent prodromal latencies. The Trail Making Test (part B), Verbal Fluency (semantic), and Rey Auditory-Verbal Learning Test (total, immediate, and delayed recalls) were the best predictors for dementia (area under the curve = 0.90-0.97). INTERPRETATION Prodromal DLB is detectible up to 6 years before onset. For clinical utility, the Trail Making Test (part B) best detects early prodromal dementia stages, whereas Verbal Fluency (semantic) and verbal episodic learning tests are best for monitoring changes over time. Ann Neurol 2018;83:1016-1026.
Collapse
Affiliation(s)
- Daphné Génier Marchand
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.,Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Ronald B Postuma
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.,Department of Neurology, Montreal General Hospital, Montreal, QC, Canada
| | - Frédérique Escudier
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.,Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Jessie De Roy
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.,Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Amélie Pelletier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada.,Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Jean-François Gagnon
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.,Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| |
Collapse
|
11
|
Chan PC, Wei CY, Hung GU, Chiu PY. Reduced vascular risk factors in Parkinson's disease dementia and dementia with Lewy bodies compared to Alzheimer's disease. Brain Behav 2018. [PMID: 29541536 PMCID: PMC5840444 DOI: 10.1002/brb3.916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The association of vascular risk factors (VRFs) with incidence of Alzheimer's disease (AD) and vascular dementia (VaD) has been well studied. However, the association between VRFs and non-AD dementia is seldom investigated. In this study, we aim to compare the concurrence of VRFs of Lewy body dementia (LBD) to AD. MATERIALS & METHODS We consecutively enrolled patients with dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and AD, and the prevalence of arterial hypertension, diabetes mellitus, hypercholesterolemia, hyperlipidemia, smoking, and obesity was assessed and compared. RESULTS A total of 167 consecutive patients were studied. Among them, 55 had DLB, 34 had PDD, and 78 had AD. History of any VRF among three groups was not significantly different. In addition, the patients with AD had significantly higher systolic pressure (SBP), diastolic pressure (DBP), waist, body mass index (BMI), ac glucose, and HbA1c (all p-value < .005). After a stepwise procedure that considered age, sex, disease severity, antiparkinson drugs, systolic and diastolic blood pressures, glycated hemoglobin, body mass index, triglyceride, total cholesterol, and low-density lipoprotein, SBP in the third tertile (144-198 mmHg), BMI in the second tertile (23.6-26.4), and TG in the third tertile (127-310) were significantly lower in LBD than in AD. CONCLUSIONS The VRFs are less associated with LBD than with AD. DLB and PDD showed a similar pattern of the association of VRFs. SBP, BMI, and TG were significantly lower in LBD compared with AD.
Collapse
Affiliation(s)
- Po-Chi Chan
- Department of Neurology Show Chwan Memorial Hospital Changhua Taiwan
| | - Cheng-Yu Wei
- Department of Neurology Chang Bing Show Chwan Memorial Hospital Changhua Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine Chang Bing Show Chwan Memorial Hospital Changhua Taiwan
| | - Pai-Yi Chiu
- Department of Neurology Show Chwan Memorial Hospital Changhua Taiwan.,Department of Neurology Chang Bing Show Chwan Memorial Hospital Changhua Taiwan
| |
Collapse
|
12
|
Thomas AJ, Taylor JP, McKeith I, Bamford C, Burn D, Allan L, O'Brien J. Development of assessment toolkits for improving the diagnosis of the Lewy body dementias: feasibility study within the DIAMOND Lewy study. Int J Geriatr Psychiatry 2017; 32:1280-1304. [PMID: 27928840 PMCID: PMC5724510 DOI: 10.1002/gps.4609] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/30/2016] [Accepted: 09/26/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The Lewy body dementias (LBD, dementia with Lewy bodies and Parkinson's disease dementia) are the second most common cause of neurodegenerative dementia but remain under-recognised, with long delays from initial assessment to diagnosis. Whilst validated instruments have been developed for key symptoms, there is no brief instrument for overall diagnostic assessment suitable for routine practice. We here report the development of such assessment toolkits. METHODS We developed the LBD assessment toolkits in three stages. First, we conducted a systematic search for brief validated assessments for key symptoms and combined these into draft instruments. Second, we obtained feedback on acceptability and feasibility through two rounds of interviews with our patient and public involvement group. This led to modification of the toolkits. Finally, we piloted the toolkits in a feasibility study in routine dementia and Parkinson's disease services to produce final instruments suitable for routine clinical practice. RESULTS Eleven clinicians, working in both dementia/memory assessment and Parkinson's disease/movement disorder services, consented to pilot the assessment toolkits and provide feedback on their feasibility. Clinicians worked in routine health service (not academic) settings and piloted the draft toolkits by integrating them into their regular clinical assessments. Feedback obtained informally, by written comments and through qualitative interviews led to modifications and production of final acceptable versions. CONCLUSIONS We were able to address an important need, the under-diagnosis of LBD, by developing toolkits for improving the recognition and diagnosis of the LBD, which were acceptable to clinicians working in routine dementia and Parkinson's disease services. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Alan J. Thomas
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - John Paul Taylor
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - Ian McKeith
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - Claire Bamford
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - David Burn
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - Louise Allan
- Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle UniversityNewcastle upon TyneUK
| | - John O'Brien
- Department of PsychiatryUniversity of CambridgeCambrigdeUK
| |
Collapse
|
13
|
Génier Marchand D, Montplaisir J, Postuma RB, Rahayel S, Gagnon JF. Detecting the Cognitive Prodrome of Dementia with Lewy Bodies: A Prospective Study of REM Sleep Behavior Disorder. Sleep 2017; 40:2660407. [PMID: 28364450 DOI: 10.1093/sleep/zsw014] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2016] [Indexed: 11/12/2022] Open
Abstract
Study Objectives Long-term studies in REM sleep behavior disorder (RBD) have shown a high rate of conversion into synucleinopathies. We aimed to prospectively follow-up a large cohort of RBD patients to identify cognitive markers for early detection of prodromal dementia. Methods Seventy-six idiopathic RBD patients underwent polysomnography and a complete neuropsychological and neurological assessment and were then followed for a mean of 3.6 years. Cognitive characteristics at baseline were compared between patients who remained disease-free and those who developed a synucleinopathy, and between those who developed dementia first and those who developed parkinsonism first. Receiver operating characteristic curves were calculated to assess the diagnostic value of cognitive tests for detecting prodromal dementia. Results At follow-up, 34 patients developed a neurodegenerative disease: 19 parkinsonism-first and 15 dementia-first. RBD patients who first developed dementia were impaired at baseline in all cognitive domains (attention/executive functions, learning/memory, and visuospatial) compared to patients who developed parkinsonism. Moreover, 93% of patients who first developed dementia had mild cognitive impairment at baseline compared to 42% of patients who developed parkinsonism. RBD patients who developed parkinsonism first were similar at baseline to disease-free RBD patients on cognition. In dementia-first patients, two cognitive tests assessing attention and executive functions (Stroop Color Word Test and Trail Making Test) reliably predicted dementia (area under the curve ≥0.85) compared to parkinsonism-first patients or controls. Conclusions This study shows that cognitive tests assessing attention and executive functions strongly predict conversion to dementia in RBD patients, and may be useful endpoints to determine the effectiveness of interventions to prevent cognitive deterioration in RBD patients.
Collapse
Affiliation(s)
- Daphné Génier Marchand
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Shady Rahayel
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
14
|
Chiu PY, Wang CW, Tsai CT, Li SH, Lin CL, Lai TJ. Depression in dementia with Lewy bodies: A comparison with Alzheimer's disease. PLoS One 2017; 12:e0179399. [PMID: 28617831 PMCID: PMC5472293 DOI: 10.1371/journal.pone.0179399] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 05/30/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Depression is highly associated with dementia, and this study will compare the frequencies, severity, and symptoms of depression between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). METHODS Frequency of depression was determined according to the DSM-IV criteria for major depression or the National Institute of Mental Health criteria for depression in AD (NIMH-dAD). Severity of depression were assessed using the Hamilton Depression Rating Scale, the Cornell Scale for Depression in Dementia, and the depression subscale in Neuropsychiatric Inventory. The rates of depressive symptoms were compared between AD and DLB. RESULTS A total of 312 patients were investigated (AD/DLB = 241/71). The frequency of major depression was significantly higher (p = 0.017) in DLB (19.7%) than in AD (8.7%). The higher frequency of depression in DLB was not reproduced by using the NIMH-dAD criteria (DLB: AD = 43.7%: 33.2%; p = 0.105). The severity of depression was higher in DLB than in AD according to the Hamilton Depression Rating Scale (p < 0.001) and the Cornell Scale for Depression in Dementia (p < 0.001). Among depressive symptoms, pervasive anhedonia had the highest odds ratio in DLB compared with AD. CONCLUSION This is the first study using the NIMH-dAD criteria to investigate the frequency of depression in DLB. Our study shows that co-morbid major depression is more frequent in DLB than in AD. Pervasive anhedonia had the greatest value for the differential diagnosis of depression between DLB and AD.
Collapse
Affiliation(s)
- Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chein-Wei Wang
- Department of Neurology, Taichung Lin-Shin Hospital, Taichung, Taiwan
| | - Chun-Tang Tsai
- Department of Guidance and Counseling, National Changhua University of Education, Changhua, Taiwan
| | - Shin-Hua Li
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chih-Li Lin
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Te-Jen Lai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan
- * E-mail: ,
| |
Collapse
|
15
|
Røen I, Selbæk G, Kirkevold Ø, Engedal K, Testad I, Bergh S. Resourse Use and Disease Couse in dementia - Nursing Home (REDIC-NH), a longitudinal cohort study; design and patient characteristics at admission to Norwegian nursing homes. BMC Health Serv Res 2017; 17:365. [PMID: 28532443 PMCID: PMC5441072 DOI: 10.1186/s12913-017-2289-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/03/2017] [Indexed: 12/18/2022] Open
Abstract
Background Earlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living. The REDIC-NH cohort was set up to study the disease course and the resources used in patients with dementia in Norway. The aim of this paper was to describe the methods and the data collection, and to present selected data about patients at admission to a nursing home. Methods We included 696 patients at admission to a nursing home and followed them with biannual assessments until death. Baseline data were collected between March 2012 and November 2014. In October 2016, patients had either completed an 18-month follow-up (n = 349), passed 18 months without assessments (n = 22), or left the study (n = 324). Data on demographics, cognition, NPS, activities of daily living (ADL) functioning, physical health, medication, Quality of Life (QoL), resource use, and caregiver burden, in addition to DNA samples were collected. Results Mean age of the participants at inclusion was 84.5 years (SD 7.5, range 50 – 105), 63.9% were women. According to data collected in the study, 83.8% had dementia, but only 55.9% of them had a diagnosis of dementia registered in their records. The most frequent dementia diagnosis was Alzheimer’s disease, which was present in 71% of those with dementia. Patients with dementia more often experienced delusions, hallucinations, agitation, anxiety, disinhibition, irritability, and aberrant motor behaviour compared to patients without dementia. Depression and anxiety were the most common NPS symptoms. Conclusions Dementia and NPS were highly prevalent among persons admitted to nursing homes. Only 55.9% of the patients with dementia had a diagnosis of dementia registered in their records.
Collapse
Affiliation(s)
- Irene Røen
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
| | - Geir Selbæk
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Kirkevold
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Norwegian University of Science and Technology (NTNU), Department of Health Science in Gjøvik, Gjøvik, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ingelin Testad
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Sverre Bergh
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| |
Collapse
|
16
|
Yang W, Yu S. Synucleinopathies: common features and hippocampal manifestations. Cell Mol Life Sci 2017; 74:1485-1501. [PMID: 27826641 PMCID: PMC11107502 DOI: 10.1007/s00018-016-2411-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 01/08/2023]
Abstract
Parkinson's disease (PD), dementia with Lewy Bodies (DLB), and multiple system atrophy (MSA) are three major synucleinopathies characterized by α-synuclein-containing inclusions in the brains of patients. Because the cell types and brain structures that are affected vary markedly between the disorders, the patients have different clinical manifestations in addition to some overlapping symptoms, which are the basis for differential diagnosis. Cognitive impairment and depression associated with hippocampal dysfunction are frequently observed in these disorders. While various α-synuclein-containing inclusions are found in the hippocampal formation, increasing evidence supports that small α-synuclein aggregates or oligomers may be the real culprit, causing deficits in neurotransmission and neurogenesis in the hippocampus and related brain regions, which constitute the major mechanism for the hippocampal dysfunctions and associated neuropsychiatric manifestations in synucleinopathies.
Collapse
Affiliation(s)
- Weiwei Yang
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Shun Yu
- Department of Neurobiology, Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
- Center of Parkinson's Disease, Beijing Institute for Brain Disorders, Beijing, China.
- Beijing Key Laboratory for Parkinson's Disease, Beijing, China.
| |
Collapse
|
17
|
Reeves SJ, Clark‐Papasavas C, Gould RL, Ffytche D, Howard RJ. Cognitive phenotype of psychotic symptoms in Alzheimer's disease: evidence for impaired visuoperceptual function in the misidentification subtype. Int J Geriatr Psychiatry 2015; 30:1147-55. [PMID: 25809437 PMCID: PMC4988507 DOI: 10.1002/gps.4265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/30/2014] [Accepted: 01/08/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Establishing the cognitive phenotype of psychotic symptoms in Alzheimer's disease (AD) could localise discrete pathology and target symptomatic treatment. This study aimed to establish whether psychotic symptoms would be associated with poorer performance on neuropsychological tests known to correlate with striatal dopaminergic function and to investigate whether these differences would be attributed to the paranoid (persecutory delusions) or misidentification (misidentification phenomena +/- hallucinations) subtype. METHODS Seventy patients with probable AD (34 psychotic and 36 nonpsychotic) were recruited to the study. Analysis of covariance was used to compare motor speed and the rapid visual processing test of sustained visual attention, after adjusting for potential confounding factors. Multivariate analyses were used to compare performance across other cognitive domains. Significant findings were explored by separating patients on the basis of subtype. RESULTS Rapid visual processing performance accuracy was reduced in patients with psychotic symptoms (F1,58 = 5.94, p = 0.02) and differed significantly across subtypes (F2,51 = 3.94, p = 0.03), largely because of poorer performance in the misidentification compared with nonpsychotic group. Multivariate analyses (corrected for multiple comparisons) showed poorer performance on the incomplete letters task in psychotic patients (F1,63 = 8.77, p = 0.004) and across subtypes (F2,55 = 10.90, p < 0.001), similarly attributed to the misidentification subtype. CONCLUSIONS These findings provide further support of the involvement of dopaminergic networks in the psychosis endophenotype in AD and, in addition, implicate the ventral (temporo-occipital) pathway in the misidentification subtype. Future studies should investigate the early trajectory of neuropathological change in vivo across psychosis subtypes.
Collapse
Affiliation(s)
- Suzanne J. Reeves
- Department of Old Age Psychiatry, Institute of PsychiatryKing's College LondonSE5 8AFUK
| | - Chloe Clark‐Papasavas
- Department of Old Age Psychiatry, Institute of PsychiatryKing's College LondonSE5 8AFUK
| | - Rebecca L. Gould
- Department of Old Age Psychiatry, Institute of PsychiatryKing's College LondonSE5 8AFUK
| | - Dominic Ffytche
- Department of Old Age Psychiatry, Institute of PsychiatryKing's College LondonSE5 8AFUK
| | - Robert J. Howard
- Department of Old Age Psychiatry, Institute of PsychiatryKing's College LondonSE5 8AFUK
| |
Collapse
|
18
|
Matsunaga S, Kishi T, Iwata N. Memantine for Lewy body disorders: systematic review and meta-analysis. Am J Geriatr Psychiatry 2015; 23:373-383. [PMID: 24406251 DOI: 10.1016/j.jagp.2013.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 11/13/2013] [Accepted: 11/27/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To clarify whether memantine is more efficacious in several outcomes and safer than placebo in patients with Lewy body disorders, we performed a meta-analysis of memantine in patients with Lewy body disorders. METHODS The meta-analysis included randomized controlled trials of memantine for Lewy body disorders in all patients with Lewy body disorders. Motor function, activities of daily living, Neuropsychiatric Inventory, Mini-Mental State Exam, discontinuation rate, and individual side effects were evaluated. RESULTS No significant effects of memantine on motor function scores, Mini-Mental State Exam scores, Neuropsychiatric Inventory scores, and activity of daily living scores were found. However, memantine was superior to placebo in Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change scores (standardized mean difference: -0.26; 95% confidence interval: -0.51 to -0.02; z = 2.08; p = 0.04; two studies; N = 258). Dropout due to all causes, inefficacy, or adverse events were similar in both groups. Moreover, no significant differences in serious adverse events, somnolence/tiredness, stroke, dizziness/vertigo, and confusion were found between the groups. CONCLUSION Our results suggest that memantine did not have a benefit for the treatment of Lewy body disorders in cognition and motor function. However, memantine may be superior to placebo for the overall impression of the disorders. Further, memantine is well tolerated.
Collapse
Affiliation(s)
- Shinji Matsunaga
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Department of Psychiatry, Okehazama Hospital, Toyoake, Aichi, Japan
| | - Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| |
Collapse
|
19
|
Ballard C, Thomas A, Gerry S, Yu LM, Aarsland D, Merritt C, Corbett A, Davison C, Sharma N, Khan Z, Creese B, Loughlin P, Bannister C, Burns A, Win SN, Walker Z. A Double-Blind Randomized Placebo-Controlled Withdrawal Trial Comparing Memantine and Antipsychotics for the Long-Term Treatment of Function and Neuropsychiatric Symptoms in People With Alzheimer's Disease (MAIN-AD). J Am Med Dir Assoc 2015; 16:316-22. [DOI: 10.1016/j.jamda.2014.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 11/29/2022]
|
20
|
Bowler RM, Lezak MD. Neuropsychologic evaluation and exposure to neurotoxicants. HANDBOOK OF CLINICAL NEUROLOGY 2015; 131:23-45. [PMID: 26563781 DOI: 10.1016/b978-0-444-62627-1.00003-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The history of neuropsychologic assessment describes the development of a psychometric approach to neuropsychologic measurement, based on the initial clinical/theoretical approach exemplified by pioneers, who also discussed different brain functions and hypotheses for clinical exploration and treatment. Early neuropsychologic assessment practices in the USA arose out of the need to screen, diagnose, and treat World War II veterans who returned with brain injuries. Clinical testing was used to determine treatment and rehabilitation potential. Clinical psychologists had previously developed educational tests to investigate students' abilities and disabilities. Using population studies, primarily in the USA, Canada and Europe, neuropsychologists developed standardized test scores, permitting comparisons of scores based on the normal curve and evolving knowledge of brain/behavior relationships. In clinical interpretations, neuropsychologists use extensive normative data based on cognitive, mood, executive, neurologic, and motor brain functions of groups with different cultural and educational backgrounds and psychiatric illnesses. Large groups of workers can be screened with a brief neuropsychologic screening test battery to assess the psychologic status of personnel. Commonly used tests by domain are described, as well as patterns of acute and chronic neurotoxicant exposures, treatment, and rehabilitation. Future developments will relate imaging studies to neuropsychologic performance.
Collapse
Affiliation(s)
- Rosemarie M Bowler
- Department of Psychology, San Francisco State University, San Francisco, CA, USA.
| | - Muriel D Lezak
- Department of Neurology, Oregon Health and Sciences University, Portland, OR, USA
| |
Collapse
|
21
|
Krolak-Salmon P, Xie J. Malattia a corpi di Lewy. Neurologia 2014. [DOI: 10.1016/s1634-7072(14)68870-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
22
|
Extrapyramidal signs by dementia severity in Alzheimer disease and dementia with Lewy bodies. Alzheimer Dis Assoc Disord 2014; 27:226-32. [PMID: 23023095 DOI: 10.1097/wad.0b013e31826f040d] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Alzheimer disease (AD) and dementia with Lewy bodies (DLB) are common etiologies of dementia with overlapping clinical features. Our objective was to determine which extrapyramidal signs (EPSs) are most helpful in identifying DLB. We analyzed data from the National Alzheimer's Coordinating Center, including demographics, Unified Parkinson's Disease Rating Scale (UPDRS) scores, Mini-Mental State Examination (MMSE) scores, and clinical diagnosis. The subjects were divided into 3 groups: AD, DLB, or Lewy body variant (LBV). The UPDRS motor scores were totaled and analyzed within and across the MMSE strata using regression techniques. Further, we divided UPDRS subscores into 9 EPSs, dichotomized as either present or absent. Logistic regression analysis was used to compare each of the EPS in the AD and Lewy body (DLB+LBV) groups. DLB subjects (n=130) were more likely to be male individuals, younger, and have higher MMSE scores (P<0.001) compared with that in AD (n=1826) or LBV (n=105) subjects. Differences were found for total UPDRS score and number of EPSs (P<0.001), after controlling for age, sex, and MMSE. Logistic regression models demonstrated that masked facies best differentiated AD from Lewy body (odds ratio=6.5, P<0.001, 95% confidence interval, 3.8-11.1). If these findings are neuropathologically validated, then the presence of specific EPS may help clinicians better differentiate AD and DLB.
Collapse
|
23
|
Vann Jones SA, O'Brien JT. The prevalence and incidence of dementia with Lewy bodies: a systematic review of population and clinical studies. Psychol Med 2014; 44:673-683. [PMID: 23521899 DOI: 10.1017/s0033291713000494] [Citation(s) in RCA: 295] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) is increasingly recognized as a common cause of dementia in older people. However, its true frequency remains unclear, with previous studies reporting a prevalence range from zero to 22.8% of all dementia cases. This review aimed to establish the population prevalence and incidence for DLB and to compare this to its prevalence in secondary care settings. METHOD A literature review of all relevant population and clinical studies was conducted using PubMed. Additional references from papers found during that process were added to this. RESULTS DLB accounted for 4.2% of all diagnosed dementias in the community. In secondary care this increased to 7.5%. The incidence of DLB was 3.8% of new dementia cases. There was a significant increase in DLB diagnoses when using the revised (2005) International Consensus Criteria (ICC) for DLB compared to the original (1996) criteria. CONCLUSIONS DLB currently accounts for around one in 25 dementia cases diagnosed in the community and one in 13 cases in secondary care. The significantly higher rates of DLB in secondary care may reflect enhanced diagnostic accuracy in specialist settings and/or the increased morbidity and carer burden of the DLB syndrome compared to other dementias. However, the true prevalence is likely to be much higher because DLB diagnoses are often missed, although there is evidence that new criteria aid case identification.
Collapse
Affiliation(s)
- S A Vann Jones
- Institute for Ageing and Health, Newcastle University, UK
| | - J T O'Brien
- Institute for Ageing and Health, Newcastle University, UK
| |
Collapse
|
24
|
Lebouvier T, Delrieu J, Evain S, Pallardy A, Sauvaget A, Letournel F, Chevrier R, Lepetit M, Vercelletto M, Boutoleau-Bretonnière C, Derkinderen P. [Dementia: Where are the Lewy bodies?]. Rev Neurol (Paris) 2013; 169:844-57. [PMID: 24103321 DOI: 10.1016/j.neurol.2013.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 11/25/2022]
Abstract
Dementia with Lewy bodies (DLB) is the second cause of degenerative dementia in autopsy studies. In clinical pratice however, the prevalence of DLB is much lower with important intercenter variations. Among the reasons for this low sensitivity of DLB diagnosis are (1) the imprecision and subjectivity of the diagnostic criteria; (2) the underestimation of non-motor symptoms (REM-sleep behavior disorder, dysautonomia, anosmia); mostly (3) the nearly constant association of Lewy bodies with Alzheimer's disease pathology, which dominates the clinical phenotype. With the avenue of targeted therapies against the protein agregates, new clinical scales able to apprehend the coexistence of Lewy pathology in Alzheimer's disease are expected.
Collapse
Affiliation(s)
- T Lebouvier
- CMRR des Pays de Loire, hôpital Laënnec, CHU de Nantes, boulevard Professeur-Jacques-Monod, 44800 Saint-Herblain, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Cohort study of prevalence and phenomenology of tremor in dementia with Lewy bodies. J Neurol 2013; 260:1731-42. [PMID: 23400498 PMCID: PMC3705145 DOI: 10.1007/s00415-013-6853-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
Abstract
To study prevalence, specific patterns and response to treatment of tremor in dementia with Lewy bodies (DLB), in comparison with other tremulous disorders prevalence, qualitative and quantitative features of tremor were studied in an incident cohort of 67 dopaminergic treatment naive DLB, 111 Parkinson's Disease (PD) and 34 Essential Tremor (ET) patients. Tremulous DLB patients (tDLB) were compared with tremulous PD (tPD) and ET patients and followed for 2 years. Double blind placebo-controlled acute drug challenge with L-Dopa and alcohol was performed in all ET, 24 tDLB and 27 tPD. Effects of dopaminergic chronic treatment in all tDLB and tPD patients and primidone in 8 tDLB were also assessed. Tremor occurred in 44.76 % of DLB patients. The tDLB patients presented a complex pattern of mixed tremors, characterized by rest and postural/action tremor, including walking tremor and standing overflow in 50 % tDLB. Standing tremor with overflow was characteristic of tDLB (p < 0.001). Head tremor was more frequent in tDLB than tPD and ET (p = 0.001). The tDLB tremors were reduced by acute and chronic dopaminergic treatments (p < 0.01) but not by alcohol or primidone. Tremor occurs commonly in DLB patients with a complex mixed tremor pattern which shows a significant response to acute and chronic dopaminergic treatments. Recognizing that there is a clinical category of tremulous DLB may help the differential diagnosis of tremors.
Collapse
|
26
|
|
27
|
Kim Y, Bowler RM, Abdelouahab N, Harris M, Gocheva V, Roels HA. Motor function in adults of an Ohio community with environmental manganese exposure. Neurotoxicology 2011; 32:606-14. [PMID: 21840336 DOI: 10.1016/j.neuro.2011.07.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/27/2011] [Accepted: 07/28/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of the present study was to evaluate motor function in order to assess the effects of long-term, low-level environmental manganese (Mn) exposure in residents of an Ohio community where a large ferro- and silico-Mn smelter has been active for more than 50 years. METHODS One hundred residents from the Mn-exposed Ohio community were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), a postural sway test, and a comprehensive questionnaire exploring demographics and general health. The results were compared to those of 90 residents from a demographically similar comparison town in Ohio. Mn exposure was assessed using modeled airborne Mn and blood Mn (Mn-B). The UPDRS was employed to evaluate parkinsonian motor features. Postural sway was measured using a CATSYS 2000 (Danish Product Development). RESULTS No significant difference between the exposed and comparison groups was evident as to Mn-B, demographics or major health outcomes. The risk of abnormal UPDRS performance using "Motor and Bradykinesia" criteria was increased in the Mn-exposed group after adjustment for potential confounders such as the presence of other neurotoxic metals, factors affecting susceptibility to Mn, potential factors influencing motor performance, and other possible demographic confounders. No participant was diagnosed with clinical manganism by neurological examination. After adjustment for various potential confounders, the Mn-exposed group showed significantly higher postural sway scores under eyes-open conditions than the comparison group. CONCLUSIONS Subclinical findings on the UPDRS and postural sway in the Mn-exposed group may possibly reflect early subtle effects of chronic low-level Mn exposure. However, the cross-sectional study design, the small to medium effect sizes, and the little biological plausibility are limiting the possibility of a causal relationship between the environmental Mn-air exposure and the early subclinical neurotoxic effects observed.
Collapse
Affiliation(s)
- Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Dong-Gu, Ulsan, South Korea.
| | | | | | | | | | | |
Collapse
|
28
|
Neuropathological correlates of volumetric MRI in autopsy-confirmed Lewy body dementia. Neurobiol Aging 2011; 33:1228-36. [PMID: 21353336 DOI: 10.1016/j.neurobiolaging.2010.12.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 10/25/2010] [Accepted: 12/27/2010] [Indexed: 11/21/2022]
Abstract
The objective of this study was to determine the neuropathological correlates of regional medial temporal lobe volume measures on magnetic resonance imaging (MRI) in subjects with Lewy body dementia (LBD). Twenty-three autopsy-confirmed LBD cases with an MRI scan close to death (mean 1.5 years) were studied. MRI-based volumetric measures were calculated for total intracranial volume, hippocampus, entorhinal cortex, and amygdala. Quantitative neuropathological analysis of plaques, tangles, and Lewy bodies were carried out in the same regions. Spearman's rho was used to examine correlations between MRI volumes and neuropathology measures and linear regression to assess the relationship between neuropathology and MRI volumes. A significant inverse correlation was observed between normalized amygdala volume and percent area of Lewy bodies in the amygdala (r = -0.461, p = 0.035). There were no other significant correlations between regional MRI volume and measures of neuropathology. Lewy body, but not Alzheimer's disease (AD) pathology was associated with reduced amygdala volume in pathologically-verified LBD cases but neither Lewy body nor Alzheimer's disease pathology was associated with volume loss in the hippocampus or entorhinal cortex, suggesting other neuropathological factors account for atrophy in these structures in LBD.
Collapse
|
29
|
Johansson C, Ballard C, Hansson O, Palmqvist S, Minthon L, Aarsland D, Londos E. Efficacy of memantine in PDD and DLB: an extension study including washout and open-label treatment. Int J Geriatr Psychiatry 2011; 26:206-13. [PMID: 20665553 DOI: 10.1002/gps.2516] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This 30-week extension trial was a continuation of the first double-blind randomized controlled trial (RCT) to study memantine in dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). The objective was to evaluate the presence of recurrence of symptoms upon drug withdrawal. Furthermore, the aim was to explore washout dynamics in order to inform clinical practice. METHODS Patients were enrolled from psychiatric, memory and neurological outpatient clinics in Norway, Sweden and the UK. The trial comprised a 4-week washout period and a 26-week open-label treatment period. Outcome measures were presence of recurrence of symptom upon drug withdrawal, Clinical Global Impression of Change (CGIC) and modified motor Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS recurrence of symptoms occurred more frequently (p=0.04) in patients receiving memantine (58%) than in patients receiving placebo (25%). There was a significant global deterioration (p=0.0003) during washout within the memantine group as measured by CGIC. The patients seemed to recover during the open-label treatment, however these findings were non-significant. CONCLUSIONS The findings inform clinical practice that any possible memantine-associated benefits might be rapidly lost after drug withdrawal. The magnitude of deterioration suggests a symptomatic rather than a disease-modifying effect of the drug. Open-label results should merely be considered inspiration for future trials.
Collapse
Affiliation(s)
- C Johansson
- Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | | | | | | | | | | | | |
Collapse
|
30
|
Johansen KK, White LR, Sando SB, Aasly JO. Biomarkers: Parkinson disease with dementia and dementia with Lewy bodies. Parkinsonism Relat Disord 2010; 16:307-15. [PMID: 20338799 DOI: 10.1016/j.parkreldis.2010.02.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 02/23/2010] [Accepted: 02/27/2010] [Indexed: 12/31/2022]
Abstract
Dementia is a common feature in Parkinson disease (PD), the time of onset determining how patients are classified. Those patients where dementia develops prior to parkinsonism or during the first year of disease are designated as having dementia with Lewy bodies (DLB). In those where dementia develops over a year after the onset of motor signs, the condition is known as Parkinson's disease with dementia (PDD). While this seems at first sight to be a definitive way to distinguish these conditions, reality is rather different. The overlap between them is considerable, and there is much uncertainty associated with patients who have both motor symptoms and early cognitive impairment. The diagnosis is still based on medical history and clinical evaluation. It is not even certain that they can be accurately distinguished at autopsy. For this reason, the data concerning these entities have been reviewed, to examine various markers employed or measured in clinical, neuropathological, neuroimaging, and biochemical investigations. The concept of PDD and DLB being separate conditions is comparatively new, and the most promising tools with which to separate them at present are cerebrospinal fluid (CSF) markers and positron emission tomography (PET) scanning that indicate increased amyloid-beta burden in DLB compared to PDD. However as yet there are no markers that unequivocally distinguish between PDD and DLB.
Collapse
Affiliation(s)
- Krisztina K Johansen
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | | | | |
Collapse
|
31
|
Levin OS, Batukaeva LA, Smolentseva IG, Amosova NA. Efficacy and safety of memantine in Lewy body dementia. ACTA ACUST UNITED AC 2009; 39:597-604. [PMID: 19517247 DOI: 10.1007/s11055-009-9167-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Lewy body dementia (LBD) is a progressive brain disease manifest as dementia and parkinsonism, along with psychotic and autonomic disorders. Although studies in recent years have demonstrated the positive effects of cholinesterase inhibitors in LBD, the search for therapeutic agents with other mechanisms of action remains relevant. An open, controlled, 16-week study was performed with the aim of evaluating the efficacy and safety of memantine in patients with clinically diagnosed LBD (criteria of McKeith et al., 1999). The study included 23 patients (mean age 69.2 +/- 5.9 years), who were divided into two groups: 14 patients received memantine at a dose of 20 mg/day and nine patients constituted the control group. Efficacy was evaluated using a battery of quantitative neurospychological tests, clinical scales for assessment of fluctuations in mental states, scales for assessment of behavioral and psychotic disorders, and the general clinical impression scale. The results demonstrated that memantine had positive effects on the patients' general status and cognitive functions (increases on the mini mental state examination by 1.5 points), mainly because of improvements in attention and control functions. There were also reductions in the severity of fluctuations in mental state, aggressivity, lack of spontaneity, and disinhibition. The severity of psychotic and motor disorders did not change significantly. Tolerance of the agent was good, only two patients withdrawing from the study because of episodes of confusion during the dose titration period.
Collapse
Affiliation(s)
- O S Levin
- Department of Neurology, Russian Postgraduate Medical Academy, Moscow, Russia
| | | | | | | |
Collapse
|
32
|
Molloy S, Minett T, O'Brien JT, McKeith IG, Burn DJ. Levodopa use and sleep in patients with dementia with Lewy bodies. Mov Disord 2009; 24:609-12. [PMID: 19191343 DOI: 10.1002/mds.22411] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Sleep disturbance and excessive daytime somnolence (EDS) are features of Parkinson's disease (PD) and dementia with Lewy bodies (DLB) that may be influenced by dopamine replacement therapy. The effect of levodopa on sleep and EDS in DLB is unknown and unclear in PD. The aim of this study is to determine if levodopa treatment alters sleep symptoms and EDS in DLB. Dopamine naïve patients with DLB (n = 15; mean mini mental state examination (MMSE) score 17.7(4.6)) and PD (n = 9; mean MMSE 25.5(2.2)) were assessed using the Epworth sleep scale, Parkinson's disease sleep scale, and the neuropsychiatric inventory prior to initiating treatment with levodopa. All measures were repeated after 3 and 6 months of levodopa therapy. The median final daily levodopa dose was 300 mg in both groups. Baseline sleep measures were comparable between groups. Levodopa treatment did not affect sleep or lead to increased EDS in DLB patients. The use of levodopa does not appear to adversely affect subjective sleep measures or increase EDS in DLB patients.
Collapse
Affiliation(s)
- Sophie Molloy
- Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, United Kingdom.
| | | | | | | | | |
Collapse
|
33
|
Aarsland D, Ballard C, Walker Z, Bostrom F, Alves G, Kossakowski K, Leroi I, Pozo-Rodriguez F, Minthon L, Londos E. Memantine in patients with Parkinson's disease dementia or dementia with Lewy bodies: a double-blind, placebo-controlled, multicentre trial. Lancet Neurol 2009; 8:613-8. [DOI: 10.1016/s1474-4422(09)70146-2] [Citation(s) in RCA: 344] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Aarsland D, Kurz M, Beyer M, Bronnick K, Piepenstock Nore S, Ballard C. Early discriminatory diagnosis of dementia with Lewy bodies. The emerging role of CSF and imaging biomarkers. Dement Geriatr Cogn Disord 2008; 25:195-205. [PMID: 18204253 DOI: 10.1159/000113417] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical diagnostic criteria for dementia with Lewy bodies (DLB) have a low sensitivity, and there are no generally accepted biomarkers to distinguish DLB from other dementias. Our aim was to identify biomarkers that may differentiate DLB from Alzheimer's disease (AD). METHOD We performed a systematic literature search for studies of EEG, imaging techniques and genetic and CSF markers that provide sensitivity and specificity in the identification of DLB. RESULTS The best evidence was for scintigraphy of the striatal dopamine transporter system using FP-CIT SPECT. Several small scintigraphy studies of cardiovascular autonomic function using metaiodobenzylguanidine SPECT have reported promising results. Studies exploring innovative techniques based on CSF have reported interesting findings for the combination of amyloid beta (abeta) isoforms as well as alpha-synuclein, and there are interesting results emerging from preliminary studies applying proteomic techniques. Data from studies using structural MRI, perfusion SPECT, genetics and EEG studies show differences between DLB and AD but only at a group level. CONCLUSION Several potential biomarkers for the differential diagnosis of probable DLB and AD have shown good diagnostic accuracy in the research setting. Data from large multicentre studies and from studies with autopsy confirmation exist for scintigraphy of the dopamine transporter system. Future studies should explore its value in possible DLB and for clinical management and health economics.
Collapse
Affiliation(s)
- Dag Aarsland
- Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
| | | | | | | | | | | |
Collapse
|
35
|
Fujimi K, Sasaki K, Noda K, Wakisaka Y, Tanizaki Y, Matsui Y, Sekita A, Iida M, Kiyohara Y, Kanba S, Iwaki T. Clinicopathological outline of dementia with Lewy bodies applying the revised criteria: the Hisayama study. Brain Pathol 2008; 18:317-25. [PMID: 18462473 DOI: 10.1111/j.1750-3639.2008.00169.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To explore the validity of the criteria for dementia with Lewy bodies (DLB) revised in 2005, we examined community based consecutive autopsy cases. 10.3% of the non-demented subjects and 31.2% of the demented subjects showed the Lewy body pathology. Applying the revised pathological criteria to the 205 demented subjects, the types of LB pathology of 11 cases (5.4%) were brainstem-predominant, 24 cases (11.7%) were limbic type and 24 cases (11.7%) were diffuse neocortical type, although there were many subjects not to fit the criteria exactly. The prevalence of Lewy bodies (LBs) was almost same regardless of gender; however, the extent of the LB pathology among females was more severe than that in males. The likelihood of DLB being modified by concomitant Alzheimer's pathology was as follows: 27 cases (13.2%) showed low likelihood, 16 cases (7.8%) showed intermediate likelihood and 16 cases (7.8%) showed high likelihood. Since the numbers of clinical features of DLB were significantly higher in the pathological intermediate and high likelihood DLB groups than in the low likelihood DLB group or no LB group, both the intermediate and high likelihood groups of DLB should be considered as pathological DLB.
Collapse
Affiliation(s)
- Kouhei Fujimi
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Ballard C, Lana MM, Theodoulou M, Douglas S, McShane R, Jacoby R, Kossakowski K, Yu LM, Juszczak E. A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial). PLoS Med 2008; 5:e76. [PMID: 18384230 PMCID: PMC2276521 DOI: 10.1371/journal.pmed.0050076] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 02/15/2008] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There have been increasing concerns regarding the safety and efficacy of neuroleptics in people with dementia, but there are very few long-term trials to inform clinical practice. The aim of this study was to determine the impact of long-term treatment with neuroleptic agents upon global cognitive decline and neuropsychiatric symptoms in patients with Alzheimer disease. METHODS AND FINDINGS DESIGN Randomised, blinded, placebo-controlled parallel two-group treatment discontinuation trial. SETTING Oxfordshire, Newcastle and Gateshead, London and Edinburgh, United Kingdom. PARTICIPANTS Patients currently prescribed the neuroleptics thioridazine, chlorpromazine, haloperidol trifluoperazine or risperidone for behavioural or psychiatric disturbance in dementia for at least 3 mo. INTERVENTIONS Continue neuroleptic treatment for 12 mo or switch to an identical placebo. OUTCOME MEASURES Primary outcome was total Severe Impairment Battery (SIB) score. Neuropsychiatric symptoms were evaluated with the Neuropsychiatric Inventory (NPI). RESULTS 165 patients were randomised (83 to continue treatment and 82 to placebo, i.e., discontinue treatment), of whom 128 (78%) commenced treatment (64 continue/64 placebo). Of those, 26 were lost to follow-up (13 per arm), resulting in 51 patients per arm analysed for the primary outcome. There was no significant difference between the continue treatment and placebo groups in the estimated mean change in SIB scores between baseline and 6 mo; estimated mean difference in deterioration (favouring placebo) -0.4 (95% confidence interval [CI] -6.4 to 5.5), adjusted for baseline value (p = 0.9). For neuropsychiatric symptoms, there was no significant difference between the continue treatment and placebo groups (n = 56 and 53, respectively) in the estimated mean change in NPI scores between baseline and 6 mo; estimated mean difference in deterioration (favouring continue treatment) -2.4 (95% CI -8.2 to 3.5), adjusted for baseline value (p = 0.4). Both results became more pronounced at 12 mo. There was some evidence to suggest that those patients with initial NPI >/= 15 benefited on neuropsychiatric symptoms from continuing treatment. CONCLUSIONS For most patients with AD, withdrawal of neuroleptics had no overall detrimental effect on functional and cognitive status. Neuroleptics may have some value in the maintenance treatment of more severe neuropsychiatric symptoms, but this benefit must be weighed against the side effects of therapy. TRIAL REGISTRATION Cochrane Central Registry of Controlled Trials/National Research Register (#ISRCTN33368770).
Collapse
Affiliation(s)
- Clive Ballard
- Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Sabbagh MN, Lahti T, Connor DJ, Caviness JN, Shill H, Vedders L, Mahant P, Samanta J, Burns RS, Evidente VGH, Driver-Dunckley E, Reisberg B, Bircea S, Adler CH. Functional ability correlates with cognitive impairment in Parkinson's disease and Alzheimer's disease. Dement Geriatr Cogn Disord 2008; 24:327-34. [PMID: 17851237 DOI: 10.1159/000108340] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Previously we have shown that functional declines in Parkinson's disease (PD) and Alzheimer's disease (AD) correlate to global measures of cognitive decline. We now determine if the correlation between cognitive impairment and functional ability in PD is similar to that in AD using individual cognitive measures. METHODS 93 PD subjects and 124 AD/MCI subjects underwent the Functional Assessment Staging (FAST), the Global Deterioration Scale (GDS), and a neuropsychological battery. RESULTS In PD subjects, the FAST and GDS correlated significantly with Rey Auditory Verbal Learning Test (AVLT), Controlled Oral Word Association (COWA), Animal Fluency, and Stroop but not with Clock Draw or Judgment Line Orientation (JLO). In AD/MCI subjects, FAST and GDS correlated with all neuropsychological components except Stroop. In the AD/MCI group, the UPDRS significantly correlated with the FAST, GDS, MMSE, and all neuropsychological parameters except the Stroop. In the PD group, the motor UPDRS significantly correlated significantly with FAST, GDS, MMSE and all neuropsychological parameters except Digit Span, Stroop, Clock Draw and JLO. CONCLUSIONS Similar to AD, functional decline in PD correlates with multiple measures of cognitive impairment. Some differences between PD and AD may be explained by the influence of motor disability and declines in visuospatial function in PD.
Collapse
Affiliation(s)
- M N Sabbagh
- The Cleo Roberts Center for Clinical Research, Sun Health Research Institute, Sun City, AZ 85351, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Piggott MA, Ballard CG, Rowan E, Holmes C, McKeith IG, Jaros E, Perry RH, Perry EK. Selective loss of dopamine D2 receptors in temporal cortex in dementia with Lewy bodies, association with cognitive decline. Synapse 2007; 61:903-11. [PMID: 17663455 DOI: 10.1002/syn.20441] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dementia with Lewy bodies (DLB) is a progressive dementia frequently accompanied by psychotic symptoms. Similar symptoms can occur in Alzheimer's disease (AD) to a lesser extent. The use of neuroleptic medication to treat psychosis in both diseases is of modest efficacy and can induce severe adverse reactions in DLB. Dopamine D2 receptors in the cerebral cortex are the putative target for the antipsychotic action of these drugs, but the status of these receptors in DLB is unknown. Autoradiography was used to examine the density D2 receptors in postmortem temporal cortex tissue from prospectively assessed patients with neuropathologically confirmed DLB and AD. D2 receptors were substantially (over 40%) and significantly (P < 0.001) reduced in temporal cortex in DLB, and in DLB with concomitant Alzheimer pathology, but was not significantly changed in AD. This reduction correlated with greater cognitive decline (P < 0.01), but was not significantly related to visual or auditory hallucinations or delusions. D2 receptor density was inversely correlated with cortical Lewy body pathology in the neocortex (P < 0.001). The specific loss of D2 receptors associated with Lewy body pathology, in conjunction with our previous finding of low D2 receptors in striatum in DLB, provides a possible explanation for neuroleptic intolerance. That the reduction of D2 receptors correlated with cognitive decline suggests that neuroleptics, as dopamine D2 receptor antagonists, may have a deleterious effect on cognition in DLB.
Collapse
Affiliation(s)
- Margaret A Piggott
- Institute for Ageing and Health, Wolfson Research Centre, Newcastle General Hospital, Newcastle-upon-Tyne NE4 6BE, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Rosano C, Brach J, Studenski S, Longstreth WT, Newman AB. Gait variability is associated with subclinical brain vascular abnormalities in high-functioning older adults. Neuroepidemiology 2007; 29:193-200. [PMID: 18043004 DOI: 10.1159/000111582] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gait variability is an index of how much gait parameters, such as step length, change from one step to the next. Gait variability increases with age and in individuals affected by cortical and subcortical neurodegenerative conditions, and it is associated with falls and incident mobility disability. The brain anatomical correlates of gait variability have not been studied in high-functioning community-dwelling older adults. METHODS Gait variability and brain MRIs were assessed in a cohort of 331 men and women (mean age = 78.3 years) free from stroke, dementia or Parkinson's disease. Gait variability was computed for spatial parameters (step length and step width) and for temporal parameters (stance time). Subclinical brain vascular abnormalities were measured on brain MRIs as infarcts and white matter hyperintensities. RESULTS Greater variability of step length was associated with greater prevalence of infarcts, including infarcts in the basal ganglia, and with greater white matter hyperintensities severity, independent of age, gender, cognitive function and cardiovascular disease. Weaker associations were found between the other variability measures and the MRI measures. CONCLUSION In this group of older adults free from neurodegenerative diseases, a greater variability of step length was associated with greater burden of subclinical brain vascular abnormalities as defined by MRI.
Collapse
Affiliation(s)
- Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | | | | | | | | |
Collapse
|
40
|
Edwards K, Royall D, Hershey L, Lichter D, Hake A, Farlow M, Pasquier F, Johnson S. Efficacy and safety of galantamine in patients with dementia with Lewy bodies: a 24-week open-label study. Dement Geriatr Cogn Disord 2007; 23:401-5. [PMID: 17409748 DOI: 10.1159/000101512] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) is a common dementia of the elderly. A significant cholinergic deficit has been demonstrated that may be responsive to treatment by cholinesterase inhibitors (ChEIs). METHODS A 24-week, open-label study was designed to assess the efficacy and safety of a ChEI, galantamine, in 50 patients with DLB. RESULTS This study showed beneficial effects with galantamine in 2 of the 3 primary efficacy parameters. The scores on the Neuropsychiatric Inventory (NPI-12) improved by 8.24 points from baseline (p = 0.01) especially in visual hallucinations and nighttime behaviors (p = 0.004). The scores on the Clinician's Global Impression of Change improved by 0.5 points from baseline (p = 0.01). The third primary efficacy parameter, the Cognitive Drug Research Computerized Cognitive Assessment System, was unchanged from baseline. Adverse events were generally mild and transient. CONCLUSION Galantamine appears to be an effective and safe therapy for patients with DLB.
Collapse
Affiliation(s)
- Keith Edwards
- Alzheimer's Diagnostic and Treatment Center, Bennington, VT 05201, USA.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Ziabreva I, Ballard CG, Aarsland D, Larsen JP, McKeith IG, Perry RH, Perry EK. Lewy body disease: thalamic cholinergic activity related to dementia and parkinsonism. Neurobiol Aging 2006; 27:433-8. [PMID: 15913843 DOI: 10.1016/j.neurobiolaging.2005.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Revised: 02/16/2005] [Accepted: 02/28/2005] [Indexed: 11/26/2022]
Abstract
Within the spectrum of Lewy body disease cognitive impairment occurs in PD with dementia (PDD) and dementia with Lewy bodies (DLB). Although neocortical cholinergic deficits are associated with cognitive impairments in PDD and DLB, no neurochemical study has been published describing the thalamic cholinergic activity whereas the thalamus plays a major role in modulating cortical activity. Choline acetyltransferase (ChAT) activity was analyzed in reticular (Re), mediodorsal (MD) and centromedian (CM) thalamic nuclei in series of nine controls, five DLB with parkinsonism (DLB + P), five DLB without parkinsonism (DLB - P), six PD without dementia and 14 PDD cases. Significant reductions in ChAT were apparent in PDD as follows: in Re and MD nuclei compared with controls; in MD and CM nuclei compared with DLB + P; and in MD compared with PD. Increased ChAT activity was found in CM nuclei in DLB + P compared with DLB - P. These findings show that significant thalamic presynaptic cholinergic deficits occur only in cases of combined cortical and subcortical neurodegeneration in which dementia developed after prolonged parkinsonism.
Collapse
Affiliation(s)
- Iryna Ziabreva
- Institute for Ageing and Health, MRC Building, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK.
| | | | | | | | | | | | | |
Collapse
|
42
|
Zanetti M, Ballabio C, Abbate C, Cutaia C, Vergani C, Bergamaschini L. Mild Cognitive Impairment Subtypes and Vascular Dementia in Community-Dwelling Elderly People: A 3-Year Follow-Up Study. J Am Geriatr Soc 2006; 54:580-6. [PMID: 16686866 DOI: 10.1111/j.1532-5415.2006.00658.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate whether mild cognitive impairment (MCI) with multiple impaired cognitive domains (mcd-MCI) is a prodromal manifestation of vascular dementia (VaD). DESIGN Prospective cohort study. SETTING Geriatric unit of the Ospedale Maggiore Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy. PARTICIPANTS Four hundred community-dwelling subjects aged 65 and older who came freely to the geriatric unit as part of a comprehensive geriatric assessment program were evaluated for memory impairment or other cognitive disorders. Subjects with MCI were kept under observation for 3 years. MEASUREMENTS Subjects with MCI were studied by applying a standardized clinical evaluation and a conducting a computed tomography brain scan. Cognitive performance was assessed using the Mini-Mental State Examination, the Clock Drawing Test, and a comprehensive battery of neuropsychological tests. Cardiovascular comorbidity was assessed on the basis of medical history and using electrocardiography, echocardiography, and carotid color Doppler ultrasound. RESULTS MCI was found in 65 of the 400 community-dwelling subjects; 31 were classified with amnestic MCI (a-MCI) and 34 with mcd-MCI. A dysexecutive syndrome characterized people with mcd-MCI, who had significantly more vascular comorbidity and signs of vascular disease on brain imaging as well as a higher prevalence of extra pyramidal features, mood disorders, and behavioral symptoms than people with a-MCI. Twenty of the 65 subjects with MCI (31%) progressed to dementia within 3 years of follow-up: 11 subjects with Alzheimer's disease (AD) and nine with VaD. All patients who evolved to AD had been classified with a-MCI at baseline, whereas all patients who evolved to subcortical VaD had been classified with mcd-MCI at baseline. CONCLUSION All subjects who converted to subcortical VaD had been classified with mcd-MCI, suggesting that mcd-MCI might be an early stage of subcortical VaD.
Collapse
Affiliation(s)
- Mariella Zanetti
- Department of Internal Medicine, Geriatric Unit, Ospedale Maggiore Istituto di Ricovero e Cura a Carattere Scientifico, University of Milan, Milan, Italy
| | | | | | | | | | | |
Collapse
|
43
|
Buracchio T, Arvanitakis Z, Gorbien M. Dementia with Lewy bodies: current concepts. Dement Geriatr Cogn Disord 2005; 20:306-20. [PMID: 16174977 DOI: 10.1159/000088346] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Accepted: 01/29/2005] [Indexed: 11/19/2022] Open
Abstract
As life expectancy continues to increase over time, dementia is becoming an increasingly more common problem and a major cause of disability in older persons. It is now more important than ever to identify and manage common causes of dementia given variations in disease course, treatments and the possibility for modification of risk factors. Dementia with Lewy bodies (DLB) is a dementia syndrome characterized by progressive cognitive decline, with fluctuating cognition, recurrent detailed and well-formed hallucinations, and parkinsonism. This article aims to provide an overview of current concepts of DLB, including a description of the key clinical features and neuropathology, neurochemistry, and genetics of DLB, then a discussion of the relationship of DLB with Alzheimer's disease and Parkinson's disease, and, finally, a summary of current management strategies available for this disorder.
Collapse
Affiliation(s)
- Teresa Buracchio
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill 6012, USA
| | | | | |
Collapse
|
44
|
Sabbagh MN, Silverberg N, Bircea S, Majeed B, Samant S, Caviness JN, Reisberg B, Adler CH. Is the functional decline of Parkinson's disease similar to the functional decline of Alzheimer's disease? Parkinsonism Relat Disord 2005; 11:311-5. [PMID: 15886042 DOI: 10.1016/j.parkreldis.2005.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 01/26/2005] [Accepted: 02/04/2005] [Indexed: 11/17/2022]
Abstract
Since many Parkinson's disease (PD) subjects develop dementia, we determined whether the correlation between functional and cognitive decline seen in Alzheimer's disease (AD) is seen in PD. Seventy-five PD subjects with and without dementia and 103 AD/MCI subjects underwent the Functional Assessment Staging (FAST), the Global Deterioration Scale (GDS), the UPDRS motor portion, and the MMSE. In AD/MCI subjects, changes in FAST and GDS scores correlated with MMSE (rho=-0.814, P<0.001; rho=-0.840, P<0.001, respectively). In PD subjects, the FAST and GDS also correlated with MMSE (rho=-0.675, P<0.001; rho=-0.647, P<0.001, respectively). The UPDRS correlated with the GDS and FAST more closely in PD than in AD. Similar to AD, functional declines in PD correlates with cognitive decline and may be influenced by motor disability in PD.
Collapse
Affiliation(s)
- M N Sabbagh
- The Cleo Roberts Center for Clinical Research, Sun Health Research Institute, 10515 West Santa Fe Drive, Sun City, AZ 85351, USA.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Papapetropoulos S, Ellul J, Argyriou AA, Chroni E, Lekka NP. The effect of depression on motor function and disease severity of Parkinson's disease. Clin Neurol Neurosurg 2005; 108:465-9. [PMID: 16150537 DOI: 10.1016/j.clineuro.2005.08.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Revised: 07/28/2005] [Accepted: 08/01/2005] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Approximately 40% of patients with Parkinson's disease (PD) experience symptoms of depression. Our aim was to evaluate the effect of depression on disease severity, motor function and other phenotypic characteristics of PD. PATIENTS AND METHODS We studied 32 PD patients with major depression (PD-D) according to the DSM-IV criteria and 32 PD patients with no depression (PD-C) matched for gender, age of onset and duration. RESULTS Major depression in PD patients was associated with increased disease severity, poorer motor function and worse performance in the activities of daily living as measured by UPDRS scores. Furthermore, there was an association of depression with the severity of bradykinesia and axial rigidity. CONCLUSIONS Depression in PD can have a profound negative impact on a patient's sense of wellbeing and motor functioning. Therefore, PD patients should be routinely and carefully screened for the presence of depression and appropriate management should be considered. Larger studies on the subject are warranted.
Collapse
Affiliation(s)
- Spiridon Papapetropoulos
- Department of Neurology, Medical School of Patras, Greece; Department of Neurology, University of Miami, School of Medicine, Room 4004, 1501 NW 9th Avenue, Miami, FL 33136, USA.
| | | | | | | | | |
Collapse
|
46
|
Molloy S, McKeith IG, O'Brien JT, Burn DJ. The role of levodopa in the management of dementia with Lewy bodies. J Neurol Neurosurg Psychiatry 2005; 76:1200-3. [PMID: 16107351 PMCID: PMC1739807 DOI: 10.1136/jnnp.2004.052332] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND One of the core clinical features of dementia with Lewy bodies (DLB) is extrapyramidal syndrome (EPS). Levodopa is currently the gold standard oral therapy for Parkinson's disease (PD), but its use in DLB has been tempered by concerns of exacerbating neuropsychiatric symptoms. AIM To assess the efficacy and tolerability of L-dopa in managing EPS in DLB and to compare the motor response with that seen in PD and PD with dementia (PDD). METHOD EPS assessment consisted of the Unified Parkinson's Disease Rating Scale, motor subsection (UPDRS III), and finger tapping and walking tests. Patients with DLB were commenced on L-dopa. After 6 months, patients were examined in the "off" state, given L-dopa and assessed for motor responses. Identical assessments were performed in patients with PD and PDD also receiving L-dopa. RESULTS Acute L-dopa challenge in 14 DLB patients yielded a mean 13.8% (p = 0.02) improvement in UPDRS III score, compared with 20.5% in PD (n = 28, p < 0.0001) and 23% in PDD (n = 30, p<0.0001) respectively. Finger tapping scores increased (12.3% v 20% and 23%), while walking test scores decreased (32% v 41% and 67%). Of the DLB patients, 36% were classified as "responders" on L-dopa challenge, compared with 70% of the PDD and 57% of the PD patients. Nineteen DLB patients were treated for 6 months with L-dopa (mean daily dose 323 mg). Two withdrew prematurely with gastrointestinal symptoms and two with worsening confusion. CONCLUSION L-dopa was generally well tolerated in DLB but produced a significant motor response in only about one third of patients. Younger DLB cases were more likely to respond to dopaminergic treatment.
Collapse
Affiliation(s)
- S Molloy
- Regional Neurosciences Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK
| | | | | | | |
Collapse
|
47
|
Ballard CG, Perry RH, McKeith IG, Perry EK. Neuroleptics are associated with more severe tangle pathology in dementia with Lewy bodies. Int J Geriatr Psychiatry 2005; 20:872-5. [PMID: 16116579 DOI: 10.1002/gps.1378] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neuroleptics are only modestly effective in dementia and associated with a range of adverse effects including cognitive decline. Effects of the drugs on molecular pathology in brain tissue from people with dementia have not been investigated. OBJECTIVES To compare the severity of Alzheimer type pathology in matched groups of people with dementia with Lewy bodies (DLB), treated and not treated with neuroleptics. METHODS The relationship between neuroleptics and Alzheimer-type pathology was determined in 40 (17 neuroleptic treated, 23 neuroleptic free, matched for age, disease duration and psychosis) clinically prospectively studied, autopsy diagnosed DLB patients. RESULTS In regression analyses, taking neuroleptics was significantly associated with increased neurofibrillary tangles but not amyloid plaques in cortical areas examined. The patient characteristics and the frequencies of key psychiatric symptoms were similar in the patients taking and not taking neuroleptics. CONCLUSION Although patients were not randomized and the results which are observed need to be interpreted cautiously, if substantiated, this is an important finding with major implications for the pharmacological management of DLB patients and highlights the need to determine the impact of neuroleptics upon tangle pathology in AD.
Collapse
Affiliation(s)
- C G Ballard
- Wolfson Centre for Age Related Diseases, King's College London, UK
| | | | | | | |
Collapse
|
48
|
Pimlott SL, Piggott M, Ballard C, McKeith I, Perry R, Kometa S, Owens J, Wyper D, Perry E. Thalamic nicotinic receptors implicated in disturbed consciousness in dementia with Lewy bodies. Neurobiol Dis 2005; 21:50-6. [PMID: 16023355 DOI: 10.1016/j.nbd.2005.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Revised: 05/20/2005] [Accepted: 06/12/2005] [Indexed: 10/25/2022] Open
Abstract
Disturbances of consciousness (DOC) are common in dementia with Lewy bodies (DLB). Following previous findings of preserved temporal cortical high-affinity nicotinic binding relating to DOC, we investigated this receptor in thalamus, an area of high nicotinic receptor concentration, implicated in consciousness. 5-[125I]-A-85380 binding, primarily reflecting the alpha4beta2 subtype, was compared in 16 DLB patients with DOC and 6 without DOC, matched for duration and severity of dementia. Binding was higher in patients with DOC compared to patients without DOC in all thalamic nuclei examined, reaching significance in the reticular and ventral anterior thalamic nuclei. Comparing DLB patients with and without DOC to previously reported controls revealed similar binding levels in patients with DOC and lower binding in patients without DOC, reaching significance in the ventral anterior, indicating preserved nicotinic receptor density in DLB patients with DOC. These findings, together with previous neocortical data, implicate nicotinic modulation of thalamo-cortical circuitry as a key component in the control of conscious awareness in DLB.
Collapse
Affiliation(s)
- Sally L Pimlott
- West of Scotland Radionuclide Dispensary, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Ray M, Bohr I, McIntosh JM, Ballard C, McKeith I, Chalon S, Guilloteau D, Perry R, Perry E, Court JA, Piggott M. Involvement of α6/α3 neuronal nicotinic acetylcholine receptors in neuropsychiatric features of Dementia with Lewy bodies: [125I]-α-conotoxin MII binding in the thalamus and striatum. Neurosci Lett 2004; 372:220-5. [PMID: 15542244 DOI: 10.1016/j.neulet.2004.09.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Revised: 09/06/2004] [Accepted: 09/20/2004] [Indexed: 11/26/2022]
Abstract
Dementia with Lewy bodies (DLB) is a neurodegenerative disease associated with a range of neuropsychiatric symptoms and reduced expression of neuronal nicotinic acetylcholine receptors (nAChRs) in neocortex, hippocampus, thalamus and basal ganglia. To determine whether there are selective associations between alterations in alpha6/alpha3 neuronal nicotinic acetylcholine receptors (nAChRs) and the two key neuropsychiatric features of DLB, impaired consciousness (IC) and visual hallucinations (VH), quantitative [(125)I]-alpha-conotoxin MII ([(125)I]-alpha-Ctx MII) autoradiography was undertaken on 28 people with DLB and 15 control cases from the Newcastle Brain Bank. There was a highly significant overall trend for reduced thalamic [(125)I]-alpha-Ctx MII binding in DLB (p < 0.001), with significant deficits in the centromedian, ventral lateral and ventroposterior medial thalamic nuclei (p < 0.05), together with caudate and putamen (p < 0.001). [(125)I]-alpha-Ctx MII binding was significantly lower in DLB cases with IC than without IC in the putamen (p < 0.05), however there was no significant association between [(125)I]-alpha-Ctx MII binding and VH. Reductions in [(125)I]-alpha-Ctx MII binding in caudate and putamen were paralleled by similar reductions in [(125)I]PE2I binding. [(125)I]PE2I binding was also significantly lower in DLB cases with IC than without IC in the caudate (p < 0.05) and putamen (p < 0.001). These results demonstrate that deficits in alpha6/alpha3 nAChRs occur in specific brain regions in DLB, may in part be related to the loss of dopaminergic neurons and may contribute to the development of impaired consciousness in the disorder.
Collapse
Affiliation(s)
- Melissa Ray
- Institute for Ageing and Health, University of Newcastle upon Tyne, MRC Building, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Kenny RA, Shaw FE, O'Brien JT, Scheltens PH, Kalaria R, Ballard C. Carotid sinus syndrome is common in dementia with Lewy bodies and correlates with deep white matter lesions. J Neurol Neurosurg Psychiatry 2004; 75:966-71. [PMID: 15201351 PMCID: PMC1739106 DOI: 10.1136/jnnp.2003.023812] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Carotid sinus syndrome (CSS) is a common cause of syncope in older persons. There appears to be a high prevalence of carotid sinus hypersensitivity (CSH) in patients with dementia with Lewy bodies (DLB) but not in Alzheimer's disease. OBJECTIVE To compare the prevalence of CSH in DLB and Alzheimer's disease, and to determine whether there is an association between CSH induced hypotension and brain white matter hyperintensities on magnetic resonance imaging (MRI). METHODS Prevalence of CSH was compared in 38 patients with DLB (mean (SD) age, 76 (7) years), 52 with Alzheimer's disease (80 (6) years), and 31 case controls (73 (5) years) during right sided supine carotid sinus massage (CSM). CSH was defined as cardioinhibitory (CICSH; >3 s asystole) or vasodepressor (VDCSH; >30 mm Hg fall in systolic blood pressure (SBP)). T2 weighted brain MRI was done in 45 patients (23 DLB, 22 Alzheimer). Hyperintensities were rated by the Scheltens scale. RESULTS Overall heart rate response to CSM was slower (RR interval = 3370 ms (640 to 9400)) and the proportion of patients with CICSH greater (32%) in DLB than in Alzheimer's disease (1570 (720 to 7800); 11.1%) or controls (1600 (720 to 3300); 3.2%) (p<0.01)). The strongest predictor of heart rate slowing and CSH was a diagnosis of DLB (Wald 8.0, p<0.005). The fall in SBP during carotid sinus massage was greater with DLB (40 (22) mm Hg) than with Alzheimer's disease (30 (19) mm Hg) or controls (24 (19) mm Hg) (both p<0.02). Deep white matter hyperintensities were present in 29 patients (64%). In DLB, there was a correlation between magnitude of fall in SBP during CSM and severity of deep white matter changes (R = 0.58, p = 0.005). CONCLUSIONS Heart rate responses to CSM are prolonged in patients with DLB, causing hypotension. Deep white matter changes from microvascular disease correlated with the fall in SBP. Microvascular pathology is a key substrate of cognitive impairment and could be reversible in DLB where there are exaggerated heart rate responses to carotid sinus stimulation.
Collapse
Affiliation(s)
- R A Kenny
- MRC Institute for Ageing and Health, University of Newcastle upon Tyne, UK.
| | | | | | | | | | | |
Collapse
|