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Choudhury P, Zhang N, Adler CH, Chen K, Belden C, Driver-Dunckley E, Mehta SH, Shprecher DR, Serrano G, Shill HA, Beach TG, Atri A. Longitudinal motor decline in dementia with Lewy bodies, Parkinson disease dementia, and Alzheimer's dementia in a community autopsy cohort. Alzheimers Dement 2023; 19:4377-4387. [PMID: 37422286 PMCID: PMC10592344 DOI: 10.1002/alz.13357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION We examined the progression of extrapyramidal symptoms and signs in autopsy-confirmed dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and Alzheimer's disease dementia (AD). METHODS Longitudinal data were obtained from Arizona Study of Aging and Neurodegenerative Disease, with PDD (n = 98), AD (n = 47) and DLB (n = 48) further sub-grouped as with or without parkinsonism (DLB+ and DLB-). Within-group Unified Parkinson's Disease Rating Scale (UPDRS) -II and UPDRS-III trajectories were analyzed using non-linear mixed effects models. RESULTS In DLB, 65.6% had parkinsonism. Baseline UPDRS-II and III scores (off-stage) were highest (P < 0.001) for PDD (mean ± SD 14.3 ± 7.8 and 27.4 ± 16.3), followed by DLB+ (6.0 ± 8.8 and 17.2 ± 17.1), DLB- (1.1 ± 1.3 and 3.3 ± 5.5) and AD (3.2 ± 6.1 and 8.2 ± 13.6). Compared to PDD, the DLB+ group had faster UPDRS-III progression over 8-years (Cohen's-d range 0.98 to 2.79, P < 0.001), driven by gait (P < 0.001) and limb bradykinesia (P = 0.02) subscales. DISCUSSION Motor deficits progress faster in DLB+ than PDD, providing insights about expected changes in motor function. HIGHLIGHTS Dementia with Lewy bodies has faster motor progression than Parkinson's disease dementia Linear and non-linear mixed modeling analysis of longitudinal data was utilized Findings have implications for clinical prognostication and trial design.
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Affiliation(s)
- Parichita Choudhury
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine, Scottsdale, Arizona, 85259, USA
| | - Charles H. Adler
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, Arizona, 85259, USA
| | - Kewei Chen
- Computational Imaging Lab, Banner Alzheimer’s Institute, Phoenix, Arizona, 85006, USA
| | - Christine Belden
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
| | - Erika Driver-Dunckley
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, Arizona, 85259, USA
| | - Shyamal H. Mehta
- Computational Imaging Lab, Banner Alzheimer’s Institute, Phoenix, Arizona, 85006, USA
| | - David R. Shprecher
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
| | - Geidy Serrano
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
| | - Holly A. Shill
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, 85013, USA
| | - Thomas G. Beach
- Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
| | - Alireza Atri
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, Arizona, 85351, USA
- Center for Brain/Mind Medicine & Department of Neurology, Brigham and Women’s Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Odawara T, Hasegawa K, Kajiwara R, Takeuchi H, Tagawa M, Kosaka K, Murata M. Long-Term Efficacy and Safety of Zonisamide for Treatment of Parkinsonism in Patients With Dementia With Lewy Bodies: An Open-Label Extension of a Phase three Randomized Controlled Trial. Am J Geriatr Psychiatry 2022; 30:314-328. [PMID: 34420834 DOI: 10.1016/j.jagp.2021.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate the long-term efficacy and safety of zonisamide, an antiepileptic agent, in dementia with Lewy bodies (DLB). DESIGN Phase three clinical trial with 12 week, randomized, placebo-controlled, double-blind, and subsequent 40 week, open-label, extension periods. SETTING A total of 109 centers in Japan between April 2015 and November 2017. PARTICIPANTS Outpatients diagnosed with probable DLB. INTERVENTION Outpatients were randomly assigned to receive placebo (P) or zonisamide 25 or 50 mg/day for 12 weeks. In the subsequent open-label 40 week period, all patients initially received zonisamide 25 mg/day for at least 2 weeks followed by optional flexible dosing with zonisamide 25 or 50 mg/day for the remaining period. MEASUREMENTS The primary outcome was efficacy on motor symptoms, assessed using the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score, over the total 52 week trial period. Effects on behavioral and psychological symptoms of dementia and cognitive function, and safety were also evaluated. RESULTS In total, 335 patients were included in the long-term analysis: 106, 117, and 112 in the P-, 25mg-, and 50mg-Flex groups, respectively. UPDRS-III score continued to improve for an additional 12 to 16 weeks in the open-label period (mean [standard deviation] change from baseline at Week 28: -5.1 [7.3] and -6.3 [8.2] in the 25mg- and 50mg-Flex groups) and remained almost constant thereafter. No unexpected neurological or psychiatric adverse events occurred, and no adverse events increased in incidence in the open-label period. CONCLUSIONS Long-term treatment with zonisamide was well tolerated and yielded sustained improvement in motor symptoms. TRIAL REGISTRATION JapicCTI-152839 (Registered on 9 March 2015) https://www.clinicaltrials.jp/cti-user/trial/ShowDirect.jsp?japicId=JapicCTI-152839.
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Affiliation(s)
- Toshinari Odawara
- Health Management Center, Yokohama City University, Kanagawa, Japan (TO)
| | - Kazuko Hasegawa
- Neurology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan (KH)
| | | | - Hisao Takeuchi
- Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan (RK, HT, MT)
| | - Masaaki Tagawa
- Sumitomo Dainippon Pharma Co., Ltd., Tokyo, Japan (RK, HT, MT).
| | | | - Miho Murata
- Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan (MM)
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Malattia a corpi di Lewy. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Liu S, Wang XD, Wang Y, Shi Z, Cai L, Liu S, Han T, Zhou Y, Wang X, Gao S, Ji Y. Clinical and neuroimaging characteristics of Chinese dementia with Lewy bodies. PLoS One 2017; 12:e0171802. [PMID: 28253276 PMCID: PMC5333817 DOI: 10.1371/journal.pone.0171802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 01/24/2017] [Indexed: 11/18/2022] Open
Abstract
Dementia with Lewy bodies (DLB) is the second most common subtype of degenerative dementia. To our knowledge, available information about the clinical features of DLB in China remains limited. Our study therefore aimed to address this issue. Thirty-seven Chinese patients with probable DLB were recruited for this study. All subjects underwent neuropsychological assessment by trained neurologists, as well as undergoing MRI, 11C-PIB PET scans for Aβ deposition and 18F-FDG PET scans for regional cerebral glucose metabolism. Our results showed that the gender ratio of patients was 16:21 (F:M). The mean age of onset was 69.5 ± 9.0 years and the mean age at diagnosis was 71.8 ± 9.1 years. At diagnosis, the prevalence of three core clinical features of DLB was: 64.9% for fluctuating cognition, 73.0% for visual hallucinations and 62.2% for parkinsonism. The result from 11C-PiB PET and 18F-FDG PET scans confirmed Aβ deposition in the cortex and demonstrated hypometabolism in the bilateral temporoparietooccipital region, the frontal lobe, the insular lobe, and the posterior cingulate, precuneus and caudate nuclei. Our study elucidated the clinical features of Chinese DLB patients, and will improve the understanding and the early diagnosis of DLB in Chinese patients.
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Affiliation(s)
- Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiao-Dan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Ying Wang
- PET-CT Center, General Hospital of Tianjin Medical University, Tianjin, China
| | - Zhihong Shi
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Li Cai
- PET-CT Center, General Hospital of Tianjin Medical University, Tianjin, China
| | - Shuling Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Tong Han
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yuying Zhou
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Xinping Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuo Gao
- PET-CT Center, General Hospital of Tianjin Medical University, Tianjin, China
| | - Yong Ji
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Tianjin Dementia Institute, Tianjin Huanhu Hospital, Tianjin, China
- * E-mail:
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Yue W, Wang XD, Shi Z, Wang Y, Liu S, Liu S, Zhang Y, Zhang Y, Lu H, Su W, Ji Y. The prevalence of dementia with Lewy bodies in a rural area of China. Parkinsonism Relat Disord 2016; 29:72-7. [DOI: 10.1016/j.parkreldis.2016.05.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/03/2016] [Accepted: 05/21/2016] [Indexed: 11/16/2022]
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Mori E, Ikeda M, Nakagawa M, Miyagishi H, Yamaguchi H, Kosaka K. Effects of Donepezil on Extrapyramidal Symptoms in Patients with Dementia with Lewy Bodies: A Secondary Pooled Analysis of Two Randomized-Controlled and Two Open-Label Long-Term Extension Studies. Dement Geriatr Cogn Disord 2016; 40:186-98. [PMID: 26226884 DOI: 10.1159/000433524] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to clarify the effects of donepezil on extrapyramidal symptoms in patients with dementia with Lewy bodies (DLB). METHODS Using pooled datasets from phase 2 and 3, 12-week randomized, placebo-controlled trials (RCT, n = 281) and 52-week open-label long-term extension trials (OLE, n = 241) of donepezil in DLB, the effects of donepezil on the incidence of extrapyramidal adverse events (AEs) and on the Unified Parkinson's Disease Rating Scale (UPDRS) part III were assessed, and potential baseline factors affecting the AEs were explored. RESULTS The RCT analysis did not show significant differences between the placebo and active (3, 5, and 10 mg donepezil) groups in extrapyramidal AE incidence (3.8 and 6.5%, p = 0.569) and change in the UPDRS (mean ± SD: -0.2 ± 4.3 and -0.6 ± 6.5, p = 0.562). In the OLE analysis (5 and 10 mg donepezil), the incidence did not increase chronologically; all AEs leading to a dose reduction or discontinuation except one were relieved. The UPDRS was unchanged for 52 weeks. An exploratory multivariate logistic regression analysis of the RCTs revealed that donepezil treatment was not a significant factor affecting the AEs. Baseline severity of parkinsonism was a predisposing factor for worsening of parkinsonism without significant interactions between donepezil and baseline severity. CONCLUSION DLB can safely be treated with donepezil without relevant worsening of extrapyramidal symptoms, but treatment requires careful attention to symptom progression when administered to patients with relatively severe parkinsonism.
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Affiliation(s)
- Etsuro Mori
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
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Feldman WB, Besterman AD, Yu JPJ, Devido JJ, Bourgeois JA. Persistent Perceptual Disturbances After Lithium Toxicity: A Case Report and Discussion. PSYCHOSOMATICS 2015; 56:306-10. [DOI: 10.1016/j.psym.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/09/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
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Krolak-Salmon P, Xie J. Malattia a corpi di Lewy. Neurologia 2014. [DOI: 10.1016/s1634-7072(14)68870-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia in older people, accounting for 10% to 15% of all cases, it occupies part of a spectrum that includes Parkinson's disease and primary autonomic failure. All these diseases share a neuritic pathology based upon abnormal aggregation of the synaptic protein α-synuciein. It is important to identify DLB patients accurately because they have specific symptoms, impairments, and functional disabilities thai differ from other common dementia syndromes such as Alzheimer's disease, vascular cognitive impairment, and frontotemporal dementia. Clinical diagnostic criteria for DLB have been validated against autopsy, but fail to detect a substantial minority of cases with atypical presentations that are often due to the presence of mixed pathology. DLB patients frequently have severe neuroleptic sensitivity reactions, which are associated with significantly increased morbidity and mortality. Cholinesterase inhibitor treatment is usually well tolerated and substantially improves cognitive and neuropsychiatrie symptoms. Although virtually unrecognized 20 years ago, DLB could within this decade become one of the most treatable neurodegenerative disorders of late life.
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Affiliation(s)
- Ian McKeith
- Institute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne, UK
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10
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Clerici F, Ratti PL, Pomati S, Maggiore L, Elia A, Mariani C. Cholinergic balance in dementia with Lewy bodies: reversible worsening of Parkinsonism at rivastigmine dosage modulation. Neurol Sci 2007; 28:282-4. [PMID: 17972045 DOI: 10.1007/s10072-007-0837-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2007] [Accepted: 08/31/2007] [Indexed: 11/26/2022]
Abstract
We describe a patient with probable dementia with Lewy bodies (DLB) whose Parkinsonism worsened after administration of rivastigmine within the therapeutic dose range. Some extrapyramidal signs (EPS) then reversed to pre-treatment level after rivastigmine dose reduction. We draw attention to the need of EPS monitoring during titration of cholinesterase inhibitors in patients with DLB. This is the first report to our knowledge of iatrogenic worsening of Parkinsonism which was successfully managed by dose reduction.
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Affiliation(s)
- F Clerici
- Centre for Research and Treatment on Cognitive Dysfunctions, Institute of Clinical Neurology, Department of Clinical Sciences, Luigi Sacco Hospital, University of Milan, Via G.B. Grassi 74, I-20157, Milan, Italy.
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11
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Merory JR, Wittwer JE, Rowe CC, Webster KE. Quantitative gait analysis in patients with dementia with Lewy bodies and Alzheimer's disease. Gait Posture 2007; 26:414-9. [PMID: 17161601 DOI: 10.1016/j.gaitpost.2006.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 10/16/2006] [Accepted: 10/25/2006] [Indexed: 02/02/2023]
Abstract
Gait disorders in people with dementia have been documented in a number of studies. There is some preliminary evidence suggesting there may be a relationship between dementia type and gait abnormality. Quantitative gait analysis has not previously been reported for people diagnosed with dementia with Lewy bodies (DLB). Therefore, this study aimed to quantify gait patterns of people with DLB and compare them with those of people with Alzheimer's disease (AD) and control subjects. Two groups of 10 subjects divided according to a diagnosis of DLB and AD, and 10 control subjects underwent gait analysis using an electronic walkway. Participants were required to walk at self-selected slow, preferred and fast speeds. There were no differences between the DLB and AD patient groups for any of the measured gait variables. Velocity and stride length values were significantly reduced in both patient groups compared to the control group at all speeds and percentage of time spent in double limb support was significantly increased in both patient groups compared to the control group at all walking speeds. Significant correlations were found between gait speeds and gait outcome variables. Spatiotemporal gait characteristics of people with AD and DLB are similar, but significantly different from the normal population.
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Affiliation(s)
- John R Merory
- Medical and Cognitive Research Unit, Neurology Department, Austin Health, Melbourne, Australia
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Burn DJ, Rowan EN, Allan LM, Molloy S, O'Brien JT, McKeith IG. Motor subtype and cognitive decline in Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies. J Neurol Neurosurg Psychiatry 2006; 77:585-9. [PMID: 16614017 PMCID: PMC2117449 DOI: 10.1136/jnnp.2005.081711] [Citation(s) in RCA: 273] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A previous cross sectional study found over-representation of a postural instability gait difficulty (PIGD) motor subtype in Parkinson's disease patients with dementia (PDD) and dementia with Lewy bodies (DLB), compared with Parkinson's disease (PD). AIMS (1) To examine rates of cognitive and motor decline over two years in PD (n=40), PDD (n=42) and DLB (n=41) subjects, compared with age matched controls (n=41), (2) to record whether motor phenotypes of PD, PDD, and DLB subjects changed during the study, (3) to find out if cognitive and motor decline in PD was associated with baseline motor subtype, and (4) to report the incidence of dementia in PD patients in relation to baseline motor subtype. RESULTS Most of PDD and DLB participants were PIGD subtype at baseline assessment. In the non-demented PD group, tremor dominant (TD) and PIGD subtypes were more evenly represented. Cognitive decline over two years was greater in PDD and DLB groups (mean decline in MMSE -4.5 and -3.9, respectively), compared with PD (-0.2) and controls (-0.3). There was an association between PIGD subtype and increased rate of cognitive decline within the PD group. Of 40 PD patients, 25% of the 16 PIGD subtype developed dementia over two years, compared with none of the 18 TD or six indeterminate phenotype cases (chi2=6.7, Fisher's exact test p<0.05). CONCLUSION A PIGD motor subtype is associated with a faster rate of cognitive decline in PD and may be considered a risk factor for incident dementia in PD.
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Affiliation(s)
- D J Burn
- Institute for Ageing and Health, University of Newcastle, Newcastle upon Tyne, NE4 6BE, UK.
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Abstract
Dementia with Lewy bodies (DLB) presents to a range of specialists and involves a number of management challenges. The nosologic status of the disorder is controversial, especially its clinical overlap with Parkinson's disease-related dementia and its pathologic distinction from Alzheimer's disease. This article considers some of the controversies surrounding DLB with reference to recent literature. Emphasis is given to clinical topics, including the clinical phenomenology, differential diagnosis, and the treatment of core features of the disease.
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Affiliation(s)
- David J Burn
- Regional Neurosciences Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, NE4 6BE, United Kingdom.
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Aarsland D, Ballard CG, Halliday G. Are Parkinson's disease with dementia and dementia with Lewy bodies the same entity? J Geriatr Psychiatry Neurol 2004; 17:137-45. [PMID: 15312277 DOI: 10.1177/0891988704267470] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnosis of Parkinson's disease with dementia (PDD) or dementia with Lewy bodies (DLB) is based on an arbitary distinction between the time of onset of motor and cognitive symptoms. These syndromes share many neurobiological similarities, but there are also differences. Deposition of beta-amyloid protein is more marked and more closely related to cognitive impairment in DLB than PDD, possibly contributing to dementia at onset. The relatively more severe executive impairment in DLB than PDD may relate to the loss of frontohippocampal projections in DLB. Visual hallucinations and delusions associate with more abundant Lewy body pathology in temporal cortex in DLB. The differential involvement of pathology in the striatum may account for the differences in parkinsonism. Longitudinal studies with neuropathological and neurochemical evaluations will be essential to enable more robust comparisons and determine pathological substrates contributing to the differences in cognitive, motor, and psychiatric symptoms.
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Affiliation(s)
- Dag Aarsland
- Psychiatric Clinic, Rogaland Central Hospital, PO Box 1163, Hillevaag, 4095 Stavanger, Norway.
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McKeith I, Mintzer J, Aarsland D, Burn D, Chiu H, Cohen-Mansfield J, Dickson D, Dubois B, Duda JE, Feldman H, Gauthier S, Halliday G, Lawlor B, Lippa C, Lopez OL, Carlos Machado J, O'Brien J, Playfer J, Reid W. Dementia with Lewy bodies. Lancet Neurol 2004; 3:19-28. [PMID: 14693108 DOI: 10.1016/s1474-4422(03)00619-7] [Citation(s) in RCA: 451] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dementia with Lewy bodies (DLB) is the second commonest cause of neurodegenerative dementia in older people. It is part of the range of clinical presentations that share a neuritic pathology based on abnormal aggregation of the synaptic protein alpha-synuclein. DLB has many of the clinical and pathological characteristics of the dementia that occurs during the course of Parkinson's disease. Here we review the current state of scientific knowledge on DLB. Accurate identification of patients is important because they have specific symptoms, impairments, and functional disabilities that differ from those of other common types of dementia. Severe neuroleptic sensitivity reactions are associated with significantly increased morbidity and mortality. Treatment with cholinesterase inhibitors is well tolerated by most patients and substantially improves cognitive and neuropsychiatric symptoms. Clear guidance on the management of DLB is urgently needed. Virtually unrecognised 20 years ago, DLB could within this decade be one of the most treatable neurodegenerative disorders of late life.
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Affiliation(s)
- Ian McKeith
- Institute for Ageing and Health, University of Newcastle, Newcastle upon Tyne, UK.
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Burn DJ, Rowan EN, Minett T, Sanders J, Myint P, Richardson J, Thomas A, Newby J, Reid J, O'Brien JT, McKeith IG. Extrapyramidal features in Parkinson's disease with and without dementia and dementia with Lewy bodies: A cross-sectional comparative study. Mov Disord 2003; 18:884-9. [PMID: 12889077 DOI: 10.1002/mds.10455] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Risk factors predicting an increased risk of dementia in Parkinson's disease (PD) are not fully established. The dementia associated with PD (PDD) closely resembles dementia with Lewy bodies (DLB). Based upon a high frequency of non-dopaminergic mediated clinical features in DLB, we predicted that a motor subtype comprising postural instability and balance problems would be more common in PDD. We examined extrapyramidal, cognitive, and affective features in 38 PD, 43 PDD, and 26 DLB patients in a cross-sectional study design. Motor subtype was subdivided into postural-instability gait difficulty (PIGD) or tremor (TD) dominant. The PIGD-subtype was more common in PDD (88% of cases) and DLB (69% of cases) groups compared with the PD group (38% of cases), in which TD and PIGD sub-types were more equally represented (P < 0.001). Although the mean depression scores overall were modest, PDD patients scored significantly higher than PD, but not DLB patients (Cornell; P = 0.006, and Geriatric Depression scale, GDS-15; P = 0.001), while within the PD group, those patients with a PIGD subtype had greater depression scores than the TD subtype (GDS-15; P < 0.05). We conclude that non-dopaminergic motor features are frequent in PDD. Neurodegeneration within the cholinergic system is likely to mediate many of these motor problems, as well as playing a significant role in determining the neuropsychiatric symptomatology of both PDD and DLB.
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Affiliation(s)
- David J Burn
- Department of Neurology, Regional Neurosciences Centre, Newcastle General Hospital, Newcastle upon Tyne, United Kingdom
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Colosimo C, Hughes AJ, Kilford L, Lees AJ. Lewy body cortical involvement may not always predict dementia in Parkinson's disease. J Neurol Neurosurg Psychiatry 2003; 74:852-6. [PMID: 12810766 PMCID: PMC1738521 DOI: 10.1136/jnnp.74.7.852] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The presence of Lewy bodies (LB) in the neocortex and limbic system in patients with Parkinson's disease (PD) is commonly thought to be linked with cognitive impairment. The authors present here a series of patients with diagnosis of PD in life and no significant cognitive impairment who, at necropsy, satisfied the current neuropathological criteria for dementia with Lewy bodies (DLB). METHODS Two hundred and seventy six brains with PD pathology were examined at the Queen Square Brain Bank in London between 1993 and 1999. The neuropathological diagnosis was PD, but 117 patients also had sufficient LB involvement above the brain stem to satisfy the current neuropathological criteria for DLB (50 patients had a neuropathological picture consistent with the limbic category of DLB and 67 with neocortical DLB). Forty eight cases were excluded who developed early cognitive impairment together with motor features of parkinsonism, 12 cases for lack of detailed clinical history, and 19 cases with coexistent features of advanced Alzheimer's disease changes. Thirty eight patients (13.8% of the total with PD pathology and 32.5 % of the total with DLB pathology) were found where there was no or very late cognitive impairment reported in the clinical records. RESULTS Selected cases were 24 men and 14 women, with a mean (SD) age at onset of parkinsonian symptoms of 60.1 (10.1) years and a mean disease duration of 15.3 (5.5) years. At some time during the evolution of the disease 21 patients developed different degrees of cognitive impairment (after a mean disease duration of 12.2 (4.8) years). Clinical diagnosis at death was PD in 10 cases and PD with dementia in 11. In the remaining 17 patients no history of cognitive impairment was ever recorded in life and all of them had a clinical diagnosis of PD at death; in this subgroup, nine patients later revealed a neuropathological picture consistent with limbic (or transitional) category of DLB and eight with neocortical DLB. Interestingly, in all these patients the parkinsonian features including the response to dopaminergic drugs were indistinguishable from classic brain stem PD. CONCLUSIONS The authors demonstrate that the classic pathology of DLB can commonly be seen outside the generally accepted clinical spectrum for DLB and that important factors other than the absolute number of LB in the neocortex and limbic system influence the development of cognitive impairment in PD. Furthermore, the pathology of PD may be indistinguishable from that reported in DLB, suggesting that the two clinicopathological syndromes may be attributable to the same biological abnormality.
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Affiliation(s)
- C Colosimo
- Queen Square Brain Bank for Neurological Disorders, Institute of Neurology, London, UK
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Abstract
Dementia with Lewy bodies (DLB) is increasingly recognized as a distinct clinical and pathologic entity. It is a progressive dementia characterized by persistent and well-formed visual hallucinations, marked second-to-second fluctuations in attention, and progressive extrapyramidal signs. The diagnostic value of additional clinical features such as delusions, depression, falls, anosmia, and rapid progression continues to be debated. Despite the growing acceptance of the diagnosis, DLB has not yet been included in either International Classification of Disease (ICD-10) or Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. However, the existing consensus diagnostic criteria continue to be validated. Most prospective studies to date indicate that their performance is acceptable, with specificity similar to the present diagnostic criteria for Alzheimer's disease. Nevertheless, at least one in five patients with DLB will continue to be misclassified.
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Affiliation(s)
- Zuzana Walker
- Royal Free and University College Medical School, University College London, London, England
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Abstract
Dementia occurs more commonly in individuals with Parkinson's disease (PD) than in the age-matched general population. Dementia in PD may result from a mixture of cortical and subcortical dementia syndromes caused by a variety of underlying pathologic processes and neurochemical deficits. A primary dementia syndrome has been described that shares several pathologic and clinical characteristics with PD. Dementia with Lewy bodies (DLB) accounts for 15% to 20% of all dementia syndromes in old age, which makes it second only to Alzheimer's disease in prevalence. The relationship between dementia in PD and DLB has not been fully resolved but may be considered useful in terms of neuropathologic substrate, clinical features, and response to treatment.
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Affiliation(s)
- I G McKeith
- Department of Old Age Psychiatry, Institute for the Health of the Elderly, Wolfson Research Center, Newcastle General Hospital, Newcastle upon Tyne, United Kingdom.
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