Research criteria for the diagnosis of prodromal dementia with Lewy bodies

The prodromal phase of dementia with Lewy bodies (DLB) includes (1) mild cognitive impairment (MCI), (2) delirium-onset, and (3) psychiatric-onset presentations. The purpose of our review is to determine whether there is sufficient information yet available to justify development of diagnostic criteria for each of these. Our goal is to achieve evidence-based recommendations for the recognition of DLB at a predementia, symptomatic stage. We propose operationalized diagnostic criteria for probable and possible mild cognitive impairment with Lewy bodies, which are intended for use in research settings pending validation for use in clinical practice. They are compatible with current criteria for other prodromal neurodegenerative disorders including Alzheimer and Parkinson disease. Although there is still insufficient evidence to propose formal criteria for delirium-onset and psychiatric-onset presentations of DLB, we feel that it is important to characterize them, raising the index of diagnostic suspicion and prioritizing them for further investigation.

Download Full-text

Magnetic Resonance Imaging in Stable Mild Cognitive Impairment, Prodromal Alzheimer’s Disease, and Prodromal Dementia with Lewy Bodies

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000510951 ◽

2020 ◽

pp. 1-6

Author(s):

Tahreem Ghazal Siddiqui ◽

Timothy Whitfield ◽

Sudhakar Janaki Praharaju ◽

Dilman Sadiq ◽

Hiba Kazmi ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Mri Scans ◽

Prodromal Alzheimer’S Disease ◽

Prodromal Dementia

Introduction: Fifteen percent of people with mild cognitive impairment (MCI) will progress to dementia within 2 years. There is increasing focus on the evaluation of biomarkers which point towards the underlying pathology. This enables better prediction of clinical outcomes. Early diagnosis of the dementia subtype is crucial for appropriate management and accurate prognosis. The aim of this study was to compare MRI measures in stable mild cognitive impairment patients (stable-MCI), prodromal Alzheimer’s disease (pro-AD), and prodromal dementia with Lewy bodies (pro-DLB). Methods: Out of 1,814 patients assessed in Essex memory clinic between 2002 and 2017, 424 had MCI at baseline with follow-up data. All patients underwent comprehensive clinical and cognitive assessment at each assessment. MRI scans were acquired at patients’ baseline assessment, corresponding to the time of initial MCI clinical diagnosis. Patients were grouped according to their diagnosis at the end of follow-up. All baseline scans were visually rated according to established rating scales for medial temporal atrophy (MTA), global cortical atrophy (GCA), and white matter lesions (WMLs). Results: MRI scans were available for 28 pro-DLB patients and were matched against 27 pro-AD and 28 stable-MCI patients for age, sex, and education. The mean follow-up duration was 34 months for the pro-AD group, 27 months for the pro-DLB group, and 21 months for the stable-MCI group. MTA scores were significantly greater in pro-AD patients compared to pro-DLB (p = 0.047) and stable-MCI patients (p = 0.012). There was no difference on GCA or WMLs between pro-AD, pro-DLB, and stable-MCI. Conclusions: This study indicates that a simple visual rating of MTA at the stage of MCI already differs at a group level between patients that progress to AD, DLB, or continue to be stable-MCI. This could aid clinicians to differentiate between MCI patients who are likely to develop AD, versus those who might progress to DLB or remain stable.

Download Full-text

Dementia

10.1093/med/9780199664368.003.0011 ◽

2016 ◽

Author(s):

Sathiji Nageshwaran ◽

Heather C Wilson ◽

Anthony Dickenson ◽

David Ledingham

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Vascular Dementia ◽

Frontotemporal Dementia ◽

Clinical Features ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Evidence Based ◽

Mixed Dementia ◽

Pharmacological Management

This chapter discusses the clinical features and evidence-based pharmacological management of dementia disorders (Alzheimer’s disease (AD), vascular dementia, dementia with Lewy bodies (DLB), Parkinson’s disease dementia (PDD), frontotemporal dementia (FTD), mixed dementia, and mild cognitive impairment (MCI)).

Download Full-text

Characterization of dementia with Lewy bodies (DLB) and mild cognitive impairment using the Lewy body dementia module (LBD‐MOD)

Alzheimer s & Dementia ◽

10.1002/alz.12334 ◽

2021 ◽

Author(s):

James E. Galvin ◽

Stephanie Chrisphonte ◽

Iris Cohen ◽

Keri K. Greenfield ◽

Michael J. Kleiman ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Lewy Body ◽

Dementia With Lewy Bodies ◽

Lewy Bodies ◽

Lewy Body Dementia

Download Full-text

Mild cognitive impairment with Lewy bodies: neuropsychiatric supportive symptoms and cognitive profile

Psychological Medicine ◽

10.1017/s0033291720002901 ◽

2020 ◽

pp. 1-9

Author(s):

Paul C Donaghy ◽

Joanna Ciafone ◽

Rory Durcan ◽

Calum A Hamilton ◽

Sally Barker ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Diagnostic Criteria ◽

Likelihood Ratio ◽

Neuropsychiatric Symptoms ◽

Lewy Bodies ◽

Cognitive Profile ◽

Anxiety And Depression ◽

Delayed Recall ◽

Independent Cohort

Abstract Background Recently published diagnostic criteria for mild cognitive impairment with Lewy bodies (MCI-LB) include five neuropsychiatric supportive features (non-visual hallucinations, systematised delusions, apathy, anxiety and depression). We have previously demonstrated that the presence of two or more of these symptoms differentiates MCI-LB from MCI due to Alzheimer's disease (MCI-AD) with a likelihood ratio >4. The aim of this study was to replicate the findings in an independent cohort. Methods Participants ⩾60 years old with MCI were recruited. Each participant had a detailed clinical, cognitive and imaging assessment including FP-CIT SPECT and cardiac MIBG. The presence of neuropsychiatric supportive symptoms was determined using the Neuropsychiatric Inventory (NPI). Participants were classified as MCI-AD, possible MCI-LB and probable MCI-LB based on current diagnostic criteria. Participants with possible MCI-LB were excluded from further analysis. Results Probable MCI-LB (n = 28) had higher NPI total and distress scores than MCI-AD (n = 30). In total, 59% of MCI-LB had two or more neuropsychiatric supportive symptoms compared with 9% of MCI-AD (likelihood ratio 6.5, p < 0.001). MCI-LB participants also had a significantly greater delayed recall and a lower Trails A:Trails B ratio than MCI-AD. Conclusions MCI-LB is associated with significantly greater neuropsychiatric symptoms than MCI-AD. The presence of two or more neuropsychiatric supportive symptoms as defined by MCI-LB diagnostic criteria is highly specific and moderately sensitive for a diagnosis of MCI-LB. The cognitive profile of MCI-LB differs from MCI-AD, with greater executive and lesser memory impairment, but these differences are not sufficient to differentiate MCI-LB from MCI-AD.

Download Full-text

The Cingulate Island Sign on FDG‐PET vs. IMP‐SPECT to Assess Mild Cognitive Impairment in Alzheimer's Disease vs. Dementia with Lewy Bodies

Journal of Neuroimaging ◽

10.1111/jon.12643 ◽

2019 ◽

Vol 29 (6) ◽

pp. 712-720 ◽

Cited By ~ 5

Author(s):

Yuhei Chiba ◽

Hiroshige Fujishiro ◽

Eizo Iseki ◽

Koji Kasanuki ◽

Kiyoshi Sato

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Fdg Pet ◽

Dementia With Lewy Bodies ◽

Lewy Bodies

Download Full-text

Clinical and Cognitive Phenotype of Mild Cognitive Impairment Evolving to Dementia with Lewy Bodies

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000441184 ◽

2015 ◽

Vol 5 (3) ◽

pp. 442-449 ◽

Cited By ~ 18

Author(s):

Annachiara Cagnin ◽

Cinzia Bussè ◽

Simona Gardini ◽

Nela Jelcic ◽

Caterina Guzzo ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Visual Attention ◽

Dementia With Lewy Bodies ◽

Rating Scale ◽

Lewy Bodies ◽

Object Perception ◽

Visual Object ◽

Visual Stream ◽

Extrapyramidal Signs

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.

Download Full-text

A Précis of Recent Advances in the Neuropsychology of Mild Cognitive Impairment(s) in Parkinson's Disease and a Proposal of Preliminary Research Criteria

Journal of the International Neuropsychological Society ◽

10.1017/s1355617711000257 ◽

2011 ◽

Vol 17 (3) ◽

pp. 393-406 ◽

Cited By ~ 33

Author(s):

Alexander I. Tröster

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Diagnostic Criteria ◽

Executive Dysfunction ◽

Cognitive Change ◽

Cognitive Changes ◽

Preliminary Research ◽

Research Criteria

AbstractCognitive changes of Parkinson's disease (PD) manifest earlier and are more heterogeneous than previously appreciated. Approximately one-third of patients have at least mild cognitive changes at PD diagnosis, and subtle changes might be appreciable among those at risk for PD. Executive dysfunction is the most common cognitive change, but other phenotypes exist. Pathobiologic and potential prognostic differences among cognitive phenotypes remain poorly understood. Progress in the neuropsychology, epidemiology and pathobiology of mild cognitive impairment (MCI) in PD is hampered by lack of diagnostic criteria. This study proposes preliminary research criteria for two categories of PD non-dementia cognitive impairment. (JINS, 2011,17, 393–406)

Download Full-text