scholarly journals Challenges in Predicting Cognitive Decline in Dementia with Lewy Bodies

2021 ◽  
pp. 1-8
Author(s):  
Konstantinos Tsamakis ◽  
Christoph Mueller
Keyword(s):  
Cognitive Impairment ◽  
Clinical Practice ◽  
Cognitive Decline ◽  
Dementia With Lewy Bodies ◽  
Sleep Disturbances ◽  
Neuropsychiatric Symptoms ◽  
Lewy Bodies ◽  
Assessment Tools ◽  
Disease Course ◽  
The Impact

Despite being the second most common form of neurodegenerative dementia, dementia with Lewy bodies (DLB) is under-recognized and carries a worse prognosis than other subtypes of the condition. Cognitive impairment is a cardinal feature of all types of dementia and DLB presents with a distinct profile with deficits in attention, executive function, and visuoperceptual abilities. This difference from Alzheimer’s disease and the common presence of neuropsychiatric symptoms may lead to challenges in predicting cognitive decline in this patient population. Firstly, the diagnosis of DLB is often delayed in clinical practice leading to variability from which time point in the disease course cognitive decline is measured. Secondly, the most frequently used measurement tools for cognitive difficulties focus on memory and naming rather than the domains affected by DLB. While there is now largely a consensus which tools are useful in diagnosing DLB, their validity in assessing deteriorating cognition is less clear. Thirdly, the presence of fluctuating cognition, the propensity to develop delirium episodes, as well as difficulties in distinguishing the two entities in clinical practice make it difficult to predict the disease course. Sleep disturbances are likely to influence cognitive decline but require further study in patients within established DLB. Fourthly, as in most cases of dementia, neuropathological comorbidities are frequently present in DLB. While the influence of Alzheimer’s pathology on cognitive decline in DLB is comparatively well understood, the impact of other pathologies remains unclear. The recent definition of research criteria for mild cognitive impairment in DLB could facilitate earlier diagnosis and more structured follow-up. Assessment tools measuring cognitive domains predominantly affected in DLB need to be more consistently used in longitudinal studies and clinical practice, as well as concurrent measures of fluctuations in cognition. Greater availability of biomarkers and digital healthcare solutions can play an important role in enabling more accurate monitoring and prediction of cognitive decline in DLB.

scholarly journals Cognitive decline profiles differ in Parkinson disease dementia and dementia with Lewy bodies

Neurology ◽  
2020 ◽  
Vol 94 (20) ◽  
pp. e2076-e2087 ◽  
Author(s):  
Denis S. Smirnov ◽  
Douglas Galasko ◽  
Steven D. Edland ◽  
J. Vincent Filoteo ◽  
Lawrence A. Hansen ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cognitive Impairment ◽  
Parkinson Disease ◽  
Cognitive Decline ◽  
Outcome Measures ◽  
Dementia With Lewy Bodies ◽  
Lewy Bodies ◽  
Domain Specific ◽  
The Impact ◽  
Power Analyses

ObjectiveTo examine whether domain-specific patterns of cognitive impairment and trajectories of decline differed in patients with clinically diagnosed Parkinson disease dementia (PDD) (N = 29) and autopsy-confirmed dementia with Lewy bodies (DLB) (N = 58) or Alzheimer disease (AD) (N = 174) and to determine the impact of pooling patients with PDD and DLB in clinical trials targeting cognition.MethodsPatients were matched on demographics and level of global cognitive impairment. Patterns of cross-sectional performance and longitudinal decline were examined in 4 cognitive domains: Visuospatial, Memory, Executive, and Language. Power analyses were performed to determine the numbers of participants needed to adequately power a hypothetical clinical trial to slow cognitive decline in pure PDD, pure DLB, or a mixed PDD/DLB group.ResultsBoth DLB and PDD were more impaired and declined more rapidly than AD in the Visuospatial domain. Patients with PDD exhibited the most impairment and fastest decline in Executive, although patients with DLB also declined faster than AD. Memory was more impaired in AD than DLB and in both compared with PDD; however, all 3 groups declined at comparable rates. In contrast, PDD declined at a slower rate on Language measures than DLB or AD. Power analyses suggest that Visuospatial and Executive outcome measures would be most sensitive in PDD, but Memory and Language in DLB.ConclusionDLB and PDD differ from each other, and from AD, in a cognitive domain-specific manner. As such, different outcome measures may be most sensitive to detecting changes in DLB vs PDD, suggesting that the 2 should be analyzed separately in clinical trials.

scholarly journals The Impact of the COVID-19 Pandemic and Lockdown on Mild Cognitive Impairment, Alzheimer's Disease and Dementia With Lewy Bodies in China: A 1-Year Follow-Up Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhi-Chao Chen ◽  
Shuai Liu ◽  
Jinghuan Gan ◽  
Lingyun Ma ◽  
Xiaoshan Du ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Dementia With Lewy Bodies ◽  
Neuropsychiatric Symptoms ◽  
Lewy Bodies ◽  
Social Contact ◽  
The Impact

Background: While the lockdown strategies taken by many countries effectively limited the spread of COVID-19, those were thought to have a negative impact on older people. This study aimed to investigate the impact of lockdown on cognitive function and neuropsychiatric symptoms over a 1-year follow-up period in patients with mild cognitive impairment (MCI), Alzheimer's disease (AD) and dementia with Lewy bodies (DLB).Methods: We enrolled consecutive patients with MCI, probable AD or DLB who were receiving outpatient memory care before the COVID-19 pandemic and followed-up with them after 1 year by face-to-face during the COVID-19 pandemic to assess changes in physical activity, social contact, cognitive function and neuropsychiatric symptoms (NPS).Results: Total 105 probable AD, 50 MCI and 22 probable DLB patients were included and completed the 1-year follow-up between October 31 and November 30, 2020. Among the respondents, 42% of MCI, 54.3% of AD and 72.7% of DLB patients had a decline in MMSE scores and 54.4% of DLB patients had worsening Neuropsychiatric inventory (NPI) scores. Patients with DLB showed a more rapid decline of MMSE than those with AD. Diminished physical activity and social contact might have hastened the deterioration of cognition and the worsening of NPS.Conclusion: Social isolation and physical inactivity even after strict lockdown for at least 6 months were correlated with accelerated decline of cognitive function and NPS in patients with AD and DLB.

scholarly journals INFLUENCE OF SLEEP DISTURBANCES ON COGNITIVE DECLINE IN PATIENTS WITH PARKINSON’S DISEASE

2020 ◽  
Vol 117 (3) ◽  
pp. 58-67
Author(s):  
Anastasiia Shkodina ◽  
Kateryna Tarianyk ◽  
Dmytro Boiko
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Rating Scale ◽  
Early Stages ◽  
The Impact

The article summarizes the arguments and counter-arguments within the scientific discussion on the impact of sleep disorders on the development of cognitive decline in patients with Parkinson's disease. The main purpose of the study is to study the possibility of predicting the development of cognitive decline by assessing the severity of sleep disorders and their differences in the presence of cognitive impairment. Systematization of literature sources and approaches to solving the problem showed that sleep disorders develop in the early stages of Parkinson's disease and are often accompanied by cognitive impairment. Cognitive decline is manifested throughout Parkinson's disease and ranges from moderate in the early stages to dementia in the late stages. The relevance of the study of the relationship between sleep disorders and cognitive functions lies in the possibility of further improving the prediction of the development of cognitive decline in order to effectively correct it. Treatment of sleep disorders can be accompanied by improved memory and even morphological changes in the brain. Therefore, the question arises about the possibility of correcting cognitive decline by influencing sleep disorders. The methodology of the study included assessment of the overall status of patients on a unified scale of Parkinson's disease, Montreal cognitive rating scale and sleep scale in Parkinson's disease. The duration of the study was 8 months. Patients with Parkinson's disease were selected as the study. The article presents the results of a survey of patients who show that patients with Parkinson's disease and cognitive decline showed a predominance of motor disorders, sleep disorders and the overall score on the sleep scale in Parkinson's disease. In the presence of cognitive decline more pronounced disorders of motor functions in everyday life, which can lead to sleep disorders and its quality. The study empirically confirms and theoretically proves that the assessment of sleep disorders can be used to predict the risk of developing cognitive impairment in patients with Parkinson's disease. The results of this study may be useful for improving the early diagnosis and prevention of cognitive impairment in patients with Parkinson's disease, which, in turn, leads to improved quality of treatment of these patients. Such changes can directly affect the choice of therapeutic tactics and improve the quality of life of patients with Parkinson's disease. The question of the features of various sleep disorders and their prognostic value in relation to cognitive decline in patients with various forms of Parkinson's disease remains open.

scholarly journals Neuropsychiatric profiles and conversion to dementia in mild cognitive impairment, a latent class analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Natalia Roberto ◽  
Maria J. Portella ◽  
Marta Marquié ◽  
Montserrat Alegret ◽  
Isabel Hernández ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Dementia With Lewy Bodies ◽  
Latent Class ◽  
Neuropsychiatric Symptoms ◽  
Lewy Bodies ◽  
Memory Clinic ◽  
Risk Effect ◽  
Anxiety Depression

AbstractNeuropsychiatric symptoms (NPS) have been recently addressed as risk factors of conversion to Alzheimer’s disease (AD) and other dementia types in patients diagnosed with Mild Cognitive Impairment (MCI). Our aim was to determine profiles based on the prominent NPS in MCI patients and to explore the predictive value of these profiles on conversion to specific types of dementia. A total of 2137 MCI patients monitored in a memory clinic were included in the study. Four NPS profiles emerged (classes), which were defined by preeminent symptoms: Irritability, Apathy, Anxiety/Depression and Asymptomatic. Irritability and Apathy were predictors of conversion to dementia (HR = 1.43 and 1.56, respectively). Anxiety/depression class showed no risk effect of conversion when compared to Asymptomatic class. Irritability class appeared as the most discriminant neuropsychiatric condition to identify non-AD converters (i.e., frontotemporal dementia, vascular dementia, Parkinson’s disease and dementia with Lewy Bodies). The findings revealed that consistent subgroups of MCI patients could be identified among comorbid basal NPS. The preeminent NPS showed to behave differentially on conversion to dementia, beyond AD. Therefore, NPS should be used as early diagnosis facilitators, and should also guide clinicians to detect patients with different illness trajectories in the progression of MCI.

Informal caregiver experiences at the end-of-life of individuals living with dementia with Lewy bodies: An interview study

Dementia ◽  
2021 ◽  
pp. 147130122110384
Author(s):  
Melissa J Armstrong ◽  
Slande Alliance ◽  
Pamela Corsentino ◽  
Angela Lunde ◽  
Angela Taylor
Keyword(s):  
End Of Life ◽  
Dementia With Lewy Bodies ◽  
Life Experiences ◽  
Family Members ◽  
Lewy Bodies ◽  
Poor Sleep ◽  
Disease Course ◽  
Life Period ◽  
Caregiver Experiences ◽  
The Impact

Individuals with dementia with Lewy bodies (DLB) commonly die from dementia-related causes, but little is known regarding caregiver experiences during the end-of-life period in DLB. This reflects a critical knowledge gap given the high frequency of informal caregiving for individuals with dementia, high caregiver burden in DLB, and the fact that most individuals with DLB die from this disease. Investigators conducted telephone interviews with family members of individuals who died with DLB in the last 5 years. Investigators used a qualitative descriptive approach to analyze interview transcripts. Participants included 15 children, 13 spouses, and 2 other family members. Interviews averaged 31 min. Major themes included caregivers as the main drivers of care for individuals with DLB throughout the disease course and at the end of life, the impact of DLB features (e.g., fluctuations, hallucinations, and delusions) on end-of-life experiences, experiences relating to the caregiving role, death and post-death experiences, and supports employed by caregivers in the end-of-life period. End-of-life experiences for caregivers of individuals with DLB built on the accumulated burden of the disease course, where caregivers were often responsible for driving DLB care—from making the diagnosis to educating healthcare professionals and double-checking medical decisions. While some end-of-life experiences were consistent with those described in dementia palliative care more generally (e.g., financial stresses, poor sleep, being overwhelmed, and needing increased education and support), many DLB features specifically affected end-of-life caregiver experiences, such as the presence of delusions. Improving caregiver experiences at the end of life in DLB will require improved diagnosis and care for individuals with DLB throughout the disease course and also better strategies for treating behavioral symptoms. More research is needed regarding drivers of quality end-of-life experiences for individuals with DLB and their families and how drivers and strategies may differ between dementias.

Dementia with Lewy bodies

2020 ◽  
pp. 424-434
Author(s):  
Anto P. Rajkumar ◽  
Dag Aarsland
Keyword(s):  
Cognitive Impairment ◽  
Dementia With Lewy Bodies ◽  
Neuropsychiatric Symptoms ◽  
Clinical Manifestations ◽  
Lewy Bodies ◽  
Current Evidence ◽  
Future Research ◽  
Pharmacological Interventions ◽  
Neurodegenerative Dementia ◽  
History Of

Lewy bodies are eosinophilic spherical neuronal intracytoplasmic inclusions. Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia. Clinical manifestations of DLB include cognitive impairment, extra-pyramidal symptoms, neuropsychiatric symptoms, and autonomic dysfunction. Studies investigating the epidemiology, pathophysiology, clinical diagnosis, and management of DLB have been exponentially increasing over the past two decades. This chapter begins with a brief history of DLB and its epidemiology. It provides an overview of the pathology of DLB, focusing on its neuropathology, neuroimaging, molecular biology, and genetics. The clinical presentation, diagnosis, differential diagnoses, and clinical course of DLB are presented. This chapter summarizes the current evidence for the pharmacological and non-pharmacological interventions of cognitive, neuropsychiatric, and other symptoms of DLB. Future research directives are highlighted at the end of this chapter.

scholarly journals Agitation in Dementia: Real-World Impact and Burden on Patients and the Healthcare System

2021 ◽  
pp. 1-13
Author(s):  
Eddie Jones ◽  
Myrlene Sanon Aigbogun ◽  
James Pike ◽  
Mia Berry ◽  
Christy R. Houle ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Healthcare Costs ◽  
Sleep Disturbances ◽  
Neuropsychiatric Symptoms ◽  
Sensitivity Analyses ◽  
Psychotic Symptoms ◽  
Base Case ◽  
Psychiatric Ward ◽  
Regression Analyses ◽  
The Impact

Background: At least 90%of patients with dementia experience behavioral or neuropsychiatric symptoms including agitation, psychotic symptoms, apathy, depression, and sleep disturbances. Agitation has been reported to be experienced by 60%of patients with mild cognitive impairment and 76%of patients with Alzheimer’s disease. Objective: We aimed to assess the impact of agitation in patients with dementia on healthcare resource utilization (HCRU) and healthcare costs. Methods: This was a retrospective analysis of physician-reported patient data from a point-in-time survey. Patients included were aged≥50 years, with early cognitive impairment or dementia. Agitated and non-agitated patients were compared. Regression analyses assessed the relationship of agitation score (calculated from number/severity of agitation symptoms) with outcomes, with covariates including age and Mini-Mental State Examination score. Sensitivity analyses compared patients with 0 and≥2 agitation symptoms following propensity score matching on the base-case covariates. Results: Data were included for 1,349 patients (agitated, n = 693; non-agitated, n = 656). Based on regression analyses, agitation score was correlated with proportion of patients with professional caregivers (p <  0.01), institutionalized (p <  0.01), hospitalized in a psychiatric ward (p <  0.05), and receiving an antipsychotic/antidepressant (both p <  0.001); number of consultations with a healthcare professional (HCP), psychiatrist, or psycho-geriatrician; number and cost of hospitalizations (p <  0.01); cost of HCP consultations (p <  0.001); and total direct healthcare costs (p <  0.001). Sensitivity analyses generally supported the base-case analysis. Conclusion: Agitation in dementia is associated with increased HCRU and healthcare costs. Effective therapies are needed to address agitation in dementia, with the potential to alleviate patient impact, HCRU, and healthcare costs.

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