Clinical presentations and diagnostic application of proposed biomarkers in psychiatric-onset prodromal dementia with Lewy bodies

Electroconvulsive therapy for dementia with Lewy bodies: A systematic review and Japanese multicenter survey

Management of psychiatric symptoms in dementia with Lewy bodies (DLB) is challenging due to hypersensitivity to psychotropic medications. Electroconvulsive therapy (ECT) is a potential therapeutic option for DLB, but its efficacy and safety remain uncertain. We systematically reviewed articles on ECT for DLB, including those published in Japanese-language journals, and surveyed institutions certified by the Japanese Psychogeriatric Society. Of 41 peer-reviewed articles, 32 were from Japan. The proportion of prodromal DLB cases was significantly higher in Japan (34.8 %) than in other countries (9.5 %) (p = 0.044). Cardiac [123I]-metaiodobenzylguanidine scintigraphy and/or striatal dopamine transporter imaging were significantly more frequently in Japan (71.8 %) than in other countries (5.5 %) (p < 0.001). ECT has shown effectiveness in treating depression, catatonia, agitation and psychosis. It was generally considered safe, with transient delirium being the most common side effect, occurring in 16.1 % of Japanese cases. However, current evidence is limited to case studies and lacks randomized controlled trials. The survey confirmed that ECT is widely performed for DLB in Japan, although the number of cases treated varied greatly across institutions. These findings underscore the need for standardized ECT guidelines for DLB. Multicenter studies with standardized assessments and longitudinal follow-up are essential to further research on ECT for DLB, including psychiatric-onset prodromal DLB.

Validation of the neuropathological criteria of the fourth Consortium on dementia with Lewy Bodies in autopsy cases from psychiatric hospitals

AIM

The pathological criteria from the fourth Consortium on Dementia With Lewy bodies (DLB) in psychiatric cohorts has not been validated. Also, the pathological differences in prodromal DLB subtypes remain unclear. This study aimed to elucidate the clinicopathological features of patients with DLB in psychiatric hospitals.

METHODS

Of 165 autopsied cases, patients who developed psychiatric symptoms at 50 years or older were investigated based on the current criteria of DLB. Clinicopathological findings were compared among prodromal DLB subtypes.

RESULTS

Sixteen of 30 cases with DLB pathology had no parkinsonism, which represented diverse nigral neurodegeneration. Regarding the scheme to estimate the likelihood of DLB syndrome, the prevalence of core clinical features excluding rapid eye movement sleep behavior disorder and probable DLB diagnosis were significantly higher in the high-likelihood group than in the low-likelihood group. Regarding the prodromal DLB subtypes, mild cognitive impairment (MCI) onset was identified in 60%, psychiatric onset in 20%, delirium onset in 10%, and motor onset in 10% of cases, and the proportion of psychiatric onset or delirium onset was significantly higher compared with those without DLB pathology. Coexistence of MCI and psychiatric symptoms was observed in 41.6% of the MCI-onset cases. Patients with psychiatric-onset cases were significantly younger at the onset, with a longer disease duration than those with MCI-onset cases. No differences were observed in other clinicopathological variables among the subtypes.

CONCLUSION

The fourth Consortium pathological criteria for DLB were applicable in a psychiatric cohort. MCI-onset cases in conjunction with core clinical features is the main prodromal DLB subtype, and four cases exhibited isolated psychiatric symptoms for long-term duration.

Evaluating Electroconvulsive Therapy for Dementia With Lewy Bodies, Including the Prodromal Stage: A Retrospective Study on Safety and Efficacy

OBJECTIVES

Managing symptoms, notably psychiatric symptoms, in dementia with Lewy bodies (DLB) is complex, affecting both patients and caregivers. People with DLB often react poorly to antipsychotics, limiting treatment options. Although electroconvulsive therapy (ECT)'s potential for DLB is acknowledged, evidence is scarce owing to limited studies. This study investigated ECT's effectiveness and safety for DLB and prodromal DLB with antecedent psychiatric symptoms.

METHODS

This retrospective study investigated people with DLB (N = 12) and mild cognitive impairment (MCI) with LB (N = 13), a prodromal form of DLB, who underwent ECT for psychiatric symptoms and had abnormal findings confirmed using dopamine transporter single-photon emission computed tomography and 123I-metaiodobenzylguanidine myocardial scintigraphy. We reviewed these patients' medical records and determined the severity of psychotic symptoms before and 1 week after the final ECT session with the Clinical Global Impressions Severity Scale (CGI-S). Improvement in psychotic symptoms was evaluated approximately 1 week after the final ECT session using the CGI Improvement Scale (CGI-I). Additionally, we assessed cognitive function and dementia severity before and after ECT, as well as any adverse events caused by ECT.

RESULTS

ECT significantly improved psychiatric symptoms, as assessed using the CGI-S, with CGI-I reports in the order of 60% "very much improved," 20% "much improved," 16% "minimally improved," and 4% "no change." Parkinsonism improved (Hoehn and Yahr: 1.76 ± 1.2 before vs. 1.04 ± 0.7 after, p < 0.001) as did dementia severity (Clinical Dementia Rating, p = 0.037). Adverse events included delirium in 24% of patients and amnesia in 4% of patients. ECT did not worsen cognitive function.

CONCLUSIONS

ECT for DLB and MCI with LB with antecedent psychiatric symptoms appears safe and effective in managing psychiatric symptoms and Parkinsonism. Further large-scale multicenter studies are warranted to conclusively establish its effectiveness and safety.

The impacts of hospital admission in very late-onset schizophrenia-like psychosis: A case report

Background

Very late-onset schizophrenia-like psychosis (VLOSLP) is a psychotic disorder with an age of onset ≥60 years, and social isolation is a risk factor. Reports on the impact of interventions for isolation and loneliness on psychiatric symptoms in VLOSLP are limited.

Case Presentation

An 87-year-old woman, widowed and living alone, developed psychosis, including paranoia, erotomania, and visual hallucinations, at 84 years old during a period when her interactions with others were limited by the COVID-19 pandemic and osteoarthritis. She was eventually brought to our hospital with a local dementia outreach team. She was admitted and diagnosed with VLOSLP with mild cognitive decline through imaging and neuropsychological tests confirming the absence of dementia. Immediately after admission, her psychotic symptoms became inactive. She was transferred to another psychiatric hospital to prepare for her move to a long-term care facility because her psychosis was alleviated. During admission, she enjoyed the company of others and occupational therapy, and her score on the UCLA Loneliness Scale Version 3 improved from 44 at admission to 35 at discharge.

Conclusion

The admission itself improved the patient's psychosis, which seemed to be related to the alleviation of isolation and loneliness.