Classification of Psychotic Symptoms in Dementia With Lewy Bodies

Background: Many cases of dementia with Lewy bodies (DLB) present with various psychotic features, including hallucinations, depression, catatonia, and delusions before the onset of cognitive impairment. However, the characteristic features of these psychotic symptoms in prodromal DLB have not been sufficiently described. Objective: To clarify and describe the psychotic features of prodromal DLB before overt cognitive impairment. Methods: The authors analyzed the characteristic psychotic features of prodromal DLB in 21 subjects who developed severe psychotic symptoms without dementia and were diagnosed as DLB after the longitudinal observation period. They were then confirmed to have DLB through indicative and supportive biomarkers of scintigraphy. Results: The psychotic features included a wide variety of symptoms, but convergent to three principal categories: catatonia, delusions-hallucinations, and depression and/or mania. Catatonia was observed in nine cases, five were delusional-hallucinatory, and seven were manic and/or depressive. Seven of the 21 cases exhibited delirium during longitudinal observation. A psychotic state repeatedly appeared without any trigger in 20 of the 21 patients. All subjects developed cognitive impairment at 9.1±4.6 (mean±SD) years after the initial appearance of psychotic symptoms, and subsequently diagnosed with DLB at 71.3±6.1 (mean±SD) years. Conclusion: Elderly patients with psychotic symptoms, such as catatonia, delusion-hallucination, manic and/or depressive features, and delirium without dementia, could indicate symptomatic psychosis or a prodromal stage of any neurocognitive disorder such as DLB. Therefore, further extensive workout (e.g., radioisotope neuroimaging) is required to avoid misdiagnosis.

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Focal atrophy on MRI and neuropathologic classification of dementia with Lewy bodies

Neurology ◽

10.1212/wnl.0b013e31826357a5 ◽

2012 ◽

Vol 79 (6) ◽

pp. 553-560 ◽

Cited By ~ 48

Author(s):

K. Kantarci ◽

T. J. Ferman ◽

B. F. Boeve ◽

S. D. Weigand ◽

S. Przybelski ◽

...

Keyword(s):

Dementia With Lewy Bodies ◽

Lewy Bodies

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Aripiprazole for the treatment of psychotic symptoms in patients with dementia with Lewy bodies: a case series

Neuropsychiatric Disease and Treatment ◽

10.2147/ndt.s189050 ◽

2019 ◽

Vol Volume 15 ◽

pp. 543-547 ◽

Cited By ~ 2

Author(s):

Yuka Sugawara Kikuchi ◽

Tetsuo Shimizu

Keyword(s):

Dementia With Lewy Bodies ◽

Case Series ◽

Lewy Bodies ◽

Psychotic Symptoms

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Aripiprazole is effective for the improvement of psychotic symptoms in patients with dementia with lewy bodies

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2008 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S543-S543

Author(s):

Y. Kikuchi ◽

T. Kanbayashi ◽

T. Shimizu

Keyword(s):

Dementia With Lewy Bodies ◽

Rating Scale ◽

Clinical Status ◽

Lewy Bodies ◽

Study Endpoint ◽

Psychotic Symptoms ◽

Clinical Dementia Rating ◽

The Mean ◽

Competing Interest ◽

Psychiatric Rating Scale

ObjectiveDementia with lewy bodies (DLB) is commonly considered the second most common form of dementia. The purpose of this study is to investigate the treatment effects of aripiprazole in patients with DLB.MethodsEleven patients who had meet the criteria for DLB participated in this study. The presence of psychotic symptoms was confirmed by scores of either the delusions or hallucinations items of the Neuropsychiatric Inventory (NPI) score. Patients who had 25 or more on the Mini-mental State Examination Scale (MMSE) at the entry or having brain damage were excluded. Aripiprazole was initiated at a low dose (3 or 6 mg/day) and titrated to higher doses at 2-weeks intervals or more rapidly based on investigator's judgment. Previous medications prior to aripiprazole administration were not changed through this trial. Patient's clinical status was assessed at baseline, then 2 weeks during the study by using NPI, Clinical Global Impression (CGI) and Brief Psychiatric Rating Scale (BPRS) to measure psychotic behavioral symptoms, and Simpson-Angus Scale (SAS) to measure parkinsonism symptoms. Clinical Dementia Rating (CDR) and MMSE were carried out at screening and end point to evaluate cognitive function.ResultsThe mean scores of the SAS and CDR were significantly decreased at the study endpoint compared to baseline. The mean scores of the NPI and BPRS improved up until 4 weeks after having started aripiprazole. After 4 weeks, improvements slowed. The mean score of the CGI-S was decreased up until 8 weeks.ConclusionThis study shows that aripiprazole may be effective for the treatment of psychotic symptoms in patients with DLB.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Utility of neuropsychiatric tools in the differential diagnosis of dementia with Lewy bodies and Alzheimer's disease: quantitative and qualitative findings

International Psychogeriatrics ◽

10.1017/s1041610213002068 ◽

2013 ◽

Vol 26 (3) ◽

pp. 453-461 ◽

Cited By ~ 13

Author(s):

Aida Suárez-González ◽

Alberto Serrano-Pozo ◽

Eva M. Arroyo-Anlló ◽

Emilio Franco-Macías ◽

Juan Polo ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Differential Diagnosis ◽

Dementia With Lewy Bodies ◽

Functional Decline ◽

Lewy Bodies ◽

Psychotic Symptoms ◽

Columbia University ◽

Memory Clinic ◽

Neuropsychiatric Manifestations

ABSTRACTBackground:Discerning dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) is one of the most common and challenging differential diagnoses at the memory clinic. Although the neuropsychiatric manifestations have been widely reported as one of the main key points in the differential diagnosis between these two diseases, to date no neuropsychiatric questionnaire has been specifically devised for this purpose.Methods:We administered the Neuropsychiatric Inventory (NPI) and the Columbia University Scale for Psychopathology in Alzheimer's Disease (CUSPAD) to a memory clinic sample of 80 patients with probable DLB and 85 age- and severity-matched patients with probable AD. Diagnosis of probable DLB was supported with a positive dopamine transporter SPECT scan. We examined the usefulness of these two neuropsychiatric tools designed for AD in the differential diagnosis between DLB and AD. We also investigated the correlations between psychotic symptoms and measures of cognitive and functional decline.Results:Auditory hallucinations were very specific of DLB and were usually preceded by visual hallucinations. Misinterpretation of real visual stimuli (illusions) was more frequent in DLB. Delusions were both quantitatively and qualitatively different between DLB and AD: delusional misidentifications were significantly more characteristic of DLB, while paranoid delusions did not show specificity for DLB.Conclusions:Neuropsychiatric tools are useful to discriminate DLB from AD. Hallucinations and delusions are not only more frequent in DLB than in AD but also have distinct qualitative characteristics and patterns of progression that can help clinicians to make a more accurate differential diagnosis.

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