Prodromal Dementia With Lewy Bodies: Evolution of Symptoms and Predictors of Dementia Onset

2021 ◽  
pp. 089198872110235
Author(s):  
Kathryn A. Wyman-Chick ◽  
Lauren R. O’Keefe ◽  
Daniel Weintraub ◽  
Melissa J. Armstrong ◽  
Michael Rosenbloom ◽  
...  
Keyword(s):  
Clinical Features ◽  
Dementia With Lewy Bodies ◽  
Clinical Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Lewy Bodies ◽  
Rem Sleep Behavior Disorder ◽  
Data Set ◽  
Wide Range ◽  
Prodromal Dementia ◽  
Dementia Onset

Background: Research criteria for prodromal dementia with Lewy bodies (DLB) were published in 2020, but little is known regarding prodromal DLB in clinical settings. Methods: We identified non-demented participants without neurodegenerative disease from the National Alzheimer’s Coordinating Center Uniform Data Set who converted to DLB at a subsequent visit. Prevalence of neuropsychiatric and motor symptoms were examined up to 5 years prior to DLB diagnosis. Results: The sample included 116 participants clinically diagnosed with DLB and 348 age and sex-matched (1:3) Healthy Controls. Motor slowing was present in approximately 70% of participants 3 years prior to DLB diagnosis. In the prodromal phase, 50% of DLB participants demonstrated gait disorder, 70% had rigidity, 20% endorsed visual hallucinations, and over 50% of participants endorsed REM sleep behavior disorder. Apathy, depression, and anxiety were common prodromal neuropsychiatric symptoms. The presence of 1+ core clinical features of DLB in combination with apathy, depression, or anxiety resulted in the greatest AUC (0.815; 95% CI: 0.767, 0.865) for distinguishing HC from prodromal DLB 1 year prior to diagnosis. The presence of 2+ core clinical features was also accurate in differentiating between groups (AUC = 0.806; 95% CI: 0.756, 0.855). Conclusion: A wide range of motor, neuropsychiatric and other core clinical symptoms are common in prodromal DLB. A combination of core clinical features, neuropsychiatric symptoms and cognitive impairment can accurately differentiate DLB from normal aging prior to dementia onset.

scholarly journals β-Amyloid and tau biomarkers and clinical phenotype in dementia with Lewy bodies

Neurology ◽  
2020 ◽  
Vol 95 (24) ◽  
pp. e3257-e3268 ◽  
Author(s):  
Daniel Ferreira ◽  
Scott A. Przybelski ◽  
Timothy G. Lesnick ◽  
Afina W. Lemstra ◽  
Elisabet Londos ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Clinical Features ◽  
Dementia With Lewy Bodies ◽  
Clinical Phenotype ◽  
Lewy Bodies ◽  
Rem Sleep Behavior Disorder ◽  
Tau Pathology ◽  
Sleep Behavior ◽  
Amyloid A ◽  
Β Amyloid

ObjectiveIn a multicenter cohort of probable dementia with Lewy bodies (DLB), we tested the hypothesis that β-amyloid and tau biomarker positivity increases with age, which is modified by APOE genotype and sex, and that there are isolated and synergistic associations with the clinical phenotype.MethodsWe included 417 patients with DLB (age 45–93 years, 31% women). Positivity on β-amyloid (A+) and tau (T+) biomarkers was determined by CSF β-amyloid1-42 and phosphorylated tau in the European cohort and by Pittsburgh compound B and AV-1451 PET in the Mayo Clinic cohort. Patients were stratified into 4 groups: A−T−, A+T−, A−T+, and A+T+.ResultsA−T− was the largest group (39%), followed by A+T− (32%), A+T+ (15%), and A−T+ (13%). The percentage of A−T− decreased with age, and A+ and T+ increased with age in both women and men. A+ increased more in APOE ε4 carriers with age than in noncarriers. A+ was the main predictor of lower cognitive performance when considered together with T+. T+ was associated with a lower frequency of parkinsonism and probable REM sleep behavior disorder. There were no significant interactions between A+ and T+ in relation to the clinical phenotype.ConclusionsAlzheimer disease pathologic changes are common in DLB and are associated with the clinical phenotype. β-Amyloid is associated with cognitive impairment, and tau pathology is associated with lower frequency of clinical features of DLB. These findings have important implications for diagnosis, prognosis, and disease monitoring, as well as for clinical trials targeting disease-specific proteins in DLB.Classification of evidenceThis study provides Class II evidence that in patients with probable DLB, β-amyloid is associated with lower cognitive performance and tau pathology is associated with lower frequency of clinical features of DLB.

scholarly journals Diagnosis of Dementia with Lewy Bodies: Fluctuations, Biomarkers, and beyond

2021 ◽  
Author(s):  
John M. Olichney ◽  
Wentao Li ◽  
Yasmine Gharbaoui ◽  
Alison P. Kwok ◽  
Jade E. Jenkins
Keyword(s):  
Dementia With Lewy Bodies ◽  
Lewy Bodies ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Sleep Behavior ◽  
Difficult Condition ◽  
Clinical Presentations ◽  
Wide Range ◽  
Diagnosis Of Dementia ◽  
Disease Subtypes

Dementia with Lewy bodies (DLB), the second most common cause of dementia, remains a difficult condition to accurately diagnose and manage. Variable involvement of motor and cognitive functions, plus psychiatric and behavioral symptoms, contributes to the difficulty in managing DLB. Additionally, DLB can cause severe sleep disruption through REM sleep behavior disorder, autonomic symptoms, disruptions of olfaction/taste and mood, hallucinations, and more. In this chapter, advances and remaining challenges in the diagnosis of DLB are discussed, including a review of the current consensus criteria for DLB. The spectrum of disorders with Lewy bodies (LBs) are described including their wide-range of clinical presentations and overlap with Alzheimer’s disease (AD) and Parkinson’s disease with and without dementia. Particular consideration is given to advancements in quantification of cognitive fluctuations through improved clinical instruments, EEG, and other advanced biomarkers. Detection of DLB has improved, but establishing the “primary” pathology in cases with concomitant LB andd AD remains difficult. Likelihood of a clinical DLB syndrome is thought to be a function of distribution of LBs and severity of AD-type pathology. Further work is needed to better understand LB disease subtypes and the underlying pathophysiological mechanisms to allow for more targeted and comprehensive therapies.

scholarly journals Delusional parasitosis in dementia with Lewy bodies: a case report

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Sho Ochiai ◽  
Hiroko Sugawara ◽  
Yusuke Kajio ◽  
Hibiki Tanaka ◽  
Tomohisa Ishikawa ◽  
...  
Keyword(s):  
Dementia With Lewy Bodies ◽  
Neuropsychiatric Symptoms ◽  
Lewy Bodies ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Sleep Behavior ◽  
Case Presentation ◽  
Delusional Parasitosis ◽  
Oral Cenesthopathy ◽  
Underlying Pathophysiology

Abstract Background Dementia with Lewy bodies (DLB) is characterized by fluctuating cognitive impairments, recurrent visual hallucinations, the motor symptoms of parkinsonism and REM sleep behavior disorder. Various neuropsychiatric symptoms including hallucination and delusions occur frequently; however, delusional parasitosis is rare in DLB. Here, we report a case of DLB patient with delusional parasitosis. Case presentation The patient was an 89-year-old woman. At the age of 88, she began to complain her oral cenesthopathy, and developed cognitive decline, delusional parasitosis and parkinsonism. As a result of examination, she was diagnosed as DLB and treated with combination of donepezil 5 mg/day and aripiprazole 1.5 mg/day, and her complaint was disappeared. Conclusions Further studies are needed to investigate the association between delusional parasitosis and underlying pathophysiology of DLB, and the utility of antipsychotics for delusional parasitosis in DLB has to be examined through more cases.

scholarly journals Hallucinations Are Real to Patients With Dementia

2017 ◽  
Vol 3 ◽  
pp. 233372141772110 ◽  
Author(s):  
R. C. Hamdy ◽  
A. Kinser ◽  
J. V. Lewis ◽  
R. Copeland ◽  
A. Depelteau ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Clinical Features ◽  
Dementia With Lewy Bodies ◽  
Stress Disorder ◽  
Lewy Bodies ◽  
Attention Span ◽  
Short Attention Span

In this case study, we present a patient with preexistent posttraumatic stress disorder and psychosis who has been recently diagnosed with Dementia with Lewy Bodies. He is experiencing vivid hallucinations. What went wrong between him and his wife as a result of these hallucinations is presented. Alternative actions that could have been used are suggested. Objectives At the end of this case study, readers will know the following: The characteristic clinical features of Dementia with Lewy Bodies (DLB). Patients experiencing hallucinations should not be contradicted, to them, these hallucinations are real. Easy distractibility and short attention span can be exploited to avert or defuse potentially catastrophic situations. Patients with dementia should not have access to loaded guns.

Severe Brain Metabolic Decreases Associated with REM Sleep Behavior Disorder in Dementia with Lewy Bodies

2016 ◽  
Vol 52 (3) ◽  
pp. 989-997 ◽  
Author(s):  
Leonardo Iaccarino ◽  
Sara Marelli ◽  
Sandro Iannaccone ◽  
Giuseppe Magnani ◽  
Luigi Ferini-Strambi ◽  
...  
Keyword(s):  
Rem Sleep ◽  
Dementia With Lewy Bodies ◽  
Lewy Bodies ◽  
Rem Sleep Behavior Disorder ◽  
Behavior Disorder ◽  
Sleep Behavior

Ultrabrief Right Unilateral Electroconvulsive Therapy for the Treatment of the Neuropsychiatric Symptoms of Dementia with Lewy Bodies

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Adriana P. Hermida ◽  
Evelina Sterina ◽  
P. Parker Schwab ◽  
Cody Michael Browning ◽  
Hannah M. Chapman ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Dementia With Lewy Bodies ◽  
Neuropsychiatric Symptoms ◽  
Lewy Bodies
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