1
|
Kang S, Yoon SH, Na HK, Lee YG, Jeon S, Baik K, Sohn YH, Ye BS. Neuropsychological Comparison of Patients With Alzheimer's Disease and Dementia With Lewy Bodies. J Clin Neurol 2023; 19:521-529. [PMID: 37455503 PMCID: PMC10622731 DOI: 10.3988/jcn.2022.0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to determine the neuropsychological differences between patients with early-stage Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) with a Clinical Dementia Rating (CDR) score of ≤1. METHODS We examined 168 patients with AD (126 with CDR score=0.5, 42 with CDR score=1) and 169 patients with DLB (104 with CDR score=0.5, 65 with CDR score=1) whose diagnoses were supported by 18F-flobetaben positron-emission tomography (PET) and 18F-N-(3-fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane PET. Neuropsychological test scores were compared after controlling for age, sex, and education duration. Using a cutoff motor score on the Unified Parkinson's Disease Rating Scale of 20, patients with AD were further divided into AD with parkinsonism (ADP+, n=86) and AD without parkinsonism (ADP-, n=82). RESULTS At CDR scores of both 0.5 and 1, the DLB group had lower scores on the attention (digit-span forward at CDR score=0.5 and backward at CDR score=1), visuospatial, and executive (color reading Stroop test at CDR score=0.5 and phonemic fluency test, Stroop tests, and digit symbol coding at CDR score=1) tests than the AD group, but higher scores on the memory tests. The ADP- and ADP+ subgroups had comparable scores on most neuropsychological tests, but the ADP+ subgroup had lower scores on the color reading Stroop test. CONCLUSIONS Patients with DLB had worse attention, visuospatial, and executive functions but better memory function than patients with AD. Parkinsonism was not uncommon in the patients with AD and could be related to attention and executive dysfunction.
Collapse
Affiliation(s)
- Sungwoo Kang
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - So Hoon Yoon
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Han Kyu Na
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Gun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seun Jeon
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
2
|
Liu S, Liu C, Wang XD, Lu H, Ji Y. Cognitive profile in mild cognitive impairment with Lewy bodies. Singapore Med J 2023; 64:487-492. [PMID: 35739625 PMCID: PMC10476914 DOI: 10.11622/smedj.2022085] [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: 04/21/2020] [Accepted: 06/23/2020] [Indexed: 11/18/2022]
Abstract
Introduction This study aimed to elucidate the cognitive profile of patients with mild cognitive impairment with Lewy bodies (MCI-LB) and to compare it to that of patients with mild cognitive impairment due to Alzheimer's disease (MCI-AD). Methods Subjects older than 60 years with probable MCI-LB (n = 60) or MCI-AD (n = 60) were recruited. All patients were tested with Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to assess their global cognitive profile. Results The MCI-AD and MCI-LB patients did not differ in total MMSE and MoCA scores. However, some sub-items in MMSE and MoCA were shown to be screening markers for differentiating MCI-LB from MCI-AD. In the visuoconstructive test, the total score and hands subitem score in the clock-drawing test were significantly lower in MCI-LB than in MCI-AD. As for the executive function, the 'animal fluency test', 'repeat digits backward test' and 'take paper by your right hand' in MMSE all showed lower scores in MCI-LB compared with MCI-AD. As for memory, 'velvet' and 'church' in MoCA and 'ball' and 'national flag' in MMSE had lower scores in MCI-AD than in MCI-LB. Conclusion This study presents the cognitive profile of patients with MCI-LB. In line with the literature on Dementia with Lewy bodies, our results showed lower performance on tests for visuoconstructive and executive function, whereas memory remained relatively spared in the early period.
Collapse
Affiliation(s)
- Shuai Liu
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Chunyan Liu
- Department of Neurology, Aviation General Hospital, Beijing, China
| | - Xiao-Dan Wang
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Huiru Lu
- Department of Geratology, Tianjin First Central Hospital, Tianjin, China
| | - Yong Ji
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| |
Collapse
|
3
|
Iannaccone S, Houdayer E, Spina A, Nocera G, Alemanno F. Quantitative EEG for early differential diagnosis of dementia with Lewy bodies. Front Psychol 2023; 14:1150540. [PMID: 37151310 PMCID: PMC10157484 DOI: 10.3389/fpsyg.2023.1150540] [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: 01/25/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Differentiating between the two most common forms of dementia, Alzheimer's dementia and dementia with Lewy bodies (DLB) remains difficult and requires the use of invasive, expensive, and resource-intensive techniques. We aimed to investigate the sensitivity and specificity of electroencephalography quantified using the statistical pattern recognition method (qEEG-SPR) for identifying dementia and DLB. Methods Thirty-two outpatients and 16 controls underwent clinical assessment (by two blinded neurologists), EEG recording, and a 6-month follow-up clinical assessment. EEG data were processed using a qEEG-SPR protocol to derive a Dementia Index (positive or negative) and DLB index (positive or negative) for each participant which was compared against the diagnosis given at clinical assessment. Confusion matrices were used to calculate sensitivity, specificity, and predictive values for identifying dementia and DLB specifically. Results Clinical assessment identified 30 cases of dementia, 2 of which were diagnosed clinically with possible DLB, 14 with probable DLB and DLB was excluded in 14 patients. qEEG-SPR confirmed the dementia diagnosis in 26 out of the 32 patients and led to 6.3% of false positives (FP) and 9.4% of false negatives (FN). qEEG-SPR was used to provide a DLB diagnosis among patients who received a positive or inconclusive result of Dementia index and led to 13.6% of FP and 13.6% of FN. Confusion matrices indicated a sensitivity of 80%, a specificity of 89%, a positive predictive value of 92%, a negative predictive value of 72%, and an accuracy of 83% to diagnose dementia. The DLB index showed a sensitivity of 60%, a specificity of 90%, a positive predictive value of 75%, a negative predictive value of 81%, and an accuracy of 75%. Neuropsychological scores did not differ significantly between DLB and non- DLB patients. Head trauma or story of stroke were identified as possible causes of FP results for DLB diagnosis. Conclusion qEEG-SPR is a sensitive and specific tool for diagnosing dementia and differentiating DLB from other forms of dementia in the initial state. This non-invasive, low-cost, and environmentally friendly method is a promising diagnostic tool for dementia diagnosis which could be implemented in local care settings.
Collapse
Affiliation(s)
- Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elise Houdayer
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Elise Houdayer,
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianluca Nocera
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Alemanno
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
4
|
Salmon DP, Smirnov DS, Coughlin DG, Hamilton JM, Landy KM, Filoteo JV, Hiniker A, Hansen LA, Galasko D. Perception of Fragmented Letters by Patients With Pathologically Confirmed Dementia With Lewy Bodies or Alzheimer Disease. Neurology 2022; 99:e2034-e2043. [PMID: 36028327 PMCID: PMC9651460 DOI: 10.1212/wnl.0000000000201068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Patients with dementia with Lewy bodies perform worse than those with Alzheimer disease (AD) on tests of visual perception, but the clinical utility of these tests remains unknown because studies often had clinically diagnosed groups that may inadvertently cross-contaminate Lewy body disease (LBD) with pure AD pathology, used experimental tests not easily adaptable for clinical use, and had no way to examine relationships between the severity of LBD pathology and degree of cognitive impairment. Therefore, we sought to determine whether performance on a widely used clinical test of visuoperceptual ability effectively differentiates between patients with autopsy-confirmed LBD or AD and correlates with the severity of LBD pathology. METHODS Patients with mild to moderate dementia (n = 42) and cognitively healthy controls (n = 22) performed a Fragmented Letters Test in which they identified letters of the alphabet that were randomly visually degraded by 70% and additional visuospatial and episodic memory tests. At autopsy, dementia cases were confirmed to have LBD (n = 19), all with concomitant AD, or only AD (n = 23). Severity of α-synuclein pathology in the hippocampus and neocortex was rated on an ordinal scale. RESULTS Patients with LBD performed worse than those with AD (B = -2.80 ± 0.91, p = 0.009) and healthy controls (B = -3.34 ± 1.09, p = 0.01) on the Fragmented Letters Test after adjustment for age, sex, education, Mini-Mental State Examination score, and ability to name intact letters. Patients with AD did not differ from controls (B = -0.55 ± 1.08, p = 0.87). The test effectively distinguished between patients with LBD or AD with 73% sensitivity and 87% specificity, and the area under the curve in receiver operating characteristic analyses was 0.85 (95% CI 0.72-0.95), higher than for standard tests of visuospatial ability (Block Design; 0.72; CI 0.35-0.75) or memory (California Verbal Learning Test, trials 1-5; 0.55; CI 0.57-0.88). Fragmented Letters Test scores were negatively correlated with LBD pathology density ratings in hippocampus and neocortical regions (Spearman rs = -0.53 to -0.69). DISCUSSION Fragmented Letters Test performance can effectively differentiate patients with LBD pathology from those with only AD pathology at a mild to moderate stage of dementia, even when LBD occurs with significant concomitant AD pathology, and may also be useful for gauging the severity of cortical α-synuclein pathology in those with LBD.
Collapse
Affiliation(s)
- David P Salmon
- From the Department of Neurosciences (D.P.S., D.S.S., D.G.C., J.M.H., K.M.L., J.V.F., L.A.H., D.G.), Psychiatry (J.V.F.), and Pathology (A.H., L.A.H.), University of California, San Diego.
| | - Denis S Smirnov
- From the Department of Neurosciences (D.P.S., D.S.S., D.G.C., J.M.H., K.M.L., J.V.F., L.A.H., D.G.), Psychiatry (J.V.F.), and Pathology (A.H., L.A.H.), University of California, San Diego
| | - David G Coughlin
- From the Department of Neurosciences (D.P.S., D.S.S., D.G.C., J.M.H., K.M.L., J.V.F., L.A.H., D.G.), Psychiatry (J.V.F.), and Pathology (A.H., L.A.H.), University of California, San Diego
| | - Joanne M Hamilton
- From the Department of Neurosciences (D.P.S., D.S.S., D.G.C., J.M.H., K.M.L., J.V.F., L.A.H., D.G.), Psychiatry (J.V.F.), and Pathology (A.H., L.A.H.), University of California, San Diego
| | - Kelly M Landy
- From the Department of Neurosciences (D.P.S., D.S.S., D.G.C., J.M.H., K.M.L., J.V.F., L.A.H., D.G.), Psychiatry (J.V.F.), and Pathology (A.H., L.A.H.), University of California, San Diego
| | - J Vincent Filoteo
- From the Department of Neurosciences (D.P.S., D.S.S., D.G.C., J.M.H., K.M.L., J.V.F., L.A.H., D.G.), Psychiatry (J.V.F.), and Pathology (A.H., L.A.H.), University of California, San Diego
| | - Annie Hiniker
- From the Department of Neurosciences (D.P.S., D.S.S., D.G.C., J.M.H., K.M.L., J.V.F., L.A.H., D.G.), Psychiatry (J.V.F.), and Pathology (A.H., L.A.H.), University of California, San Diego
| | - Lawrence A Hansen
- From the Department of Neurosciences (D.P.S., D.S.S., D.G.C., J.M.H., K.M.L., J.V.F., L.A.H., D.G.), Psychiatry (J.V.F.), and Pathology (A.H., L.A.H.), University of California, San Diego
| | - Douglas Galasko
- From the Department of Neurosciences (D.P.S., D.S.S., D.G.C., J.M.H., K.M.L., J.V.F., L.A.H., D.G.), Psychiatry (J.V.F.), and Pathology (A.H., L.A.H.), University of California, San Diego
| |
Collapse
|
5
|
Yamada Y, Kobayashi M, Shinkawa K, Nemoto M, Ota M, Nemoto K, Arai T. Characteristics of Drawing Process Differentiate Alzheimer’s Disease and Dementia with Lewy Bodies. J Alzheimers Dis 2022; 90:693-704. [DOI: 10.3233/jad-220546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Early differential diagnosis of Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) is important for treatment and disease management, but it remains challenging. Although computer-based drawing analysis may help differentiate AD and DLB, it has not been extensively studied. Objective: We aimed to identify the differences in features characterizing the drawing process between AD, DLB, and cognitively normal (CN) individuals, and to evaluate the validity of using these features to identify and differentiate AD and DLB. Methods: We collected drawing data with a digitizing tablet and pen from 123 community-dwelling older adults in three clinical diagnostic groups of mild cognitive impairment or dementia due to AD (n = 47) or Lewy body disease (LBD; n = 27), and CN (n = 49), matched for their age, sex, and years of education. We then investigated drawing features in terms of the drawing speed, pressure, and pauses. Results: Reduced speed and reduced smoothness in speed and pressure were observed particularly in the LBD group, while increased pauses and total durations were observed in both the AD and LBD groups. Machine-learning models using these features achieved an area under the receiver operating characteristic curve (AUC) of 0.80 for AD versus CN, 0.88 for LBD versus CN, and 0.77 for AD versus LBD. Conclusion: Our results indicate how different types of drawing features were particularly discriminative between the diagnostic groups, and how the combination of these features can facilitate the identification and differentiation of AD and DLB.
Collapse
Affiliation(s)
| | | | | | - Miyuki Nemoto
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Miho Ota
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| |
Collapse
|
6
|
Prasad S, Katta MR, Abhishek S, Sridhar R, Valisekka SS, Hameed M, Kaur J, Walia N. Recent advances in Lewy body dementia: A comprehensive review. Dis Mon 2022; 69:101441. [PMID: 35690493 DOI: 10.1016/j.disamonth.2022.101441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Lewy Body Dementia is the second most frequent neurodegenerative illness proven to cause dementia, after Alzheimer's disease (AD). It is believed to be vastly underdiagnosed, as there is a significant disparity between the number of cases diagnosed clinically and those diagnosed via neuropathology at the time of postmortem autopsy. Strikingly, many of the pharmacologic treatments used to treat behavioral and cognitive symptoms in other forms of dementia exacerbate the symptoms of DLB. Therefore, it is critical to accurately diagnose DLB as these patients require a specific treatment approach. This article focuses on its pathophysiology, risk factors, differentials, and its diverse treatment modalities. In this study, an English language literature search was conducted on Medline, Cochrane, Embase, and Google Scholar till April 2022. The following search strings and Medical Subject Headings (MeSH) terms were used: "Lewy Body Dementia," "Dementia with Lewy bodies," and "Parkinson's Disease Dementia." We explored the literature on Lewy Body Dementia for its epidemiology, pathophysiology, the role of various genes and how they bring about the disease, biomarkers, its differential diagnoses and treatment options.
Collapse
Affiliation(s)
- Sakshi Prasad
- Faculty of Medicine, National Pirogov Memorial Medical University, 21018, Vinnytsya, Ukraine.
| | | | | | | | | | - Maha Hameed
- Alfaisal University College of Medicine, Riyadh, Saudi Arabia
| | | | - Namrata Walia
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, Texas, United States of America
| |
Collapse
|
7
|
Gu Y, Kociolek A, Fernandez KK, Cosentino SA, Zhu CW, Jin Z, Leverenz JB, Stern YB. Clinical Trajectories at the End of Life in Dementia Patients With Alzheimer Disease and Lewy Body Neuropathologic Changes. Neurology 2022; 98:e2140-e2149. [PMID: 35379761 DOI: 10.1212/wnl.0000000000200259] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Evaluating and understanding the heterogeneity in dementia course has important implications for clinical practice, healthcare decision-making, and research. However, inconsistent findings have been reported with regard to the disease courses of the two most common dementias, Alzheimer's disease (AD) and Dementia with Lewy bodies (DLB). Using autopsy-confirmed diagnoses, we aimed to examine the disease trajectories in the years before death among dementia patients with pure AD, pure DLB, or mixed (AD and DLB) pathologies. METHODS The current retrospective longitudinal study included 62 participants with autopsy-confirmed diagnoses of pure AD (n=34), mixed AD and DLB (AD+DLB, n = 17), or pure DLB (n=11) from the Predictors 2 Cohort Study, a prospective, clinic-based, cohort of dementia patients. Generalized estimating equation models, with time zero at death, were used to examine the trajectory of cognition (Folstein Mini-Mental State Examination, MMSE), function (Activities of Daily Living, ADL), and dependence scale among patients with different autopsy-confirmed diagnosis (pure AD, AD+DLB, and pure DLB). The models were adjusted for age, sex, education, and baseline features including extrapyramidal signs, MMSE, ADL, and dependence scale. RESULTS The participants on average received 9.4±4.6 assessments at 6-month intervals during a mean 5.4±2.9 years of follow-up time. The three groups were similar in both cognition and function status at baseline. Cognition and function were highly correlated among AD+DLB patients but not in pure AD or pure DLB patients at baseline. Patients of the three groups all declined in both cognition and function but had different trajectories of decline. More specifically, the pure DLB patients experienced approximately double the rate of both cognitive decline and functional decline than the pure AD patients, and the mixed pathology group showed double the rate of functional decline as compared to pure AD patients. DISCUSSION In this longitudinal study, we found that among patients with dementia, those with Lewy body pathology experienced faster cognitive and functional decline than those with pure AD pathology.
Collapse
Affiliation(s)
- Yian Gu
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA .,Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Taub Institute for Research in Alzheimer's Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anton Kociolek
- Taub Institute for Research in Alzheimer's Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Kayri K Fernandez
- Taub Institute for Research in Alzheimer's Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie A Cosentino
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Taub Institute for Research in Alzheimer's Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| | - Carolyn Wei Zhu
- Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Geriatrics Research, Education, and Clinical Center (GRECC), James J Peters VA Medical Center, Bronx, NY, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - James B Leverenz
- Cleveland Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA
| | - Yaakov B Stern
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.,Gertrude H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.,Taub Institute for Research in Alzheimer's Disease and the Aging, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
8
|
Mehraram R, Peraza LR, Murphy NRE, Cromarty RA, Graziadio S, O'Brien JT, Killen A, Colloby SJ, Firbank M, Su L, Collerton D, Taylor JP, Kaiser M. Functional and structural brain network correlates of visual hallucinations in Lewy body dementia. Brain 2022; 145:2190-2205. [PMID: 35262667 PMCID: PMC9246710 DOI: 10.1093/brain/awac094] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 12/02/2022] Open
Abstract
Visual hallucinations are a common feature of Lewy body dementia. Previous studies have shown that visual hallucinations are highly specific in differentiating Lewy body dementia from Alzheimer’s disease dementia and Alzheimer–Lewy body mixed pathology cases. Computational models propose that impairment of visual and attentional networks is aetiologically key to the manifestation of visual hallucinations symptomatology. However, there is still a lack of experimental evidence on functional and structural brain network abnormalities associated with visual hallucinations in Lewy body dementia. We used EEG source localization and network based statistics to assess differential topographical patterns in Lewy body dementia between 25 participants with visual hallucinations and 17 participants without hallucinations. Diffusion tensor imaging was used to assess structural connectivity between thalamus, basal forebrain and cortical regions belonging to the functionally affected network component in the hallucinating group, as assessed with network based statistics. The number of white matter streamlines within the cortex and between subcortical and cortical regions was compared between hallucinating and not hallucinating groups and correlated with average EEG source connectivity of the affected subnetwork. Moreover, modular organization of the EEG source network was obtained, compared between groups and tested for correlation with structural connectivity. Network analysis showed that compared to non-hallucinating patients, those with hallucinations feature consistent weakened connectivity within the visual ventral network, and between this network and default mode and ventral attentional networks, but not between or within attentional networks. The occipital lobe was the most functionally disconnected region. Structural analysis yielded significantly affected white matter streamlines connecting the cortical regions to the nucleus basalis of Meynert and the thalamus in hallucinating compared to not hallucinating patients. The number of streamlines in the tract between the basal forebrain and the cortex correlated with cortical functional connectivity in non-hallucinating patients, while a correlation emerged for the white matter streamlines connecting the functionally affected cortical regions in the hallucinating group. This study proposes, for the first time, differential functional networks between hallucinating and not hallucinating Lewy body dementia patients, and provides empirical evidence for existing models of visual hallucinations. Specifically, the outcome of the present study shows that the hallucinating condition is associated with functional network segregation in Lewy body dementia and supports the involvement of the cholinergic system as proposed in the current literature.
Collapse
Affiliation(s)
- Ramtin Mehraram
- Experimental Oto-rhino-laryngology (ExpORL) Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium.,NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | | | - Nicholas R E Murphy
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX 77030, USA.,The Menninger Clinic, Houston, TX, 77035, USA.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Sara Graziadio
- NIHR Newcastle in vitro Diagnostics Cooperative, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Alison Killen
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Sean J Colloby
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Li Su
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK.,Department of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Daniel Collerton
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK.,NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
9
|
Wakasugi N, Hanakawa T. It Is Time to Study Overlapping Molecular and Circuit Pathophysiologies in Alzheimer's and Lewy Body Disease Spectra. Front Syst Neurosci 2021; 15:777706. [PMID: 34867224 PMCID: PMC8637125 DOI: 10.3389/fnsys.2021.777706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022] Open
Abstract
Alzheimer's disease (AD) is the leading cause of dementia due to neurodegeneration and is characterized by extracellular senile plaques composed of amyloid β1 - 42 (Aβ) as well as intracellular neurofibrillary tangles consisting of phosphorylated tau (p-tau). Dementia with Lewy bodies constitutes a continuous spectrum with Parkinson's disease, collectively termed Lewy body disease (LBD). LBD is characterized by intracellular Lewy bodies containing α-synuclein (α-syn). The core clinical features of AD and LBD spectra are distinct, but the two spectra share common cognitive and behavioral symptoms. The accumulation of pathological proteins, which acquire pathogenicity through conformational changes, has long been investigated on a protein-by-protein basis. However, recent evidence suggests that interactions among these molecules may be critical to pathogenesis. For example, Aβ/tau promotes α-syn pathology, and α-syn modulates p-tau pathology. Furthermore, clinical evidence suggests that these interactions may explain the overlapping pathology between AD and LBD in molecular imaging and post-mortem studies. Additionally, a recent hypothesis points to a common mechanism of prion-like progression of these pathological proteins, via neural circuits, in both AD and LBD. This suggests a need for understanding connectomics and their alterations in AD and LBD from both pathological and functional perspectives. In AD, reduced connectivity in the default mode network is considered a hallmark of the disease. In LBD, previous studies have emphasized abnormalities in the basal ganglia and sensorimotor networks; however, these account for movement disorders only. Knowledge about network abnormalities common to AD and LBD is scarce because few previous neuroimaging studies investigated AD and LBD as a comprehensive cohort. In this paper, we review research on the distribution and interactions of pathological proteins in the brain in AD and LBD, after briefly summarizing their clinical and neuropsychological manifestations. We also describe the brain functional and connectivity changes following abnormal protein accumulation in AD and LBD. Finally, we argue for the necessity of neuroimaging studies that examine AD and LBD cases as a continuous spectrum especially from the proteinopathy and neurocircuitopathy viewpoints. The findings from such a unified AD and Parkinson's disease (PD) cohort study should provide a new comprehensive perspective and key data for guiding disease modification therapies targeting the pathological proteins in AD and LBD.
Collapse
Affiliation(s)
- Noritaka Wakasugi
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takashi Hanakawa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Integrated Neuroanatomy and Neuroimaging, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
10
|
Chin KS, Yassi N, Churilov L, Masters CL, Watson R. Prevalence and clinical associations of tau in Lewy body dementias: A systematic review and meta-analysis. Parkinsonism Relat Disord 2020; 80:184-193. [PMID: 33260030 DOI: 10.1016/j.parkreldis.2020.09.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Alzheimer's disease neuropathologies (amyloid-β and tau) frequently co-exist to varying degrees in Lewy body dementias (LBD), which include dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). OBJECTIVES To investigate the prevalence of tau in DLB and PDD, and its associations with clinical outcomes. METHODS We searched the major electronic databases using the search term: ("dementia with Lewy bodies" OR "diffuse Lewy body disease" OR "Lewy body variant of Alzheimer's disease") AND ("tau protein" OR "tauopathy" OR "neurofibrillary tangle"), for relevant studies which evaluated tau in LBD. Forty-nine articles met the inclusion criteria for data extraction. Where appropriate, a random-effect meta-analysis was performed to obtain pooled estimates for prevalence and risk ratios (RR) or standardized mean differences (SMD) for clinical features, diagnostic accuracy and cognition. RESULTS Braak neurofibrillary tangle stage ≥ III was observed in 66% (n = 1511, 95%CI 60%-73%) of DLB and 52% (n = 433, 95%CI 27%-76%) of PDD at autopsy. Abnormal CSF phosphorylated-tau levels were present in 28% (n = 925, 95%CI 25%-31%) of DLB and 15% (n = 172, 95%CI 5%-24%) of PDD cases. Higher tau burden in DLB was associated with reduced likelihood of manifesting visual hallucinations (RR 0.56; 95%CI 0.40-0.77) and motor parkinsonism (RR 0.62; 95%CI 0.40-0.98), lower diagnostic accuracy of DLB during life (RR 0.49; 95%CI 0.38-0.64) and worse cognition prior to death (SMD 0.63; 95%CI 0.46-0.81). CONCLUSIONS Tau is common in LBD and may reduce clinical diagnostic accuracy in people with DLB. Prospective longitudinal studies are needed to understand the roles of co-morbid neuropathologies in Lewy body dementias.
Collapse
Affiliation(s)
- Kai Sin Chin
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3050, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia.
| | - Nawaf Yassi
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3050, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia; Department of Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3050, Australia
| | - Leonid Churilov
- Department of Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3050, Australia; Department of Medicine (Austin Health), Melbourne Medical School, University of Melbourne, Heidelberg, VIC, 3084, Australia
| | - Colin Louis Masters
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, 3052, Australia
| | - Rosie Watson
- Department of Medicine - The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3050, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
| |
Collapse
|
11
|
Bertoux M, Cassagnaud P, Lebouvier T, Lebert F, Sarazin M, Le Ber I, Dubois B, Auriacombe S, Hannequin D, Wallon D, Ceccaldi M, Maurage CA, Deramecourt V, Pasquier F. Does amnesia specifically predict Alzheimer's pathology? A neuropathological study. Neurobiol Aging 2020; 95:123-130. [PMID: 32795849 DOI: 10.1016/j.neurobiolaging.2020.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022]
Abstract
Amnesia is a key component of Alzheimer's disease (AD) and the most important feature of its clinical diagnosis but its specificity has recently been challenged. This study investigated the ability of amnesia to predict AD in a clinicopathological dementia series. Ninety-one patients to which free and cued verbal memory assessment was administered during early cognitive decline, were followed until autopsy. Patients' histological diagnoses were classified as pure AD, mixed AD, and non-AD pathologies. Data-driven automated classification procedures explored the correspondence between memory performance and pathological diagnoses. Classifications revealed 3 clusters of performance reflecting different levels of amnesia. Little correspondence between these clusters and the presence of AD pathology was retrieved. A third of patients with pure/mixed AD pathology were non-amnesic at presentation and ≈45% of patients without AD pathology were amnesic. Data-driven prediction of AD pathology based on memory also had a poor accuracy. Free and cued memory assessments are fair tools to diagnose an amnesic syndrome but lack accuracy to predict AD pathology.
Collapse
Affiliation(s)
- Maxime Bertoux
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172) Degenerative and Vascular Cognitive Disorders, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France.
| | - Pascaline Cassagnaud
- Univ Lille, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France
| | - Thibaud Lebouvier
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172) Alzheimer & Tauopathies, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France
| | - Florence Lebert
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172) Degenerative and Vascular Cognitive Disorders, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France
| | - Marie Sarazin
- Unit of Neurology of Memory and Language, GHU-Paris Psychiatrie et Neurosciences, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; UMR 1023 IMIV, Service Hospitalier Frédéric Joliot, CEA, Inserm, Université Paris Sud, CNRS, Université Paris-Saclay, Orsay, France
| | - Isabelle Le Ber
- Brain & Spine Institute, UMR 975, Paris, France; Neurology Department, CHU Pitié-Salpêtrière, IM2A, Paris, France
| | - Bruno Dubois
- Brain & Spine Institute, UMR 975, Paris, France; Neurology Department, CHU Pitié-Salpêtrière, IM2A, Paris, France
| | -
- Brain & Spine Institute, UMR 975, Paris, France
| | | | - Didier Hannequin
- Neurology Department, Univ Rouen, CHU Charles Nicolle, Rouen, France
| | - David Wallon
- Neurology Department, Univ Rouen, CHU Charles Nicolle, Rouen, France
| | - Mathieu Ceccaldi
- Neurology and Neuropsychology Department, CHU La Timone, Marseille, France
| | - Claude-Alain Maurage
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172), Development and Plasticity of the Neuroendocrine Brain, Lille, France; Department of Neuropathology, Univ Lille, CHU Lille, Lille, France
| | - Vincent Deramecourt
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172) Alzheimer & Tauopathies, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France; Department of Neuropathology, Univ Lille, CHU Lille, Lille, France
| | - Florence Pasquier
- Univ Lille, Lille Neuroscience & Cognition (Inserm UMRS1172) Degenerative and Vascular Cognitive Disorders, CHU Lille, Laboratory of Excellence Distalz (Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease), Lille, France
| |
Collapse
|
12
|
Azar M, Chapman S, Gu Y, Leverenz JB, Stern Y, Cosentino S. Cognitive tests aid in clinical differentiation of Alzheimer's disease versus Alzheimer's disease with Lewy body disease: Evidence from a pathological study. Alzheimers Dement 2020; 16:1173-1181. [PMID: 32558217 DOI: 10.1002/alz.12120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/23/2020] [Accepted: 04/30/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Clinical differentiation between Alzheimer's disease (AD) and AD with Lewy body disease (LBD) is relatively imprecise. The current study examined pathologically confirmed group differences in neuropsychological functioning, and the classification ability of specific tests. METHODS Fifty-one participants with postmortem diagnoses of AD (n = 34) and AD plus LBD (n = 17) were drawn from the Predictors Study. One-way analyses of variance (ANOVAs) and χ2 analyses examined group differences in neuropsychological performance. Binary logistic regressions examined predictive utility of specific tests for pathological diagnosis. RESULTS Individuals with AD had better visuoconstruction (P = .006), phonemic fluency (P = .08), and processing speed than AD plus LBD (P = .013). No differences were found in memory, naming, semantic fluency, or set-switching. Processing speed and visuoconstruction predicted pathologic group (P = .03). DISCUSSION Processing speed and visuoconstruction predicted postmortem diagnosis of AD versus AD plus LBD. Current results offer guidance in the selection and interpretation of neuropsychological tests to be used in the differential diagnosis of early dementia.
Collapse
Affiliation(s)
- Martina Azar
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
| |
Collapse
|
13
|
Wang CT, Hung GU, Wei CY, Tzeng RC, Chiu PY. An Informant-Based Simple Questionnaire for Visuospatial Dysfunction Assessment in Dementia. Front Neurosci 2020; 14:44. [PMID: 32082114 PMCID: PMC7006475 DOI: 10.3389/fnins.2020.00044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives Visuospatial dysfunction (VSD) is one of the most important symptoms for the diagnosis of dementia with Lewy bodies (DLB). The aim of this study was to validate a novel VSD questionnaire and determine the cutoff score for the screening for VSD in DLB. Methods This is a retrospective analysis of data from a project of the History-based Artificial Intelligent Clinical Dementia Diagnostic System (HAICDDS). VSD of non-demented control (NDC), Alzheimer’s disease (AD), and DLB participants were analyzed and compared using the visuospatial questionnaire in the HAICDDS (HAI-VSQ), the Draw subscale in the Cognitive Abilities Screening Instrument (CASI-Draw), and the visuospatial subscale in Montreal Cognitive Assessment (MoCA-VS). Results A total of 440 individuals were studied, including 154 NDC, 229 AD, and 57 DLB participants. Compared to NDC or AD participants, DLB participants showed a higher total score on HAI-VSQ after adjustment for age. Using HAI-VSQ, a cutoff score ≥ 2 was useful for the screening for VSD in DLB with a sensitivity of 0.77 and a specificity of 0.94. Compared with CASI-Draw or MoCA-VS, HAI-VSQ was least influenced by gender, age, and education and had the highest correlation with the sum of boxes of the Clinical Dementia Rating scale. After adjustment for age, education, gender, and global cognitive function, HAI-VSQ significantly discriminated DLB from AD and NDC whereas MoCA-VS or CASI-Draw did not. Conclusion Our study showed that the newly designed simple questionnaire was a practical screening tool for VSD in DLB that can be applied in clinical practice as well as on a registration platform.
Collapse
Affiliation(s)
- Ching-Tsu Wang
- Department of Neurology, Tainan Municipal Hospital, Tainan, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Cheng-Yu Wei
- Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
| | - Ray-Chang Tzeng
- Department of Neurology, Tainan Municipal Hospital, Tainan, Taiwan
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| |
Collapse
|
14
|
Matar E, Phillips JR, Martens KAE, Halliday GM, Lewis SJG. Impaired Color Discrimination-A Specific Marker of Hallucinations in Lewy Body Disorders. J Geriatr Psychiatry Neurol 2019; 32:257-264. [PMID: 31035850 DOI: 10.1177/0891988719845501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
There is emerging evidence indicating that color discrimination impairments can predict the development of Lewy body dementia in patients with rapid eye movement sleep behavior disorder, Parkinson disease, and in patients with mild cognitive impairment. Despite this clear relationship, color vision deficits are not seen uniformly in patients with dementia with Lewy bodies (DLB), suggesting a more nuanced association with the underlying neuropathology. Visual hallucinations represent a discriminating feature of DLB, and recent evidence implicates visual pathway dysfunction as a significant contributor to this phenomenon. In this study, we examined the relationship between color vision impairment and visual hallucinations, along with other clinical and neuropsychological features in 24 well-characterized patients with DLB alongside 25 healthy controls. Color discrimination impairment was seen in 16 (67%) of 24 DLB participants with a higher error score relative to controls (P = .001). We demonstrate for the first time a strong association between color discrimination errors on the Farnsworth-Munsell 100 hue test and both the presence and severity of hallucinatory symptoms in DLB based on clinician-derived (P = .008) and questionnaire-derived (P = .03) measures. Correlation with clinical and neuropsychological variables revealed that color discrimination is significantly related to visuospatial difficulties measured by the clock-drawing task (P = .02) but not to global measures of cognition, motor severity, age, or disease duration in our cohort. Factor analysis confirmed a unique relationship between color discrimination, visual hallucinations, and visuospatial function. Our results suggest that color discrimination does not simply relate to dementia but rather indexes higher order perceptual deficits that may predict visual hallucinations in Lewy body disorders and share a common pathophysiological substrate.
Collapse
Affiliation(s)
- Elie Matar
- 1 Brain and Mind Centre and Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, Australia
| | - Joseph R Phillips
- 2 School of Social Sciences and Psychology & Marcs Institute for Brain and Behaviour, Western Sydney University, Sydney, New South Wales, Australia
| | - Kaylena A Ehgoetz Martens
- 1 Brain and Mind Centre and Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, Australia
| | - Glenda M Halliday
- 1 Brain and Mind Centre and Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, Australia
| | - Simon J G Lewis
- 1 Brain and Mind Centre and Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, Australia
| |
Collapse
|
15
|
Schaeffer MJ, Callahan BL. Investigating the Association Between Verbal Forgetting and Pathological Markers of Alzheimer's and Lewy Body Diseases. J Alzheimers Dis 2019; 70:877-887. [PMID: 31282412 DOI: 10.3233/jad-180962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The percentage of verbal forgetting (VF%) measure of the Rey Auditory Verbal Learning Test (RAVLT) has been proposed to differentiate patients diagnosed clinically with Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). OBJECTIVE To determine if VF% aligns with gold-standard biomarker and autopsy evidence of AD and DLB neuropathology. METHODS Clinical, cognitive, sociodemographic, and biomarker data were collected from 315 patients with baseline cognitive impairment and 485 normal controls from the Alzheimer's Disease Neuroimaging Initiative (ADNI). AD markers included reduced cerebrospinal fluid (CSF) amyloid-β, elevated total-tau and phosphorylated-tau, hippocampal atrophy, and the presence of amyloid plaques and neurofibrillary tangles at autopsy. DLB markers included reduced CSF α-synuclein, preserved hippocampus, atrophied putamen, occipital glucose metabolism, and the presence of Lewy bodies at autopsy. Cognitively impaired participants were classified as ADVF% (n = 190) or DLBVF% (n = 125) based on their RAVLT VF% scores using a 75% cut-off (≥75% = ADVF%, <75% = DLBVF%). Postmortem data were available for 13 ADVF% participants, 13 DLBVF% patients, and six healthy controls. RESULTS ADVF% and DLBVF% participants did not differ on CSF or neuroimaging biomarkers, with the exception of total tau levels which were higher in ADVF%. In the subset of participants with autopsy data, comorbid AD and DLB pathology was most frequent in ADVF% participants, and pure DLB pathology was most frequent in DLBVF% participants, however, these differences were not statistically significant. CONCLUSION The RAVLT VF% measure does not reliably align with AD and DLB neuropathology in ADNI participants.
Collapse
Affiliation(s)
| | - Brandy L Callahan
- Department of Psychology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada.,Mathison Centre for Mental Health Research & Education, Calgary, AB, Canada
| | | |
Collapse
|
16
|
Roudil J, Deramecourt V, Dufournet B, Dubois B, Ceccaldi M, Duyckaerts C, Pasquier F, Lebouvier T. Influence of Lewy Pathology on Alzheimer's Disease Phenotype: A Retrospective Clinico-Pathological Study. J Alzheimers Dis 2019; 63:1317-1323. [PMID: 29758938 PMCID: PMC6218122 DOI: 10.3233/jad-170914] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Studies have shown the frequent coexistence of Lewy pathology (LP) in Alzheimer’s Disease (AD). Objective: The aim of this study was to determine the influence of LP on the clinical and cognitive phenotype in a cohort of patients with a neuropathological diagnosis of AD. Methods: We reviewed neuropathologically proven AD cases, reaching Braak stages V and VI in the brain banks of Lille and Paris between 1993 and 2016, and classified them according to LP extension (amygdala, brainstem, limbic, or neocortical). We then searched patient files for all available clinical and neuropsychiatric features and neuropsychological data. Results: Thirty-three subjects were selected for this study, among which 16 were devoid of LP and 17 presented AD with concomitant LP. The latter were stratified into two subgroups according to LP distribution: 7 were AD with amygdala LP and 10 were AD with ‘classical’ (brainstem, limbic or neocortical) LP. When analyzing the incidence of each clinical feature at any point during the disease course, we found no significant difference in symptom frequency between the three groups. However, fluctuations appeared significantly earlier in patients with classical LP (2±3.5 years) than in patients without LP (7±1.7 years) or with amygdala LP (8±2.8 years; p < 0.01). There was no significant difference in cognitive profiles. Conclusion: Our findings suggest that the influence of LP on the clinical phenotype of AD is subtle. Core features of dementia with Lewy bodies do not allow clinical diagnosis of a concomitant LP on a patient-to-patient basis.
Collapse
Affiliation(s)
- Jennifer Roudil
- University of Lille, Inserm U1171, CHU, DISTALZ, Lille, France.,University Nancy, CHU-Nancy, Nancy, France
| | | | - Boris Dufournet
- AP-HM-Hôpital de la Timone, Neurology and Neuropsychology Department, and Aix Marseille University, Marseille, France
| | - Bruno Dubois
- Institute for Memory and Alzheimer's disease (IM2A) and ICM, Salpêtrière University Hospital, Paris University, France
| | - Mathieu Ceccaldi
- AP-HM-Hôpital de la Timone, Neurology and Neuropsychology Department, and Aix Marseille University, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Charles Duyckaerts
- Laboratoire de Neuropathologie Escourolle, Salpêtrière University Hospital, Paris University, France
| | | | | | | |
Collapse
|
17
|
Hansen D, Ling H, Lashley T, Holton JL, Warner TT. Review: Clinical, neuropathological and genetic features of Lewy body dementias. Neuropathol Appl Neurobiol 2019; 45:635-654. [PMID: 30977926 DOI: 10.1111/nan.12554] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/09/2019] [Indexed: 01/08/2023]
Abstract
Lewy body dementias are the second most common neurodegenerative dementias after Alzheimer's disease and include dementia with Lewy bodies and Parkinson's disease dementia. They share similar clinical and neuropathological features but differ in the time of dementia and parkinsonism onset. Although Lewy bodies are their main pathological hallmark, several studies have shown the emerging importance of Alzheimer's disease pathology. Clinical amyloid-β imaging using Pittsburgh Compound B (PiB) supports neuropathological studies which found that amyloid-β pathology is more common in dementia with Lewy bodies than in Parkinson's disease dementia. Nevertheless, other co-occurring pathologies, such as cerebral amyloid angiopathy, TDP-43 pathology and synaptic pathology may also influence the development of neurodegeneration and dementia. Recent genetic studies demonstrated an important role of APOE genotype and other genes such as GBA and SNCA which seem to be involved in the pathophysiology of Lewy body dementias. The aim of this article is to review the main clinical, neuropathological and genetic aspects of dementia with Lewy bodies and Parkinson's disease dementia. This is particularly relevant as future management for these two conditions may differ.
Collapse
Affiliation(s)
- D Hansen
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK
| | - H Ling
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T Lashley
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - J L Holton
- Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - T T Warner
- Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK.,Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
18
|
Caminiti SP, Sala A, Iaccarino L, Beretta L, Pilotto A, Gianolli L, Iannaccone S, Magnani G, Padovani A, Ferini-Strambi L, Perani D. Brain glucose metabolism in Lewy body dementia: implications for diagnostic criteria. ALZHEIMERS RESEARCH & THERAPY 2019; 11:20. [PMID: 30797240 PMCID: PMC6387558 DOI: 10.1186/s13195-019-0473-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/10/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND [18F]FDG-PET hypometabolism patterns are indicative of different neurodegenerative conditions, even from the earliest disease phase. This makes [18F]FDG-PET a valuable tool in the diagnostic workup of neurodegenerative diseases. The utility of [18F]FDG-PET in dementia with Lewy bodies (DLB) needs further validation by considering large samples of patients and disease comparisons and applying state-of-the-art statistical methods. Here, we aimed to provide an extensive validation of the [18F]FDG-PET metabolic signatures in supporting DLB diagnosis near the first clinical assessment, which is characterized by high diagnostic uncertainty, at the single-subject level. METHODS In this retrospective study, we included N = 72 patients with heterogeneous clinical classification at entry (mild cognitive impairment, atypical parkinsonisms, possible DLB, probable DLB, and other dementias) and an established diagnosis of DLB at a later follow-up. We generated patterns of [18F]FDG-PET hypometabolism in single cases by using a validated voxel-wise analysis (p < 0.05, FWE-corrected). The hypometabolism patterns were independently classified by expert raters blinded to any clinical information. The final clinical diagnosis at follow-up (2.94 ± 1.39 [0.34-6.04] years) was considered as the diagnostic reference and compared with clinical classification at entry and with [18F]FDG-PET classification alone. In addition, we calculated the diagnostic accuracy of [18F]FDG-PET maps in the differential diagnosis of DLB with Alzheimer's disease dementia (ADD) (N = 60) and Parkinson's disease (PD) (N = 36). RESULTS The single-subject [18F]FDG-PET hypometabolism pattern, showing temporo-parietal and occipital involvement, was highly consistent across DLB cases. Clinical classification at entry produced several misclassifications with an agreement of only 61.1% with the diagnostic reference. On the contrary, [18F]FDG-PET hypometabolism maps alone accurately predicted diagnosis of DLB at follow-up (88.9%). The high power of the [18F]FDG-PET hypometabolism signature in predicting the final clinical diagnosis allowed a ≈ 50% increase in accuracy compared to the first clinical assessment alone. Finally, [18F]FDG-PET hypometabolism maps yielded extremely high discriminative power, distinguishing DLB from ADD and PD conditions with an accuracy of > 90%. CONCLUSION The present validation of the diagnostic and prognostic accuracy of the disease-specific brain metabolic signature in DLB at the single-subject level argues for the consideration of [18F]FDG-PET in the early phase of the DLB diagnostic flowchart. The assessment of the [18F]FDG-PET hypometabolism pattern at entry may shorten the diagnostic time, resulting in benefits for treatment options and management of patients.
Collapse
Affiliation(s)
- Silvia Paola Caminiti
- Vita-Salute San Raffaele University, Via Olgettina, 60, Segrate, 20132, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, Segrate, 20132, Milan, Italy
| | - Arianna Sala
- Vita-Salute San Raffaele University, Via Olgettina, 60, Segrate, 20132, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, Segrate, 20132, Milan, Italy
| | - Leonardo Iaccarino
- Vita-Salute San Raffaele University, Via Olgettina, 60, Segrate, 20132, Milan, Italy.,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, Segrate, 20132, Milan, Italy
| | - Luca Beretta
- In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, Segrate, 20132, Milan, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa, 11, 25123, Brescia, Italy.,Parkinson's Disease Rehabilitation Centre, FERB Onlus S. Isidoro Hospital, Via Ospedale, 34, 24069, Trescore Balneario, Italy
| | - Luigi Gianolli
- Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Via Olgettina, 60, Segrate, 20132, Milan, Italy
| | - Sandro Iannaccone
- Clinical Neuroscience Department, San Raffaele Turro Hospital, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Giuseppe Magnani
- Department of Neurology and INSPE, San Raffaele Scientific Institute, Via Olgettina, 60, Segrate, 20132, Milan, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa, 11, 25123, Brescia, Italy
| | - Luigi Ferini-Strambi
- Vita-Salute San Raffaele University, Via Olgettina, 60, Segrate, 20132, Milan, Italy.,Department of Clinical Neurosciences, San Raffaele Scientific Institute, Neurology, Sleep Disorders Center, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Via Olgettina, 60, Segrate, 20132, Milan, Italy. .,In Vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, Segrate, 20132, Milan, Italy. .,Nuclear Medicine Unit, IRCCS San Raffaele Hospital, Via Olgettina, 60, Segrate, 20132, Milan, Italy.
| |
Collapse
|
19
|
Surendranathan A, Su L, Mak E, Passamonti L, Hong YT, Arnold R, Vázquez Rodríguez P, Bevan-Jones WR, Brain SAE, Fryer TD, Aigbirhio FI, Rowe JB, O’Brien JT. Early microglial activation and peripheral inflammation in dementia with Lewy bodies. Brain 2018; 141:3415-3427. [PMID: 30403785 PMCID: PMC6262214 DOI: 10.1093/brain/awy265] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/31/2018] [Accepted: 09/05/2018] [Indexed: 12/17/2022] Open
Abstract
Inflammation is increasingly recognized as part of the pathology of neurodegenerative conditions such as Alzheimer's disease and Parkinson's disease, but its role in dementia with Lewy bodies remains unclear. Using multimodal imaging and peripheral cytokine analysis, we therefore investigated central and peripheral inflammation in this common form of dementia. Nineteen participants with probable dementia with Lewy bodies and 16 similarly aged controls underwent 3 T MRI and PET imaging with 11C-PK11195, a marker of microglial activation in vivo. Peripheral blood inflammatory cytokines were also measured in all subjects, as well as in an additional 10 controls, using the Mesoscale Human Cytokine 36 plex panel and additional assays for high sensitivity c-reactive protein, tumour necrosis factor receptor 1, IL-34, YKL-40 (chitinase-3-like protein 1) and colony stimulating factor 1. To test for the presence of in vivo amyloid, 11C-Pittsburgh compound B PET imaging was also performed in 16 of the dementia with Lewy body participants. Microglial activation was elevated in dementia with Lewy bodies subjects with mild disease when compared to those with moderate/severe impairment, where disease severity was indexed by cognitive performance on the revised Addenbrooke's Cognitive Examination. In patients, strong correlations were found between cognitive performance and 11C-PK11195 non-displaceable binding potential in several regions including the caudate nucleus (R = 0.83, P = 0.00008) and cuneus (R = 0.77, P = 0.0005). Several inflammatory cytokines were altered in the patients compared to controls, with elevated macrophage inflammatory protein-3 (P = 0.001), IL-17A (P = 0.008) and IL-2 (P = 0.046) and reduced IL-8 (P = 0.024). There was no correlation between cortical 11C-Pittsburgh compound B standardized uptake value ratio and clinical features, regional 11C-PK11195 binding or peripheral cytokine levels. Nor was there any regional correlation between 11C-PK11195 non-displaceable binding potentials and 11C-Pittsburgh compound B standardized uptake value ratios. Our findings provide evidence for both central and peripheral inflammatory changes in dementia with Lewy bodies, with microglial activation occurring early in the disease in key regions known to be associated with pathology, before declining as cognition declines. Raised peripheral cytokines associated with T cell function further suggest a role for the adaptive immune system in the pathogenesis of the disease.
Collapse
Affiliation(s)
| | - Li Su
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Sino-Britain Centre for Cognition and Ageing Research, Faculty of Psychology, Southwest University, Chongqing, China
| | - Elijah Mak
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Young T Hong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Robert Arnold
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | | | - Tim D Fryer
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Franklin I Aigbirhio
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
20
|
Chabran E, Roquet D, Gounot D, Sourty M, Armspach JP, Blanc F. Functional Disconnectivity during Inter-Task Resting State in Dementia with Lewy Bodies. Dement Geriatr Cogn Disord 2018; 45:105-120. [PMID: 29723870 DOI: 10.1159/000486780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/11/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS Limited research has been done on the functional connectivity in visuoperceptual regions in dementia with Lewy bodies (DLB) patients. This study aimed to investigate the functional connectivity differences between a task condition and an inter-task resting state condition within a visuoperceptual paradigm, in DLB patients compared with Alzheimer disease (AD) patients and healthy elderly control subjects. METHODS Twenty-six DLB, 29 AD, and 22 healthy subjects underwent a detailed clinical and neuropsychological examination along with a functional MRI during the different conditions of a visuoperceptual paradigm. Functional images were analyzed using group-level spatial independent component analysis and seed-based connectivity analyses. RESULTS While the DLB patients scored well and did not differ from the control and AD groups in terms of functional activity and connectivity during the task conditions, they showed decreased functional connectivity in visuoperceptual regions during the resting state condition, along with a temporal impairment of the default-mode network activity. Functional connectivity disturbances were also found within two attentional-executive networks and between these networks and visuoperceptual regions. CONCLUSION We found a specific functional profile in the switching between task and resting state conditions in DLB patients. This result could help better characterize functional impairments in DLB and their contribution to several core symptoms of this pathology such as visual hallucinations and cognitive fluctuations.
Collapse
Affiliation(s)
- Eléna Chabran
- IMIS/Neurocrypto, French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Daniel Roquet
- IMIS/Neurocrypto, French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Daniel Gounot
- IMIS/Neurocrypto, French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Marion Sourty
- IMIS/Neurocrypto, French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Jean-Paul Armspach
- IMIS/Neurocrypto, French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Frédéric Blanc
- IMIS/Neurocrypto, French National Centre for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France.,Geriatrics Day Hospital and Neuropsychology Unit, Geriatrics Department and Neurology Service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France
| |
Collapse
|
21
|
Kim MS, Yoon JH, Hong JM. Early differentiation of dementia with Lewy bodies and Alzheimer's disease: Heart rate variability at mild cognitive impairment stage. Clin Neurophysiol 2018; 129:1570-1578. [PMID: 29883835 DOI: 10.1016/j.clinph.2018.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 04/16/2018] [Accepted: 05/19/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Our study aimed to investigate whether heart rate variability (HRV) could be a useful diagnostic screening tool at MCI (mild cognitive impairment) stage of Dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). METHODS This retrospective study used a selected sample from Ajou neurological registry. We identified MCI patients who underwent HRV testing at baseline, and who developed probable DLB (MCI-DLB: n = 23) or AD (MCI-AD: n = 32). RESULTS The MCI-DLB group exhibited significantly lower levels of almost all HRV parameters compared with the MCI-AD group. Fronto-executive function and visuospatial abilities were poorer in the MCI-DLB group, whereas the extent of verbal memory impairment was greater in the MCI-AD. Verbal memory score was negatively correlated with overall HRV parameters, and visuospatial function was positively correlated with the frequency domain of HRV. Receiver operating curve area under the curve (AUC) analysis revealed that the low frequency component was the best potential diagnostic marker (AUC = 0.88). CONCLUSION MCI-DLB patients exhibited greater cardiac autonomic dysfunction (as measured by HRV) and greater fronto-executive and visuospatial deficit compared with MCI-AD patients. SIGNIFICANCE HRV may be useful method to differentiate DLB from AD in patients with MCI; this would facilitate early disease-specific intervention.
Collapse
Affiliation(s)
- Min Seung Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Jung Han Yoon
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea.
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| |
Collapse
|
22
|
Erskine D, Ding J, Thomas AJ, Kaganovich A, Khundakar AA, Hanson PS, Taylor JP, McKeith IG, Attems J, Cookson MR, Morris CM. Molecular changes in the absence of severe pathology in the pulvinar in dementia with Lewy bodies. Mov Disord 2018; 33:982-991. [PMID: 29570843 DOI: 10.1002/mds.27333] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dementia with Lewy bodies is characterized by transient clinical features, including fluctuating cognition and visual hallucinations, implicating dysfunction of cerebral hub regions, such as the pulvinar nuclei of the thalamus. However, the pulvinar is typically only mildly affected by Lewy body pathology in dementia with Lewy bodies, suggesting additional factors may account for its proposed dysfunction. METHODS We conducted a comprehensive analysis of postmortem pulvinar tissue using whole-transcriptome RNA sequencing, protein expression analysis, and histological evaluation. RESULTS We identified 321 transcripts as significantly different between dementia with Lewy bodies cases and neurologically normal controls, with gene ontology pathway analysis suggesting the enrichment of transcripts related to synapses and positive regulation of immune functioning. At the protein level, proteins related to synaptic efficiency were decreased, and general synaptic markers remained intact. Analysis of glial subpopulations revealed astrogliosis without activated microglia, which was associated with synaptic changes but not neurodegenerative pathology. DISCUSSION These results indicate that the pulvinar, a region with relatively low Lewy body pathological burden, manifests changes at the molecular level that differ from previous reports in a more severely affected region. We speculate that these alterations result from neurodegenerative changes in regions connected to the pulvinar and likely contribute to a variety of cognitive changes resulting from decreased cortical synchrony in dementia with Lewy bodies. © 2018 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Daniel Erskine
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Jinhui Ding
- Laboratory of Neurogenetics, National Institutes of Health, Bethesda, Maryland, USA
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Alice Kaganovich
- Laboratory of Neurogenetics, National Institutes of Health, Bethesda, Maryland, USA
| | - Ahmad A Khundakar
- School of Science, Engineering and Design, Teesside University, Middlesbrough, UK
| | - Peter S Hanson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Ian G McKeith
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Johannes Attems
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Mark R Cookson
- Laboratory of Neurogenetics, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher M Morris
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Laboratory of Neurogenetics, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
23
|
Thomas AJ, Mahin-Babaei F, Saidi M, Lett D, Taylor JP, Walker L, Attems J. Improving the identification of dementia with Lewy bodies in the context of an Alzheimer's-type dementia. ALZHEIMERS RESEARCH & THERAPY 2018; 10:27. [PMID: 29490691 PMCID: PMC5831205 DOI: 10.1186/s13195-018-0356-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Dementia due to Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are the two most common neurodegenerative causes of dementia. They commonly occur together, especially in older people, but clinical identification of these diseases in dementia is difficult in such circumstances. We therefore conducted a study using cases with both comprehensive prospective clinical assessments and complete neuropathological examination to determine if it is possible to identify such mixed cases clinically and to determine features which may identify DLB in the presence of AD dementia. METHODS At Newcastle Brain Bank we identified subjects who had a clinical diagnosis of dementia and who also had autopsy diagnoses of pure AD, pure DLB, or mixed AD+DLB. All subjects had undergone prospective longitudinal clinical assessments. Mixed AD+DLB patients met neuropathological criteria for both DLB (limbic/neocortical Lewy body disease) and AD (Braak stage V/VI and CERAD B/C). The records of these subjects were carefully reviewed by two specialists in old-age psychiatry blind to autopsy findings to determine baseline and final clinical diagnoses based on these detailed records. The presence of characteristic Lewy body symptoms and other clinical information was also recorded. RESULTS Of 59 subjects included, 19 were AD, 18 DLB, and 22 mixed AD+DLB. At baseline no subjects were correctly identified as having mixed AD+DLB and by final diagnosis only 23% were identified. The only symptom which helped in identifying the presence of Lewy body disease in the context of a mixed AD+DLB dementia was complex visual hallucinations. CONCLUSIONS Whilst the identification of DLB in the context of a dementia with an AD pattern is difficult, the emergence of complex visual hallucinations in the context of such a degenerative dementia suggests the presence of Lewy body disease and should encourage a careful assessment. Biomarkers appear likely to be necessary to help improve identification of different disease subtypes underlying dementia.
Collapse
Affiliation(s)
- Alan J Thomas
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - Fariba Mahin-Babaei
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Mohammad Saidi
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Debbie Lett
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John Paul Taylor
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Lauren Walker
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Johannes Attems
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| |
Collapse
|
24
|
Xu Y, Chen K, Zhao Q, Guo Q. Comparing the neuropsychological profiles of mild dementia with Lewy bodies and mild Alzheimer's disease. Psychogeriatrics 2018; 18:64-71. [PMID: 29372601 DOI: 10.1111/psyg.12293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 03/30/2017] [Accepted: 07/17/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The present study was conducted to detect neuropsychological differences and to identify discriminators between mild dementia with L ewy bodies (DLB ) and mild A lzheimer's disease (AD ). METHODS The present study included 37 mild DLB patients, 48 mild AD patients, and 80 healthy elderly individuals. A comprehensive battery of neuropsychological tests was administrated to assess their cognitive function. Linear stepwise discriminant analysis was used to identify the neuropsychological measures with values that could differentiate between mild DLB and mild AD . RESULTS The mild DLB group had greater impairments in attention, executive function, and visuospatial ability, while mild AD patients performed significantly worse on memory tests. Linear stepwise discriminant analysis indicated that the M emory and E xecutive S creening's 5-min delayed recall test was the best neuropsychological discriminator between mild DLB and mild AD . CONCLUSIONS Different patterns of cognitive impairment facilitate the differentiation of mild DLB from mild AD . For patients with mild dementia, better performance on the M emory and E xecutive S creening's 5-min delayed recall test suggests that the diagnosis is more likely DLB than AD .
Collapse
Affiliation(s)
- Yan Xu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Keliang Chen
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianhua Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qihao Guo
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
25
|
Jellinger KA. Dementia with Lewy bodies and Parkinson's disease-dementia: current concepts and controversies. J Neural Transm (Vienna) 2017; 125:615-650. [PMID: 29222591 DOI: 10.1007/s00702-017-1821-9] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/28/2017] [Indexed: 12/15/2022]
Abstract
Dementia with Lewy bodies (DLB) and Parkinson's disease-dementia (PDD), although sharing many clinical, neurochemical and morphological features, according to DSM-5, are two entities of major neurocognitive disorders with Lewy bodies of unknown etiology. Despite considerable clinical overlap, their diagnosis is based on an arbitrary distinction between the time of onset of motor and cognitive symptoms: dementia often preceding parkinsonism in DLB and onset of cognitive impairment after onset of motor symptoms in PDD. Both are characterized morphologically by widespread cortical and subcortical α-synuclein/Lewy body plus β-amyloid and tau pathologies. Based on recent publications, including the fourth consensus report of the DLB Consortium, a critical overview is given. The clinical features of DLB and PDD include cognitive impairment, parkinsonism, visual hallucinations, and fluctuating attention. Intravitam PET and post-mortem studies revealed more pronounced cortical atrophy, elevated cortical and limbic Lewy pathologies (with APOE ε4), apart from higher prevalence of Alzheimer pathology in DLB than PDD. These changes may account for earlier onset and greater severity of cognitive defects in DLB, while multitracer PET studies showed no differences in cholinergic and dopaminergic deficits. DLB and PDD sharing genetic, neurochemical, and morphologic factors are likely to represent two subtypes of an α-synuclein-associated disease spectrum (Lewy body diseases), beginning with incidental Lewy body disease-PD-nondemented-PDD-DLB (no parkinsonism)-DLB with Alzheimer's disease (DLB-AD) at the most severe end, although DLB does not begin with PD/PDD and does not always progress to DLB-AD, while others consider them as the same disease. Both DLB and PDD show heterogeneous pathology and neurochemistry, suggesting that they share important common underlying molecular pathogenesis with AD and other proteinopathies. Cognitive impairment is not only induced by α-synuclein-caused neurodegeneration but by multiple regional pathological scores. Recent animal models and human post-mortem studies have provided important insights into the pathophysiology of DLB/PDD showing some differences, e.g., different spreading patterns of α-synuclein pathology, but the basic pathogenic mechanisms leading to the heterogeneity between both disorders deserve further elucidation. In view of the controversies about the nosology and pathogenesis of both syndromes, there remains a pressing need to differentiate them more clearly and to understand the processes leading these synucleinopathies to cause one disorder or the other. Clinical management of both disorders includes cholinesterase inhibitors, other pharmacologic and nonpharmacologic strategies, but these have only a mild symptomatic effect. Currently, no disease-modifying therapies are available.
Collapse
Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
| |
Collapse
|
26
|
Yamamoto E, Mourany L, Colleran R, Whitman C, Tousi B. Utility of Montreal Cognitive Assessment in Differentiating Dementia With Lewy Bodies From Alzheimer's Dementia. Am J Alzheimers Dis Other Demen 2017; 32:468-471. [PMID: 28871793 PMCID: PMC10852593 DOI: 10.1177/1533317517725811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are the 2 most common neurodegenerative dementias. Identification of patients with DLB is necessary to guide appropriate clinical management and medication trials. Patients with DLB are reported to perform poorly on tasks of visuospatial and executive function, compared to patients with AD who perform poorly on memory tasks. Using the Montreal Cognitive Assessment, we found that patients with DLB (n = 73) had statistically significant lower performance in clock drawing (visuospatial and executive function) and higher performance in delayed recall (memory) subscores compared to patients with AD (n = 57). This score pattern should raise suspicion for a DLB diagnosis at initial evaluation of patients with dementia.
Collapse
Affiliation(s)
- Erin Yamamoto
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Lyla Mourany
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA
| | - Rosemary Colleran
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA
| | - Christine Whitman
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA
| | - Babak Tousi
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
27
|
Insular atrophy at the prodromal stage of dementia with Lewy bodies: a VBM DARTEL study. Sci Rep 2017; 7:9437. [PMID: 28842567 PMCID: PMC5573371 DOI: 10.1038/s41598-017-08667-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Abstract
Diffuse atrophy including the insula was previously demonstrated in dementia with Lewy bodies (DLB) patients but little is known about the prodromal stage of DLB (pro-DLB). In this prospective study, we used SPM8-DARTEL to measure gray matter (GM) and white matter (WM) atrophy in pro-DLB patients (n = 54), prodromal Alzheimer’s disease (pro-AD) patients (n = 16), DLB patients at the stage of dementia (mild-DLB) (n = 15), and Alzheimer’s disease patients at the stage of dementia (mild-AD) (n = 28), and compared them with healthy elderly controls (HC, n = 22). Diminished GM volumes were found in bilateral insula in pro-DLB patients, a trend to significance in right hippocampus and parahippocampal gyrus in pro-AD patients, in left insula in mild-DLB patients, and in medial temporal lobes and insula in mild-AD patients. The comparison between prodromal groups did not showed any differences. The comparison between groups with dementia revealed atrophy around the left middle temporal gyrus in mild-AD patients. Reduced WM volume was observed in mild-DLB in the pons. The insula seems to be a key region in DLB as early as the prodromal stage. MRI studies looking at perfusion, and functional and anatomical connectivity are now needed to better understand the role of this region in DLB.
Collapse
|
28
|
Kemp J, Philippi N, Phillipps C, Demuynck C, Albasser T, Martin-Hunyadi C, Schmidt-Mutter C, Cretin B, Blanc F. Cognitive profile in prodromal dementia with Lewy bodies. ALZHEIMERS RESEARCH & THERAPY 2017; 9:19. [PMID: 28302161 PMCID: PMC5356316 DOI: 10.1186/s13195-017-0242-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/06/2017] [Indexed: 01/18/2023]
Abstract
Background Cortical and subcortical cognitive impairments have been found in dementia with Lewy bodies (DLB). Roughly, they comprise visuoconstructive and executive dysfunction, whereas memory would remain relatively spared. However, the cognitive profile of patients with prodromal DLB remains poorly illustrated to date. Methods We included 37 patients with prodromal DLB (age 67.2 ± 8.6 years, 18 men, Mini Mental State Examination [MMSE] score 27.4 ± 2) and 29 healthy control subjects (HCs; age 68.8 ± 7.9 years, 15 men, MMSE score 29.0 ± 0.9). They were presented with an extensive neuropsychological test battery to assess memory; speed of processing; executive function; visuoperceptual, visuospatial and visuoconstructive abilities; language; and social cognition. Results Compared with HCs, patients had lower scores on a visual recognition memory test (Delayed Matching to Sample-48 items; p ≤ 0.021) and lower free recall (all p ≤ 0.035), but not total recall, performance on a verbal episodic memory test (Free and Cued Selective Reminding Test). Short-term memory (p = 0.042) and working memory (p = 0.002) scores were also lower in patients. Assessment of executive function showed no slowing but overall lower performance in patients than in HCs (all p ≤ 0.049), whereas assessment of instrumental function yielded mixed results. Indeed, patients had lower scores on language tests (p ≤ 0.022), apraxia for pantomime of tool use (p = 0.002) and imitation of meaningless gesture (p = 0.005), as well as weakened visuospatial abilities (p = 0.047). Visuoconstruction was also impaired in patients. However, visuoperceptual abilities did not differ between groups. Finally, theory of mind abilities were lower in patients than in HCs (p < 0.05), but their emotion recognition abilities were similar. Conclusions This study presents the cognitive profile in patients with prodromal DLB. In line with the literature on DLB with dementia, our results show lower performance on tests of executive function and visuoconstruction. However, we found, from a prodromal stage of DLB, memory (free recall and visual recognition) and social cognition deficits, as well as weakened visuospatial and praxic abilities.
Collapse
Affiliation(s)
- Jennifer Kemp
- Neuropsychology Unit, Neurology Department, University Hospitals of Strasbourg, Strasbourg, France. .,Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital, Strasbourg, France. .,CMRR (Memory Resources and Research Center), University Hospitals of Strasbourg, Strasbourg, France. .,Team IMIS/Neurocrypto, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), University Hospitals of Strasbourg and CNRS, Strasbourg, France.
| | - Nathalie Philippi
- Neuropsychology Unit, Neurology Department, University Hospitals of Strasbourg, Strasbourg, France.,Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital, Strasbourg, France.,CMRR (Memory Resources and Research Center), University Hospitals of Strasbourg, Strasbourg, France.,Team IMIS/Neurocrypto, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), University Hospitals of Strasbourg and CNRS, Strasbourg, France
| | - Clélie Phillipps
- Neuropsychology Unit, Neurology Department, University Hospitals of Strasbourg, Strasbourg, France.,Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital, Strasbourg, France.,CMRR (Memory Resources and Research Center), University Hospitals of Strasbourg, Strasbourg, France
| | - Catherine Demuynck
- Neuropsychology Unit, Neurology Department, University Hospitals of Strasbourg, Strasbourg, France.,Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital, Strasbourg, France.,CMRR (Memory Resources and Research Center), University Hospitals of Strasbourg, Strasbourg, France
| | - Timothée Albasser
- Neuropsychology Unit, Neurology Department, University Hospitals of Strasbourg, Strasbourg, France.,Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital, Strasbourg, France.,CMRR (Memory Resources and Research Center), University Hospitals of Strasbourg, Strasbourg, France
| | - Catherine Martin-Hunyadi
- Neuropsychology Unit, Neurology Department, University Hospitals of Strasbourg, Strasbourg, France.,Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital, Strasbourg, France.,CMRR (Memory Resources and Research Center), University Hospitals of Strasbourg, Strasbourg, France
| | - Catherine Schmidt-Mutter
- INSERM Centre d'Investigation Clinique-1434, University Hospitals of Strasbourg, Strasbourg, France
| | - Benjamin Cretin
- Neuropsychology Unit, Neurology Department, University Hospitals of Strasbourg, Strasbourg, France.,Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital, Strasbourg, France.,CMRR (Memory Resources and Research Center), University Hospitals of Strasbourg, Strasbourg, France.,Team IMIS/Neurocrypto, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), University Hospitals of Strasbourg and CNRS, Strasbourg, France
| | - Frédéric Blanc
- Neuropsychology Unit, Neurology Department, University Hospitals of Strasbourg, Strasbourg, France.,Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital, Strasbourg, France.,CMRR (Memory Resources and Research Center), University Hospitals of Strasbourg, Strasbourg, France.,Team IMIS/Neurocrypto, ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), University Hospitals of Strasbourg and CNRS, Strasbourg, France.,INSERM Centre d'Investigation Clinique-1434, University Hospitals of Strasbourg, Strasbourg, France
| |
Collapse
|
29
|
The Differential Effects of Alzheimer's Disease and Lewy Body Pathology on Cognitive Performance: a Meta-analysis. Neuropsychol Rev 2016; 27:1-17. [PMID: 27878426 DOI: 10.1007/s11065-016-9334-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
Abstract
Differential diagnosis of Alzheimer's disease (AD) from normal aging and other dementia etiologies is imperative for disease specific treatment options and long-term care planning. Neuropathological confirmation is the gold standard for neurodegenerative disease diagnosis, yet most published studies examining the use of neuropsychological tests in the differential diagnosis of dementia rely upon clinical diagnostic outcomes. The present study undertook a meta-analytic review of the literature to identify cognitive tests and domains that allow for the differentiation of individuals with AD pathology from individuals with dementia with Lewy Bodies (DLB) pathology and pathology-free individuals. A comprehensive literature search yielded 14 studies that met the inclusion criteria for the present meta-analysis. Six studies comprised 222 decedents with AD compared to 433 normal controls, and eight studies comprised 431 cases of AD compared to 155 decedents with DLB. Results revealed that the effect of having neuropathologically confirmed AD versus DLB lowered performance in the memory domain, and having DLB decreased performance in the visuospatial domain. No single test differed significantly across the AD and DLB groups. For the AD and pathology free comparison, results indicated that that AD was associated with poorer performance on the memory and language domains. With respect to specific cognitive tests, AD produced lower scores on list learning tests, category fluency, and the Digit Symbol substitution test. The limited number of studies meeting inclusion criteria warrants formulation of guidelines for reporting in clinico-pathological studies; suggested guidelines are provided.
Collapse
|
30
|
Scharre DW, Chang SI, Nagaraja HN, Park A, Adeli A, Agrawal P, Kloos A, Kegelmeyer D, Linder S, Fritz N, Kostyk SK, Kataki M. Paired Studies Comparing Clinical Profiles of Lewy Body Dementia with Alzheimer’s and Parkinson’s Diseases. J Alzheimers Dis 2016; 54:995-1004. [DOI: 10.3233/jad-160384] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Shu-Ing Chang
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Haikady N. Nagaraja
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ariane Park
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Anahita Adeli
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Punit Agrawal
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Anne Kloos
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Deb Kegelmeyer
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Shannon Linder
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Nora Fritz
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Sandra K. Kostyk
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Maria Kataki
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
31
|
Rabinovici GD, Carrillo MC, Forman M, DeSanti S, Miller DS, Kozauer N, Petersen RC, Randolph C, Knopman DS, Smith EE, Isaac M, Mattsson N, Bain LJ, Hendrix JA, Sims JR. Multiple comorbid neuropathologies in the setting of Alzheimer's disease neuropathology and implications for drug development. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2016; 3:83-91. [PMID: 29067320 PMCID: PMC5651346 DOI: 10.1016/j.trci.2016.09.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Dementia is often characterized as being caused by one of several major diseases, such as Alzheimer's disease (AD), cerebrovascular disease, Lewy body disease, or a frontotemporal degeneration. Failure to acknowledge that more than one entity may be present precludes attempts to understand interactive relationships. The clinicopathological studies of dementia demonstrate that multiple pathologic processes often coexist. How overlapping pathologic findings affect the diagnosis and treatment of clinical AD and other dementia phenotypes was the topic taken up by the Alzheimer's Association's Research Roundtable in October 2014. This review will cover the neuropathologic basis of dementia, provide clinical perspectives on multiple pathologies, and discuss therapeutics and biomarkers targeting overlapping pathologies and how these issues impact clinical trials.High prevalence of multiple pathologic findings among individuals with clinical diagnosis of AD suggests that new treatment strategies may be needed to effectively treat AD and other dementing illnesses.
Collapse
Affiliation(s)
- Gil D Rabinovici
- Memory & Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Maria C Carrillo
- Division of Medical & Scientific Relations, Alzheimer's Association, Chicago IL, USA
| | | | | | | | | | - Ronald C Petersen
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Christopher Randolph
- MedAvante, Hamilton, NJ, USA.,Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Eric E Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Niklas Mattsson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Lisa J Bain
- Independent Science Writer, Elverson, PA, USA
| | - James A Hendrix
- Division of Medical & Scientific Relations, Alzheimer's Association, Chicago IL, USA
| | | |
Collapse
|
32
|
Brønnick K, Breitve MH, Rongve A, Aarsland D. Neurocognitive Deficits Distinguishing Mild Dementia with Lewy Bodies from Mild Alzheimer’s Disease are Associated with Parkinsonism. J Alzheimers Dis 2016; 53:1277-85. [DOI: 10.3233/jad-160294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kolbørn Brønnick
- Institute of Health, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Monica H. Breitve
- Department of Research and Innovation, Helse-Fonna HF, Haugesund Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Arvid Rongve
- Department of Research and Innovation, Helse-Fonna HF, Haugesund Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Old age psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
| |
Collapse
|
33
|
Peavy GM, Edland SD, Toole BM, Hansen LA, Galasko DR, Mayo AM. Phenotypic differences based on staging of Alzheimer's neuropathology in autopsy-confirmed dementia with Lewy bodies. Parkinsonism Relat Disord 2016; 31:72-78. [PMID: 27475955 DOI: 10.1016/j.parkreldis.2016.07.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/05/2016] [Accepted: 07/17/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The goal was to compare subgroups of dementia with Lewy Bodies (DLB) using neuropathological measures to differentiate 'pure' Lewy body (LB) dementia from 'mixed' DLB [co-occurring LB and Alzheimer's disease (AD) pathology] to facilitate diagnostic decision-making and future development of interventions based on predicted type(s) of neuropathology. Studies comparing these groups are rare relative to those differentiating 'pure' AD and all-cause DLB, and are limited by insufficient sample size, brief cognitive batteries, and/or absence of autopsy confirmation. To address these limitations, we assessed cognition and other features in a large, autopsy-confirmed DLB sample using an extensive neuropsychological battery. METHODS Subjects from an AD research center autopsy series satisfying DLB pathology criteria were divided by an AD neuropathology index into DLB-LB (Braak stage 0-3) (n = 38) and DLB-AD (Braak stage 4-6) (n = 41) and compared on baseline variables from chart reviews and standardized measures. RESULTS DLB-LB subjects were more impaired on visuospatial constructions, visual conceptual reasoning, and speed of processing, but less impaired on verbal memory and confrontation naming. All-type hallucinations occurred more frequently in DLB-LB, while delusions were common in both groups. Groups were similar in education and age at onset, and in baseline age, dementia severity, and functional capacity. CONCLUSION Salient findings included greater impairment on visual tasks and speed of processing and more frequent reports of all-type hallucinations in DLB-LB compared to DLB-AD. Relatively intact confrontation naming in DLB-LB and no differences in reported delusions were of note. Identifying differences in phenotypic features can improve prediction of underlying neuropathology.
Collapse
Affiliation(s)
- Guerry M Peavy
- Department of Neurosciences, University of California, San Diego, United States.
| | - Steven D Edland
- Department of Neurosciences, University of California, San Diego, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States
| | - Belinda M Toole
- Hahn School of Nursing and Health Science, University of San Diego, United States
| | - Lawrence A Hansen
- Department of Neurosciences, University of California, San Diego, United States; Department of Pathology, University of California, San Diego, United States
| | - Douglas R Galasko
- Department of Neurosciences, University of California, San Diego, United States
| | - Ann M Mayo
- Hahn School of Nursing and Health Science, University of San Diego, United States
| |
Collapse
|
34
|
Blanc F, Colloby SJ, Cretin B, de Sousa PL, Demuynck C, O'Brien JT, Martin-Hunyadi C, McKeith I, Philippi N, Taylor JP. Grey matter atrophy in prodromal stage of dementia with Lewy bodies and Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2016; 8:31. [PMID: 27484179 PMCID: PMC4970221 DOI: 10.1186/s13195-016-0198-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 06/29/2016] [Indexed: 01/28/2023]
Abstract
Background Little is known about the patterns of brain atrophy in prodromal dementia with Lewy bodies (pro-DLB). Methods In this study, we used SPM8 with diffeomorphic anatomical registration through exponentiated lie algebra to measure grey matter (GM) volume and investigate patterns of GM atrophy in pro-DLB (n = 28) and prodromal Alzheimer’s disease (pro-AD) (n = 27) and compared and contrasted them with those in elderly control subjects (n = 33) (P ≤ 0.05 corrected for family-wise error). Results Patients with pro-DLB showed diminished GM volumes of bilateral insulae and right anterior cingulate cortex compared with control subjects. Comparison of GM volume between patients with pro-AD and control subjects showed a more extensive pattern, with volume reductions in temporal (hippocampi and superior and middle gyri), parietal and frontal structures in the former. Direct comparison of prodromal groups suggested that more atrophy was evident in the parietal lobes of patients with pro-AD than patients with pro-DLB. In patients with pro-DLB, we found that visual hallucinations were associated with relative atrophy of the left cuneus. Conclusions Atrophy in pro-DLB involves the insulae and anterior cingulate cortex, regions rich in von Economo neurons, which we speculate may contribute to the early clinical phenotype of pro-DLB.
Collapse
Affiliation(s)
- Frederic Blanc
- Geriatrics day hospital and neuropsychology unit. Geriatrics department and Neurology service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France. .,Team IMIS/Neurocrypto, French National Center for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France. .,Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, UK.
| | - Sean J Colloby
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Benjamin Cretin
- Geriatrics day hospital and neuropsychology unit. Geriatrics department and Neurology service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France.,Team IMIS/Neurocrypto, French National Center for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Paulo Loureiro de Sousa
- Team IMIS/Neurocrypto, French National Center for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - Catherine Demuynck
- Geriatrics day hospital and neuropsychology unit. Geriatrics department and Neurology service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France
| | - John T O'Brien
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, UK.,Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Catherine Martin-Hunyadi
- Geriatrics day hospital and neuropsychology unit. Geriatrics department and Neurology service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France
| | - Ian McKeith
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Nathalie Philippi
- Geriatrics day hospital and neuropsychology unit. Geriatrics department and Neurology service, Memory Resources and Research Centre (CMRR), University Hospital of Strasbourg, Strasbourg, France.,Team IMIS/Neurocrypto, French National Center for Scientific Research (CNRS), ICube Laboratory and Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France
| | - John-Paul Taylor
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
35
|
Seifan A, Marder KS, Mez J, Noble JM, Cortes EP, Vonsattel JP, Honig LS. Hippocampal laminar distribution of tau relates to Alzheimer's disease and age of onset. J Alzheimers Dis 2016; 43:315-24. [PMID: 25079799 DOI: 10.3233/jad-140279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cerebral deposition of phospho-tau in Alzheimer's disease (AD) occurs with varying patterns within hippocampus. Lamina-specific tau changes in AD may reflect trans-synaptic propagation of phospho-tau along neuroanatomical pathways. OBJECTIVE To study patterns of tau deposition within inner (IML) and outer (OML) molecular layers of dentate gyrus and their clinical and neuropathological correlates. METHODS 98 consecutive autopsied brains from the Columbia University Brain Bank were stained for phospho-tau using AT-8. Staining density was rated as High versus Low within IML and OML. Four patterns were observed among the 98 brains: High IML&OML, n = 44; High OML Only (n = 35); High IML Only (n = 5); and Low IML&OML (n = 14). Demographic, clinical, and neuropathological characteristics of these four groups were compared. RESULTS High IML&OML subjects, versus High OML Only, were more likely to fulfill CERAD criteria for Definite AD (93% versus 66%, p < 0.01) and to have higher median Braak stage (6 versus 5, p < 0.01) and earlier mean age of onset (65.9 versus 73.7 y, p = 0.02), with similar symptom duration. Using logistic regression, the association between High IML&OML and AD remained significant after adjustment for demographics but not symptom duration. In the 70 subjects with Definite AD, High IML&OML was associated with younger age of onset (mean difference 3.7 years, 95%CI -6.7 to -0.7, p < 0.01), after adjustment for demographics and symptom duration. CONCLUSIONS Phospho-tau pathology, when prominent within both IML and OML, is associated with CERAD diagnosis of Definite AD and earlier age of onset in AD. Laminar patterns of tau deposition reflect regional involvements during disease course.
Collapse
Affiliation(s)
- Alon Seifan
- Department of Neurology, Columbia University, New York, NY, USA Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Karen S Marder
- Department of Neurology, Columbia University, New York, NY, USA Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Jesse Mez
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - James M Noble
- Department of Neurology, Columbia University, New York, NY, USA Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Etty P Cortes
- Department of Neuropathology, Columbia University, New York, NY, USA
| | | | - Lawrence S Honig
- Department of Neurology, Columbia University, New York, NY, USA Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| |
Collapse
|
36
|
Cagnin A, Bussè C, Gardini S, Jelcic N, Guzzo C, Gnoato F, Mitolo M, Ermani M, Caffarra P. Clinical and Cognitive Phenotype of Mild Cognitive Impairment Evolving to Dementia with Lewy Bodies. Dement Geriatr Cogn Dis Extra 2015; 5:442-9. [PMID: 26674638 PMCID: PMC4677697 DOI: 10.1159/000441184] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objective The aim of this study was to determine which characteristics could better distinguish dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) at the mild cognitive impairment (MCI) stage, with particular emphasis on visual space and object perception abilities. Methods Fifty-three patients with mild cognitive deficits that were eventually diagnosed with probable DLB (MCI-DLB: n = 25) and AD (MCI-AD: n = 28) at a 3-year follow-up were retrospectively studied. At the first visit, the patients underwent cognitive assessment including the Qualitative Scoring Mini Mental State Examination Pentagon Test and the Visual Object and Space Perception Battery. The Neuropsychiatric Inventory Questionnaire, Unified Parkinson's Disease Rating Scale (UPDRS) and questionnaires for cognitive fluctuations and sleep disorders were also administered. Results The best clinical predictor of DLB was the presence of soft extrapyramidal signs (mean UPDRS score: 4.04 ± 5.9) detected in 72% of patients, followed by REM sleep behavior disorder (60%) and fluctuations (60%). Wrong performances in the pentagon's number of angles were obtained in 44% of DLB and 3.7% of AD patients and correlated with speed of visual attention. Executive functions, visual attention and visuospatial abilities were worse in DLB, while verbal episodic memory impairment was greater in AD. Deficits in the visual-perceptual domain were present in both MCI-DLB and AD. Conclusions Poor performance in the pentagon's number of angles is specific of DLB and correlates with speed of visual attention. The dorsal visual stream seems specifically more impaired in MCI-DLB with respect to the ventral visual stream, the latter being involved in both DLB and AD. These cognitive features, associated with subtle extrapyramidal signs, should alert clinicians to a diagnostic hypothesis of DLB.
Collapse
Affiliation(s)
- Annachiara Cagnin
- Department of Neurosciences, University of Padova, Padova, Italy ; IRCCS San Camillo Research Hospital, Venice, Italy
| | - Cinzia Bussè
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Simona Gardini
- Department of Neuroscience, University of Parma, Italy ; Center for Cognitive Disorders, AUSL of Parma, Parma, Italy
| | - Nela Jelcic
- Department of Neurosciences, University of Padova, Padova, Italy ; IRCCS San Camillo Research Hospital, Venice, Italy
| | - Caterina Guzzo
- Department of Neuroscience, University of Parma, Italy ; Center for Cognitive Disorders, AUSL of Parma, Parma, Italy
| | - Francesca Gnoato
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Mario Ermani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Paolo Caffarra
- Department of Neuroscience, University of Parma, Italy ; Center for Cognitive Disorders, AUSL of Parma, Parma, Italy
| |
Collapse
|
37
|
Abstract
The broad importance of dementia is undisputed, with Alzheimer's disease justifiably getting the most attention. However, dementia with Lewy bodies and Parkinson's disease dementia, now called Lewy body dementias, are the second most common type of degenerative dementia in patients older than 65 years. Despite this, Lewy body dementias receive little attention and patients are often misdiagnosed, leading to less than ideal management. Over the past 10 years, considerable effort has gone into improving diagnostic accuracy by refining diagnostic criteria and using imaging and other biomarkers. Dementia with Lewy bodies and Parkinson's disease dementia share the same pathophysiology, and effective treatments will depend not only on successful treatment of symptoms but also on targeting the pathological mechanisms of disease, ideally before symptoms and clinical signs develop. We summarise the most pertinent progress from the past 10 years, outlining some of the challenges for the future, which will require refinement of diagnosis and clarification of the pathogenesis, leading to disease-modifying treatments.
Collapse
Affiliation(s)
- Zuzana Walker
- Division of Psychiatry, University College London, London, UK; North Essex Partnership University NHS Foundation Trust, Epping, UK.
| | - Katherine L Possin
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Bradley F Boeve
- Division of Behavioral Neurology, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Division of Movement Disorders, Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Center for Sleep Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Dag Aarsland
- Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway; Department of Geriatric Psychiatry, Akershus University Hospital, Oslo, Norway; Department of Neurobiology, Care Sciences and Society, Division of Alzheimer's Disease Research Centre, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
38
|
Mackin RS, Insel P, Zhang J, Mohlenhoff B, Galasko D, Weiner M, Mattsson N. Cerebrospinal fluid α-synuclein and Lewy body-like symptoms in normal controls, mild cognitive impairment, and Alzheimer's disease. J Alzheimers Dis 2015; 43:1007-16. [PMID: 25125463 DOI: 10.3233/jad-141287] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Reduced cerebrospinal fluid (CSF) α-synuclein has been described in synucleinopathies, including dementia with Lewy bodies (DLB). Common symptoms of DLB include visual hallucinations and visuospatial and executive deficits. Co-occurrence of Lewy body pathology is common in Alzheimer's disease (AD) patients, but it is unknown if reduced CSF α-synuclein is associated with Lewy body-like symptomatology in AD. OBJECTIVE Determine associations between CSF α-synuclein and Lewy body-like symptomatology. METHODS We included 73 controls (NC), 121 mild cognitive impairment (MCI) patients, and 61 AD patients (median follow-up 3.5 years, range 0.6-7.8). We tested associations between baseline CSF α-synuclein and visual hallucinations and (longitudinal) cognition. Models were tested with and without co-varying for CSF total tau (T-tau), which is elevated in AD patients, and believed to reflect neurodegeneration. RESULTS Hallucinations were reported in 20% of AD patients, 13% of MCI patients, and 8% of NC. In AD, low CSF α-synuclein was associated with hallucinations. When adjusting for CSF T-tau, low CSF α-synuclein was associated with accelerated decline of executive function (NC, MCI, and AD), memory (MCI and AD), and language (MCI). CONCLUSION The associations of low CSF α-synuclein with hallucinations and poor executive function, which are hallmarks of DLB, indirectly suggest that this biomarker may reflect underlying synuclein pathology. The associations with memory and language in MCI and AD suggests either that reduced CSF α-synuclein also partly reflects global impaired neuronal/synaptic function, or that non-specific overall cognitive deterioration is accelerated in the presence of synuclein related pathology. The findings will require autopsy verification.
Collapse
Affiliation(s)
- R Scott Mackin
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Philip Insel
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA
| | - Jing Zhang
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Brian Mohlenhoff
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA Department of Psychiatry, University of California, San Francisco, CA, USA Mental Health Service, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Michael Weiner
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Niklas Mattsson
- Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases, San Francisco, CA, USA Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| |
Collapse
|
39
|
Armstrong R, Kergoat H. Oculo-visual changes and clinical considerations affecting older patients with dementia. Ophthalmic Physiol Opt 2015; 35:352-76. [DOI: 10.1111/opo.12220] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 05/19/2015] [Indexed: 12/18/2022]
Affiliation(s)
| | - Hélène Kergoat
- École d'optométrie; Université de Montréal; Montreal Canada
| |
Collapse
|
40
|
Blanc F, Colloby SJ, Philippi N, de Pétigny X, Jung B, Demuynck C, Phillipps C, Anthony P, Thomas A, Bing F, Lamy J, Martin-Hunyadi C, O'Brien JT, Cretin B, McKeith I, Armspach JP, Taylor JP. Cortical Thickness in Dementia with Lewy Bodies and Alzheimer's Disease: A Comparison of Prodromal and Dementia Stages. PLoS One 2015; 10:e0127396. [PMID: 26061655 PMCID: PMC4489516 DOI: 10.1371/journal.pone.0127396] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/15/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives To assess and compare cortical thickness (CTh) of patients with prodromal Dementia with Lewy bodies (pro-DLB), prodromal Alzheimer's disease (pro-AD), DLB dementia (DLB-d), AD dementia (AD-d) and normal ageing. Methods Study participants(28 pro-DLB, 27 pro-AD, 31 DLB-d, 54 AD-d and 33 elderly controls) underwent 3Tesla T1 3D MRI and detailed clinical and cognitive assessments. We used FreeSurfer analysis package to measure CTh and investigate patterns of cortical thinning across groups. Results Comparison of CTh between pro-DLB and pro-AD (p<0.05, FDR corrected) showed more right anterior insula thinning in pro-DLB, and more bilateral parietal lobe and left parahippocampal gyri thinning in pro-AD. Comparison of prodromal patients to healthy elderly controls showed the involvement of the same regions. In DLB-d (p<0.05, FDR corrected) cortical thinning was found predominantly in the right temporo-parietal junction, and insula, cingulate, orbitofrontal and lateral occipital cortices. In AD-d(p<0.05, FDR corrected),the most significant areas affected included the entorhinal cortices, parahippocampal gyri and parietal lobes. The comparison of AD-d and DLB-d demonstrated more CTh in AD-d in the left entorhinal cortex (p<0.05, FDR corrected). Conclusion Cortical thickness is a sensitive measure for characterising patterns of grey matter atrophy in early stages of DLB distinct from AD. Right anterior insula involvement may be a key region at the prodromal stage of DLB and needs further investigation.
Collapse
Affiliation(s)
- Frederic Blanc
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de MédecineTranslationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
- University Hospital of Strasbourg, Hôpital de jour de gériatrie, Geriatry Service, Strasbourg, France
- * E-mail:
| | - Sean J. Colloby
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nathalie Philippi
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de MédecineTranslationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
| | - Xavier de Pétigny
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
- University Hospital of Strasbourg, Hôpital de jour de gériatrie, Geriatry Service, Strasbourg, France
| | - Barbara Jung
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de MédecineTranslationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
- University Hospital of Strasbourg, Hôpital de jour de gériatrie, Geriatry Service, Strasbourg, France
| | - Catherine Demuynck
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
- University Hospital of Strasbourg, Hôpital de jour de gériatrie, Geriatry Service, Strasbourg, France
| | - Clélie Phillipps
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
- University Hospital of Strasbourg, Hôpital de jour de gériatrie, Geriatry Service, Strasbourg, France
| | - Pierre Anthony
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
| | - Alan Thomas
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fabrice Bing
- University Hospital of Strasbourg, Neuroradiology Service, Strasbourg, France
| | - Julien Lamy
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de MédecineTranslationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France
| | - Catherine Martin-Hunyadi
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
- University Hospital of Strasbourg, Hôpital de jour de gériatrie, Geriatry Service, Strasbourg, France
| | - John T. O'Brien
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Benjamin Cretin
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de MédecineTranslationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Strasbourg, France
| | - Ian McKeith
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jean-Paul Armspach
- University of Strasbourg and CNRS, ICube laboratory UMR 7357 and FMTS (Fédération de MédecineTranslationnelle de Strasbourg), team IMIS/Neurocrypto, Strasbourg, France
| | - John-Paul Taylor
- Institute of Neuroscience, Campus for Aging and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
41
|
Yoon JH, Kim M, Moon SY, Yong SW, Hong JM. Olfactory function and neuropsychological profile to differentiate dementia with Lewy bodies from Alzheimer's disease in patients with mild cognitive impairment: A 5-year follow-up study. J Neurol Sci 2015; 355:174-9. [PMID: 26076880 DOI: 10.1016/j.jns.2015.06.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a well-known precursor of Alzheimer's disease (AD) but often also precedes dementia with Lewy bodies (DLB). The early differentiation of DLB from AD is important to delay disease progression. Olfactory dysfunction is a well-known early sign of both AD and Lewy body disorders, including Parkinson's disease (PD) and DLB. Thus, the aim of the present study was to determine whether olfactory and neuropsychological tests can aid in the differentiation of DLB from AD at the MCI stage. METHODS The present study included 122 MCI patients who were monitored until they developed dementia or until their condition stabilized; the follow-up period averaged 4.9 years (range: 3.9-6.2 years). Baseline olfactory function as measured with the Cross-Cultural Smell Identification (CCSI) test and neuropsychological data were compared. RESULTS During the follow-up period, 32 subjects developed probable AD (MCI-AD), 18 had probable DLB (MCI-DLB), 45 did not convert to dementia (MCI-stable), and eight developed a non-AD/DLB dementia. The mean CCSI score (95% confidence interval [CI]) in patients with MCI-DLB (4.6; 95% CI: 4.0-5.3) was significantly lower than that of MCI-AD patients (6.4; 95% CI: 6.0-6.7, p<0.001) and MCI-stable patients (7.3; 95% CI: 6.9-7.8, p<0.001). The area under the curve of the receiver operating characteristic to discriminate MCI-DLB from MCI-AD using CCSI scores was (0.84; 95% CI: 0.72-0.97). Frontal-executive function and visuospatial ability was worse in patients with MCI-DLB, while verbal recognition memory impairment was greater in those with MCI-AD. CONCLUSION Olfactory and neuropsychological tests can help predict conversion to DLB or AD in patients with MCI.
Collapse
Affiliation(s)
- Jung Han Yoon
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea.
| | - Min Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - So Young Moon
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Seok Woo Yong
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| |
Collapse
|
42
|
Abstract
BACKGROUND Dementia with Lewy body (DLB) is considered to be the second most common form of neurodegenerative disorders after Alzheimer's disease (AD), affecting as many as 100,000 people in the UK and up to 1.3 million in the USA. However, nearly half of patients with DLB remain undiagnosed thus depriving many of them from an early and adequate treatment of their distressing symptoms. Accurate and early diagnosis of DLB is important for both patients and their caregivers, since the neuropsychiatric symptoms require specific management. METHODS In the current study, we review the most recent developments in the field of molecular nuclear imaging to diagnose DLB. RESULTS The review addresses, the neurotransmitter based (dopaminergic, cholinergic, and glutamatergic) nuclear imaging techniques, role of the autonomic dysfunction and its visualization in DLB with myocardial sympathetic imaging and vesicular catecholamine uptake, as well as the use of amyloid polypeptides and glial markers as molecular imaging probes in the clinical diagnosis of DLB. CONCLUSIONS Most of the above nuclear imaging methods are restricted to highly specialized clinical centers, and thus not applicable to a large number of patients requiring dementia (e.g. DLB) diagnosis in routine clinical setting. Validating them against more readily accessible peripheral biomarkers, e.g. CSF and blood biomarkers linked to the DLB process, may facilitate their use in wider clinical settings.
Collapse
|
43
|
Frey KA, Petrou M. Imaging Amyloidopathy in Parkinson Disease and Parkinsonian Dementia Syndromes. Clin Transl Imaging 2015; 3:57-64. [PMID: 25745616 DOI: 10.1007/s40336-015-0104-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Dementia arising in patients with Parkinson disease or parkinsonian neurodegeneration comprises a heterogeneous neuropathology. Clinical labeling of patients with both dementia and Parkinson disease is dichotomous, depending on the temporal development of cognitive impairment and motor parkinsonism. Patients with dementia arising first (or within the first year of PD) are classified as dementia with Lewy bodies; patients with PD for more than one year before cognitive decline are classified as Parkinson disease with dementia. Despite this differential clinical classification, autopsy studies demonstrate variable admixtures of cortical synuicleinopathy, Aβ-amyloidopathy and tau neurofibrillary tangle deposition. There are no routine clinical diagnostic measures that accurately distinguish the underlying neuropathologies in individual patients. In the present paper, we review the published literature describing characteristics of fibrillary Aβ-amyloid deposition on the basis of PET radiotracer imaging in patients with Parkinson disease and in parkinsonian dementia syndromes. Although individual reports often include only small-to-modest subject numbers, there is overall suggestion that PD patients have a lower incidence of Aβ-amyloid deposition than seen amongst elderly normal subjects, and that Parkinson disease with dementia patients have a lower incidence of Aβ-amyloid deposition than do patients with dementia with Lewy bodies. These apparent features contrast the findings of Aβ-amyloid-PET imaging in normal aging and the development of Alzheimer disease, where Aβ-amyloid deposition arises asymptomatically and apparently many years before development of signs or symptoms of dementia. It is proposed that focused, prospective studies are needed to further address and understand the complex role(s) of Aβ-amyloid pathology in Parkinson disease, and that this understanding will be critical to the development of targeted disease-modifying therapy for dementia in PD.
Collapse
Affiliation(s)
- Kirk A Frey
- Departments of Radiology and Neurology and the Molecular and Behavioral Neuroscience Institute, The University of Michigan, Ann Arbor, MI USA
| | - Myria Petrou
- Departments of Radiology and Neurology and the Molecular and Behavioral Neuroscience Institute, The University of Michigan, Ann Arbor, MI USA
| |
Collapse
|
44
|
Abstract
BACKGROUND The clinical condition of dementia is now recognized as a diagnosis that can only be applied too late in the disease process to be useful for therapeutic approaches centring on disease modification. As a result, in recent years increasing attention has been given to mild cognitive impairment (MCI) and the diagnosis of prodromal dementia. This paper reviews the evidence for the clinical presentation of prodromal dementia with Lewy bodies (DLB). METHOD A Medline search was carried out to identify articles with original data on the prodromal presentation of DLB. RESULTS In MCI cohorts that progress to dementia, the proportion diagnosed with DLB is similar to that reported in dementia cohorts. Prodromal DLB may present as any MCI subtype, although visuospatial and executive domains may be most commonly affected. Rapid eye movement (REM) sleep behaviour disorder (RBD), autonomic symptoms, hyposmia, hallucinations and motor symptoms seem to be more common in prodromal DLB than in prodromal Alzheimer's disease (AD). Some of these symptoms can precede the diagnosis of DLB by several years. There has been little research into the use of biomarkers in prodromal DLB, although in RBD cohorts, clinical and imaging biomarkers have been associated with the development of DLB. CONCLUSIONS The evidence available suggests that prodromal DLB may be differentiated from other dementia prodromes in most cases. Further research is needed to confirm this, and to assess the utility of biomarkers such as 123I-FP-CIT and 123I-MIBG imaging.
Collapse
Affiliation(s)
- P C Donaghy
- Institute for Ageing and Health, Newcastle University,Campus for Ageing and Vitality, Newcastle upon Tyne,UK
| | - J T O'Brien
- Department of Psychiatry,University of Cambridge,Cambridge Biomedical Campus, Cambridge,UK
| | - A J Thomas
- Institute for Ageing and Health, Newcastle University,Campus for Ageing and Vitality, Newcastle upon Tyne,UK
| |
Collapse
|
45
|
Breitve MH, Chwiszczuk LJ, Hynninen MJ, Rongve A, Brønnick K, Janvin C, Aarsland D. A systematic review of cognitive decline in dementia with Lewy bodies versus Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2014; 6:53. [PMID: 25478024 PMCID: PMC4255525 DOI: 10.1186/s13195-014-0053-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/25/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The aim of this review was to investigate whether there is a faster cognitive decline in dementia with Lewy bodies (DLB) than in Alzheimer's disease (AD) over time. METHODS PsycINFO and Medline were searched from 1946 to February 2013. A quality rating from 1 to 15 (best) was applied to the included studies. A quantitative meta-analysis was done on studies with mini mental state examination (MMSE) as the outcome measure. RESULTS A total of 18 studies were included. Of these, six (36%) reported significant differences in the rate of cognitive decline. Three studies reported a faster cognitive decline on MMSE in patients with mixed DLB and AD compared to pure forms, whereas two studies reported a faster decline on delayed recall and recognition in AD and one in DLB on verbal fluency. Mean quality scores for studies that did or did not differ were not significantly different. Six studies reported MMSE scores and were included in the meta-analysis, which showed no significant difference in annual decline on MMSE between DLB (mean 3.4) and AD (mean 3.3). CONCLUSIONS Our findings do not support the hypothesis of a faster rate of cognitive decline in DLB compared to AD. Future studies should apply recent diagnostic criteria, as well as extensive diagnostic evaluation and ideally autopsy diagnosis. Studies with large enough samples, detailed cognitive tests, at least two years follow up and multivariate statistical analysis are also needed.
Collapse
Affiliation(s)
- Monica H Breitve
- Section of Mental Health Research, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Haugesund, 5504, Norway ; Old Age Department, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Haugesund, 5504, Norway
| | - Luiza J Chwiszczuk
- Section of Mental Health Research, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Haugesund, 5504, Norway ; Neurological Department, Clinic of Medicine, Helse-Fonna HF Haugesund Hospital, Haugesund, 5504, Norway
| | - Minna J Hynninen
- Department of Clinical Psychology, University of Bergen, Christies gate 12, Bergen, 5015, Norway ; NKS Olaviken Hospital for Old Age Psychiatry, Ulriksdal 8, Bergen, 5009, Norway
| | - Arvid Rongve
- Section of Mental Health Research, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Haugesund, 5504, Norway ; Old Age Department, Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital, Haugesund, 5504, Norway ; Faculty of Medicine, University of Bergen, Bergen, 5020, Norway
| | - Kolbjørn Brønnick
- TIPS, Regional Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, 4068, Norway ; Network for Medical Sciences, Stavanger University Hospital, Stavanger, 4068, Norway
| | - Carmen Janvin
- Centre for Age Related Medicine, Stavanger University Hospital, Stavanger, 4068, Norway
| | - Dag Aarsland
- Centre for Age Related Medicine, Stavanger University Hospital, Stavanger, 4068, Norway ; Department NVS, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, Huddinge, 14157, Sweden
| |
Collapse
|
46
|
Morra LF, Donovick PJ. Clinical presentation and differential diagnosis of dementia with Lewy bodies: a review. Int J Geriatr Psychiatry 2014; 29:569-76. [PMID: 24150834 DOI: 10.1002/gps.4039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/23/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dementia with Lewy bodies is one of the most prevalent dementia diagnoses. However, differential diagnosis between dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia can still be very difficult given the overlap in neuropathology, clinical presentation, cognitive, and neuroanatomical changes. METHOD A literature review of dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia was conducted using PubMed. RESULTS AND IMPLICATIONS Accurate diagnosis of dementia with Lewy bodies is crucial in order to more accurately predict the progression of the disease and negative side effects from pharmacological treatment. The differences and similarities between dementia with Lewy bodies, Alzheimer's disease, and Parkinson's disease with dementia are highlighted in order to aid clinicians in differential diagnosis.
Collapse
Affiliation(s)
- L F Morra
- State University of New York at Binghamton, Binghamton, NY, USA
| | | |
Collapse
|
47
|
Blanc F. Does cognitive profile distinguish Lewy body disease from Alzheimer's disease in the early stages? J Neurol Neurosurg Psychiatry 2013; 84:1299-300. [PMID: 23591555 DOI: 10.1136/jnnp-2012-304694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
48
|
Yoshizawa H, Vonsattel JPG, Honig LS. Presenting neuropsychological testing profile of autopsy-confirmed frontotemporal lobar degeneration. Dement Geriatr Cogn Disord 2013; 36:279-89. [PMID: 23949428 PMCID: PMC4559565 DOI: 10.1159/000353860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2013] [Indexed: 12/12/2022] Open
Abstract
AIMS We aimed to investigate how neuropsychological test measures at presentation might differentiate frontotemporal lobar degeneration (FTLD) from Alzheimer's disease (AD). METHODS We compared autopsy-confirmed FTLD and definite AD with Clinical Dementia Rating ≤1. Factor scores and t values of each neuropsychological test measure were compared between FTLD and AD patients. Logistic regression analyses were applied to identify independent predictors within test measures for the differentiation of FTLD from AD. RESULTS Factor analyses showed that the memory domain was more severely impaired in AD than in FTLD, whereas the language and attention domains were more severely impaired in FTLD than in AD. Multiple logistic regression analysis showed that Letter Fluency, Boston Naming Test and delayed memory recall remained independent predictors of FTLD compared to AD. However, test measures did not discriminate between FTLD-tau and FTLD-ubiquitin. CONCLUSION We confirm that memory and language function tests discriminate between FTLD and AD.
Collapse
Affiliation(s)
- Hiroshi Yoshizawa
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians & Surgeons
| | - Jean Paul G. Vonsattel
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians & Surgeons,Department of Pathology and Cell Biology, Columbia University College of Physicians & Surgeons
| | - Lawrence S. Honig
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University College of Physicians & Surgeons,Gertrude H. Sergievsky Center, Columbia University College of Physicians & Surgeons,Department of Neurology, Columbia University College of Physicians & Surgeons
| |
Collapse
|