Your browser doesn't support javascript.
loading
: 20 | 50 | 100
1 - 20 de 295
1.
J Alzheimers Dis ; 99(1): 101-103, 2024.
Article En | MEDLINE | ID: mdl-38669552

The following commentary discusses a review by Cressot et al. entitled: 'Psychosis in Neurodegenerative Dementias: A Systematic Comparative Review'. The authors describe the epidemiology and phenomenology of psychosis across neurodegenerative dementias. Dementia with Lewy bodies had the highest reported prevalence of psychosis at 74% followed by Alzheimer's disease, 54% and frontotemporal degeneration, 42%. Detailed characterization of psychosis shows differences in the types of hallucinations and delusions by dementia type. These findings suggest that different types of dementia related pathology are associated with high rates of psychosis with more specific symptom profiles than previously appreciated. Understanding the differences and variety of psychotic experiences across dementia types may have diagnostic and therapeutic implications for treating hallucinations and delusions in populations suffering from neurodegenerative diseases.


Dementia , Neurodegenerative Diseases , Psychotic Disorders , Humans , Psychotic Disorders/epidemiology , Psychotic Disorders/psychology , Psychotic Disorders/complications , Neurodegenerative Diseases/epidemiology , Neurodegenerative Diseases/complications , Neurodegenerative Diseases/psychology , Dementia/epidemiology , Dementia/psychology , Lewy Body Disease/complications , Lewy Body Disease/psychology , Lewy Body Disease/epidemiology , Delusions/epidemiology , Delusions/psychology , Delusions/etiology , Hallucinations/epidemiology , Hallucinations/etiology , Alzheimer Disease/epidemiology , Alzheimer Disease/psychology , Alzheimer Disease/complications , Neurobiology
2.
J Alzheimers Dis ; 99(1): 85-99, 2024.
Article En | MEDLINE | ID: mdl-38669539

Background: Psychosis, characterized by delusions and/or hallucinations, is frequently observed during the progression of Alzheimer's disease (AD) and other neurodegenerative dementias (ND) (i.e., dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD)) and cause diagnostic and management difficulties. Objective: This review aims at presenting a concise and up-to-date overview of psychotic symptoms that occur in patients with ND with a comparative approach. Methods: A systematic review was conducted following the PRISMA guidelines. 98 original studies investigating psychosis phenotypes in neurodegenerative dementias were identified (40 cohort studies, 57 case reports). Results: Psychosis is a frequently observed phenomenon during the course of ND, with reported prevalence ranging from 22.5% to 54.1% in AD, 55.9% to 73.9% in DLB, and 18% to 42% in FTD. Throughout all stages of these diseases, noticeable patterns emerge depending on their underlying causes. Misidentification delusions (16.6-78.3%) and visual hallucinations (50-69.6%) are frequently observed in DLB, while paranoid ideas and somatic preoccupations seem to be particularly common in AD and FTD, (respectively 9.1-60.3% and 3.10-41.5%). Limited data were found regarding psychosis in the early stages of these disorders. Conclusions: Literature data suggest that different ND are associated with noticeable variations in psychotic phenotypes, reflecting disease-specific tendencies. Further studies focusing on the early stages of these disorders are necessary to enhance our understanding of early psychotic manifestations associated with ND and help in differential diagnosis issues.


Psychotic Disorders , Humans , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Neurodegenerative Diseases/epidemiology , Neurodegenerative Diseases/complications , Neurodegenerative Diseases/psychology , Neurodegenerative Diseases/diagnosis , Lewy Body Disease/diagnosis , Lewy Body Disease/complications , Lewy Body Disease/psychology , Lewy Body Disease/epidemiology , Frontotemporal Dementia/diagnosis , Frontotemporal Dementia/epidemiology , Alzheimer Disease/diagnosis , Alzheimer Disease/epidemiology , Alzheimer Disease/psychology , Alzheimer Disease/complications , Delusions/diagnosis , Delusions/epidemiology , Delusions/etiology , Dementia/epidemiology , Dementia/diagnosis
3.
Parkinsonism Relat Disord ; 122: 106062, 2024 May.
Article En | MEDLINE | ID: mdl-38452445

INTRODUCTION: Visual rating of the cingulate island sign (CIS) on [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) has a high specificity for dementia with Lewy bodies (DLB) in selected cohorts such as DLB versus Alzheimer's disease (AD). In a mixed memory clinical population this study aimed to uncover the prevalence of CIS, the diagnostic accuracy for DLB, and the relationship between CIS and disease severity. METHODS: CIS on [18F]FDG-PET was retrospectively assessed with the visual CIS rating scale (CISRs) in 1000 patients with a syndrome diagnosis of mild cognitive impairment (MCI) or dementia with no restrictions in etiological diagnosis. RESULTS: In this cohort 24.3 % had a CISRs score ≥1 and 3.5 % had a CISRs score = 4. The prevalence of a CISRs score ≥1 was highest in DLB (74.0 %, n = 57). A CISRs score ≥1 was present in at least 9 % in other diagnostic groups. The prevalence of CIS across disease severities showed no statistically significant difference (p = 0.23). To differentiate DLB from non-DLB the optimal cut-off was a CISRs score ≥1 (balanced accuracy = 77.1 %) in MCI/mild dementia and a CISRs score ≥2 (balanced accuracy = 80.6 %) in moderate/severe dementia. The positive predictive value of a CISRs score = 4 for DLB was 57.7 % in MCI/mild dementia and 33.3 % in moderate/severe dementia. CONCLUSION: The CISRs is useful in differentiating DLB from other etiologies in a mixed memory clinical population. Balanced accuracy and positive predictive value may vary across disease severities in the population studied.


Cognitive Dysfunction , Fluorodeoxyglucose F18 , Gyrus Cinguli , Lewy Body Disease , Positron-Emission Tomography , Humans , Male , Female , Aged , Lewy Body Disease/epidemiology , Lewy Body Disease/diagnostic imaging , Lewy Body Disease/diagnosis , Cognitive Dysfunction/diagnostic imaging , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/diagnosis , Prevalence , Retrospective Studies , Middle Aged , Gyrus Cinguli/diagnostic imaging , Aged, 80 and over , Cohort Studies , Sensitivity and Specificity
4.
Neurobiol Aging ; 134: 74-83, 2024 Feb.
Article En | MEDLINE | ID: mdl-38006706

Cerebral microbleeds (CMB) are often associated with vascular risk factors and/or cerebral amyloid angiopathy and are frequently identified in people with dementia. The present study therefore aimed to estimate the pooled prevalence and associations of CMB in Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), using meta-analytic methods. Sixty-five MRI studies were included after a systematic search on major electronic databases. We found that the prevalence of CMB was comparable across the three dementia subtypes (31-36%) and was highly influenced by the MRI techniques used. CMB in AD were associated with a history of hypertension and amyloid-ß burden. In contrast, CMB in DLB, despite being predominantly lobar, were associated with hypertension, but not amyloid-ß burden. These findings suggest that the underlying pathophysiology of CMB in DLB might differ from that of AD. There was substantially larger number of AD studies identified and more studies evaluating CMB in Lewy body dementias are warranted.


Alzheimer Disease , Dementia , Hypertension , Lewy Body Disease , Parkinson Disease , Humans , Alzheimer Disease/epidemiology , Alzheimer Disease/complications , Lewy Body Disease/complications , Lewy Body Disease/epidemiology , Dementia/epidemiology , Dementia/etiology , Parkinson Disease/complications , Parkinson Disease/epidemiology , Prevalence , Amyloid beta-Peptides , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/epidemiology , Cerebral Hemorrhage/complications , Hypertension/complications
5.
Clin Auton Res ; 33(4): 433-442, 2023 08.
Article En | MEDLINE | ID: mdl-37405543

PURPOSE: To explore the prevalence of undetected bradyarrhythmia in a cohort of people with dementia with Lewy bodies. METHODS: Thirty participants diagnosed with dementia with Lewy bodies were enrolled from three memory clinics in southern Sweden between May 2021 and November 2022. None had a history of high-grade atrioventricular block or sick sinus syndrome. Each participant underwent orthostatic testing, cardiac [123I]metaiodobenzylguanidine scintigraphy and 24-h ambulatory electrocardiographic monitoring. Concluding bradyarrhythmia diagnosis was obtained until the end of December 2022. RESULTS: Thirteen participants (46.4%) had bradycardia at rest during orthostatic testing and four had an average heart rate < 60 beats per minute during ambulatory electrocardiographic monitoring. Three participants (10.7%) received a diagnosis of sick sinus syndrome, of whom two received pacemaker implants to manage associated symptoms. None received a diagnosis of second- or third-degree atrioventricular block. CONCLUSION: This report showed a high prevalence of sick sinus syndrome in a clinical cohort of people with dementia with Lewy bodies. Further research on the causes and consequences of sick sinus syndrome in dementia with Lewy bodies is thus warranted.


Atrioventricular Block , Lewy Body Disease , Humans , Bradycardia/diagnosis , Bradycardia/epidemiology , Bradycardia/etiology , Atrioventricular Block/diagnosis , Atrioventricular Block/epidemiology , Atrioventricular Block/etiology , Sick Sinus Syndrome , Lewy Body Disease/complications , Lewy Body Disease/diagnosis , Lewy Body Disease/epidemiology , Prevalence
6.
Ann Neurol ; 94(2): 259-270, 2023 08.
Article En | MEDLINE | ID: mdl-37098633

OBJECTIVE: The purpose of this study was to simultaneously contrast prediagnostic clinical characteristics of individuals with a final diagnosis of dementia with Lewy Bodies (DLB), Parkinson's disease (PD), and Alzheimer's disease (AD) compared with controls without neurodegenerative disorders. METHODS: Using the longitudinal THIN database in the United Kingdom, we tested the association of each neurodegenerative disorder with a selected list of symptoms and broad families of treatments, and compared the associations between disorders to detect disease-specific effects. We replicated the main findings in the UK Biobank. RESULTS: We used data of 28,222 patients with PD, 20,214 with AD, 4,682 with DLB, and 20,214 healthy controls. All neurodegenerative disorders were significantly associated with the presence of multiple clinical characteristics before their diagnosis, including sleep disorders, falls, psychiatric symptoms, and autonomic dysfunctions. When comparing patients with DLB with patients with PD and patients with AD patients, falls, psychiatric symptoms, and autonomic dysfunction were all more strongly associated with DLB in the 5 years preceding the first neurodegenerative diagnosis. The use of statins was lower in patients who developed PD and higher in patients who developed DLB compared to patients with AD. In patients with PD, the use of statins was associated with the development of dementia in the 5 years following PD diagnosis. INTERPRETATION: Prediagnostic presentations of falls, psychiatric symptoms, and autonomic dysfunctions were more strongly associated with DLB than PD and AD. This study also suggests that although several associations with medications are similar in neurodegenerative disorders, statin usage is negatively associated with PD but positively with DLB and AD as well as development of dementia in PD. ANN NEUROL 2023;94:259-270.


Alzheimer Disease , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Lewy Body Disease , Parkinson Disease , Humans , Alzheimer Disease/diagnosis , Alzheimer Disease/complications , Parkinson Disease/complications , Parkinson Disease/diagnosis , Parkinson Disease/epidemiology , Lewy Body Disease/diagnosis , Lewy Body Disease/epidemiology , Lewy Body Disease/complications , Biological Specimen Banks , Primary Health Care
7.
Clin Auton Res ; 33(2): 133-141, 2023 04.
Article En | MEDLINE | ID: mdl-36862320

PURPOSE: Orthostatic hypotension (OH), one of the supportive clinical features in the diagnosis of dementia with Lewy bodies (DLB), is a significant problem in advanced age because of its severe negative consequences. The aim of this meta-analysis was to investigate the prevalence and risk of OH in patients with DLB. METHODS: The indexes and databases cited to identify relevant studies were PubMed, ScienceDirect, Cochrane, and Web of Science. The keywords for the search were "Lewy body dementia" and "autonomic dysfunction" or "dysautonomia" or "postural hypotension" or "orthostatic hypotension." English-language articles published from January 1990 to April 2022 were searched. The Newcastle-Ottawa scale was applied to evaluate the quality of the studies. Odds ratios (OR) and risk ratios (RR) were extracted with 95% confidence intervals (CI) and combined using the random effects model after logarithmic transformation. The prevalence in the patients with DLB was also combined using the random effects model. RESULTS: Eighteen studies (10 case controls and 8 case series) were included to evaluate the prevalence of OH in patients with DLB. Higher rates of OH were found to be associated with DLB (OR 7.71, 95% CI 4.42, 13.44; p < 0.001), and 50.8% of 662 patients had OH. CONCLUSION: DLB increased the risk of OH by 3.62- to 7.71-fold compared to healthy controls. Therefore, it will be useful to evaluate postural blood pressure changes in the follow-up and treatment of patients with DLB.


Hypotension, Orthostatic , Lewy Body Disease , Primary Dysautonomias , Humans , Lewy Body Disease/complications , Lewy Body Disease/epidemiology , Hypotension, Orthostatic/diagnosis , Hypotension, Orthostatic/epidemiology , Hypotension, Orthostatic/etiology , Prospective Studies , Primary Dysautonomias/complications
8.
Parkinsonism Relat Disord ; 107: 105244, 2023 02.
Article En | MEDLINE | ID: mdl-36630736

INTRODUCTION: Epidemiological studies show correlations between constipation and development of Parkinson's disease (PD); however, few studies have explored the association between constipation and dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), and multiple system atrophy (MSA). We sought to explore the lifelong association of constipation and PD, DLB, PDD, and MSA (α-Synucleinopathies), compared to age- and sex-matched controls. METHODS: Using the Rochester Epidemiology Project (REP), we established an incident cohort of clinically defined α-synucleinopathies. A movement-disorder specialist reviewed all medical charts to establish clinical diagnoses. RESULTS: We identified 453 incident cases of clinically diagnosed α-synucleinopathies and an identical number of age- and sex-matched controls in Olmsted County (MN), 1991-2010. There were 303 cases of PD; 80, DLB; 54, PDD; and 16, MSA. Approximately 50% of α-synucleinopathies of all types reported constipation, compared to 27% in controls. The earliest pre-motor onset constipation was in DLB (median, 3.76 years prior to α-synucleinopathies motor-symptom onset); latest onset post-motor constipation was in PD (median, 5.15 years after motor-symptom onset). PD also had the highest longstanding constipation rate (18.2%). All α-synucleinopathies had higher odds of constipation compared to controls, except for MSA (p = 0.09), likely due to a limited sample size. CONCLUSION: PD, DLB, and PDD had higher odds of constipation compared to controls; PD had the most widespread onset of lifelong constipation, both longstanding and pre- or post-motor onset symptoms. Our results indicate that constipation rates do not differ among α-synucleinopathies but do differ in terms of temporal onset compared to disease onset.


Constipation , Synucleinopathies , Humans , alpha-Synuclein/metabolism , Chronic Disease , Constipation/epidemiology , Constipation/etiology , Dementia/epidemiology , Lewy Body Disease/epidemiology , Minnesota/epidemiology , Multiple System Atrophy/diagnosis , Parkinson Disease/diagnosis , Parkinson Disease/epidemiology , Synucleinopathies/diagnosis , Synucleinopathies/epidemiology
9.
Ageing Res Rev ; 83: 101782, 2023 01.
Article En | MEDLINE | ID: mdl-36356799

This study aimed to systematically review and meta-analyse the prevalence of sleep disturbances in people with dementia and examine demographic predictors and whether overall prevalence has changed over time. We searched Embase, MEDLINE and PsycINFO for studies reporting the prevalence of sleep disturbances in people with dementia living at home. We meta-analysed the data and calculated the pooled prevalence of sleep disturbances in people with dementia overall and in dementia subtypes. We used meta-regressions to investigate the effects of study characteristics, publication dates and participant demographics. Eleven studies fulfilled the inclusion criteria. The pooled prevalence of any symptoms of sleep disturbance was 26 % (95 % confidence intervals, CI: 23-30 %; n = 2719) and of clinically significant sleep disturbance 19 % (13-25 %; n = 2753). The pooled prevalence of sleep disturbance symptoms was significantly lower among people with Alzheimer's disease (24 %; 16-33 %, n = 310) than Lewy body dementia (49 %; 37-61 %, n = 65). Meta-regression analysis did not find that publication year, participant's age, sex and study quality predicted prevalence. Sleep disturbances are common among people with dementia living in the community, especially in Lewy body dementia. There was no change in prevalence according to publication dates, suggesting treatment has not improved over time.


Dementia , Sleep Wake Disorders , Humans , Alzheimer Disease/epidemiology , Lewy Body Disease/epidemiology , Prevalence , Sleep Wake Disorders/epidemiology , Dementia/epidemiology , Male , Female , Independent Living
10.
Eur Geriatr Med ; 14(1): 19-27, 2023 02.
Article En | MEDLINE | ID: mdl-36512254

PURPOSE: Identifying the associated clinical conditions in patients with newly diagnosed dementia with Lewy bodies (DLB) may contribute to the disease management. This study aimed to examine the clinical features and coexisting geriatric syndromes of patients with newly diagnosed DLB. METHOD: This cross-sectional study included newly diagnosed DLB participants who were admitted to a tertiary geriatric outpatient clinic. Of the 857 patients with dementia, 116 DLB diagnoses were eligible for analysis. The core and supportive clinical features of DLB were recorded. Geriatric syndromes including polypharmacy, depression, insomnia, dependency, a history of delirium, falls, malnutrition, urinary incontinence, functional impairment, and living alone, were assessed and recorded at baseline. RESULTS: The mean age was 79.0 ± 6.9 years, and 50.9% of the participants were female. The majority (63.8%) had mild dementia, 31.9% had moderate, and 4.3% had severe disease. Cognitive fluctuations (78.4%), visual hallucinations (77.6%), and Parkinsonism (73.3%) were the most common clinical features. Functional impairment (59.5%) and urinary incontinence (59.5%) were the leading geriatric syndromes, followed by polypharmacy (56.9%), depressive symptoms (54.7%), falls (52.6%), insomnia (49.1%), malnutrition (24.3%), and delirium (6.0%). Women had more functional impairment and depressive symptoms than men. CONCLUSION: Although most patients had mild dementia, three-quarters of the DLB cohort had hallucinations, and nearly two-thirds were functionally impaired. The proportion of other serious health conditions also increased, indicating a high comorbidity and geriatric syndrome burden. Comprehensive geriatric assessment is strongly recommended for DLB patients from the time of diagnosis until death to reduce disability and comorbidities. THE CLINICAL TRIAL REGISTRATION NUMBER: NCT05052450.


Delirium , Dementia , Lewy Body Disease , Sleep Initiation and Maintenance Disorders , Urinary Incontinence , Male , Humans , Female , Aged , Aged, 80 and over , Lewy Body Disease/complications , Lewy Body Disease/diagnosis , Lewy Body Disease/epidemiology , Retrospective Studies , Turkey/epidemiology , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/complications , Cross-Sectional Studies , Syndrome , Dementia/diagnosis , Dementia/epidemiology , Hallucinations/epidemiology , Hallucinations/complications , Urinary Incontinence/epidemiology , Urinary Incontinence/complications , Delirium/diagnosis , Delirium/epidemiology
11.
Am J Geriatr Psychiatry ; 31(1): 33-43, 2023 01.
Article En | MEDLINE | ID: mdl-35970734

OBJECTIVE: Onset of neuropsychiatric symptoms in older adults may represent prodromal manifestations of neurodegenerative disorders. The association between the onset of somatic symptom and related disorders (SSRD) and the subsequent development of neurodegenerative disorders remains unclear. A critical review of studies describing the association between SSRD and neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Frontotemporal dementia, and Lewy body dementia was performed. OBJECTIVE: To critically review studies describing the association between SSRD and neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Frontotemporal dementia, and Lewy body dementia. METHODS: A systematic review of Web of Science Core databases was carried out from inception of databases up to May 2021 to identify observational studies pertaining to both SSRD and neurodegenerative disorders. Data was extracted and compiled regarding subjects enrolled, age at onset of the SSRD and at onset of the neurodegenerative disorders, and specific SSRD manifestations and underlying neuropathologies reported. RESULTS: Thirteen articles were included. Of the 123 identified subjects with SSRD at baseline, 34.1% developed a neurodegenerative disorder, with 80.9% of these being a Lewy body spectrum disorder. The interval between onset of SSRD manifestations and subsequent development of a neurodegenerative disorder was less than 3 years for half of the cases. Of the 1,494 subjects with a neurodegenerative disorder at baseline retrieved, SSRD manifestations were reported in 33.4% of Lewy body spectrum disorders cases. Onset of SSRD manifestations antedated or was concomitant to the diagnosis of the Lewy body spectrum disorder in 65.6% of cases. CONCLUSION: While limited, current evidence suggests a possible association between late-onset SSRD and the subsequent development of neurodegenerative disorders, notably Lewy body spectrum disorders.


Alzheimer Disease , Frontotemporal Dementia , Lewy Body Disease , Medically Unexplained Symptoms , Neurodegenerative Diseases , Parkinson Disease , Humans , Aged , Lewy Body Disease/complications , Lewy Body Disease/epidemiology , Lewy Body Disease/diagnosis , Parkinson Disease/complications , Alzheimer Disease/complications , Frontotemporal Dementia/epidemiology , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/epidemiology , Neurocognitive Disorders/complications , Neurodegenerative Diseases/complications , Neurodegenerative Diseases/epidemiology
12.
Int J Methods Psychiatr Res ; 32(2): e1948, 2023 06.
Article En | MEDLINE | ID: mdl-36178374

OBJECTIVES: To explore mortality of patients with Alzheimer's disease (AD), frontotemporal dementia (FTD), or Lewy body dementias (LBD) who had criminal behavior in the year preceding diagnosis. METHODS: Data were obtained from the nationwide registers. Mortality was compared between disorder groups with and without criminal acts and with the general population. The cohort included patients who had received a discharge register diagnosis of AD (N = 80,540), FTD (N = 1060), or LBD (N = 10,591) between 1998 and 2015. The incidences of crimes were calculated in the year preceding diagnosis. We further calculated age- and sex-adjusted survivals of different dementia groups with and without criminal acts, and in relation to the general population (SMR, Standardized Mortality Ratio). RESULTS: Criminal behavior was more common in men than in women. It was associated with decreased mortality in the AD group. SMRs due to unnatural causes, and in the LBD and FTD female groups, were higher in patients with criminal behavior than in those without. CONCLUSION: LBD and female FTD patients, who had criminal behavior before diagnosis, were at higher risk of death than patients without such behavior. Novel criminality in older adults may be associated with neurocognitive disorder, in which case medical attention is justified.


Alzheimer Disease , Frontotemporal Dementia , Lewy Body Disease , Male , Humans , Female , Aged , Frontotemporal Dementia/epidemiology , Frontotemporal Dementia/diagnosis , Frontotemporal Dementia/psychology , Finland/epidemiology , Alzheimer Disease/epidemiology , Lewy Body Disease/epidemiology , Crime
13.
Parkinsonism Relat Disord ; 105: 52-57, 2022 12.
Article En | MEDLINE | ID: mdl-36368094

BACKGROUND: In contrast to Alzheimer's disease (AD)-related pathology, the influence of comorbid limbic-predominant age-related TDP-43 encephalopathy neuropathological change (LATE-NC) or argyrophilic grains (AG) on structural imaging in Lewy body disease (LBD) has seldom been evaluated. OBJECTIVE: This study aimed to investigate whether non-AD limbic comorbidities, including LATE-NC and AG, cause cortical atrophy in LBD. METHODS: Seventeen patients with pathologically confirmed LBD with lower Braak neurofibrillary tangle stage (

Alzheimer Disease , Lewy Body Disease , Humans , Aged , Lewy Body Disease/complications , Lewy Body Disease/diagnostic imaging , Lewy Body Disease/epidemiology , Brain/pathology , Atrophy/pathology , Alzheimer Disease/diagnosis , Neurofibrillary Tangles/pathology
14.
J Alzheimers Dis ; 90(3): 1263-1275, 2022.
Article En | MEDLINE | ID: mdl-36245379

BACKGROUND: Lewy body dementia is the second most common neurodegenerative dementia, but data concerning the onset age and clinical features in the prodromal stage remain limited in China. OBJECTIVE: To investigate the associations between onset age and clinical manifestations of cognitive impairment with Lewy bodies in a large-sample cohort. METHODS: We included 74 patients with mild cognitive impairment with Lewy bodies (MCI-LB), 533 patients with dementia with Lewy bodies (DLB), 118 patients with Parkinson's disease with MCI (PD-MCI), and 313 patients with Parkinson's disease dementia (PDD) in this multicenter cohort from 22 memory clinics of China from 1 January 2018 to 31 March 2022. The onset age, clinical manifestations, and neuropsychological assessments were recorded and analyzed after reviewing the medical records. RESULTS: The average onset age of memory loss was 68.28 (±7.00) years, and parkinsonism happened 2.00 (±1.24) years later for patients with MCI-LB. The average onset age of parkinsonism was 60.56 (±8.96) years, and the memory loss happened 3.49 (±3.02) years later for patients with PD-MCI. Rapid eye movement sleep behavior disorder and visual hallucinations were frequently reported in MCI-LB, DLB, and PDD, while visual hallucinations were least frequently reported in PD-MCI. Lower scores of MMSE and depression, and higher scores of activities of daily living and delusions, were independently associated with older onset age in DLB. CONCLUSION: The onset of PD-MCI precedes MCI-LB, and memory loss occurs 3 years after parkinsonism. The onset age is associated with cognition and neuropsychiatric symptoms in process.


Alzheimer Disease , Cognitive Dysfunction , Dementia , Lewy Body Disease , Parkinson Disease , Humans , Aged , Lewy Body Disease/complications , Lewy Body Disease/epidemiology , Lewy Body Disease/diagnosis , Dementia/complications , Parkinson Disease/complications , Parkinson Disease/diagnosis , Parkinson Disease/epidemiology , Activities of Daily Living , Cognitive Dysfunction/psychology , Alzheimer Disease/complications , Hallucinations/complications , Memory Disorders/complications
15.
BMC Neurol ; 22(1): 355, 2022 Sep 19.
Article En | MEDLINE | ID: mdl-36123648

INTRODUCTION: Geriatric symptoms are common in dementia cases, while few studies have focused on these symptoms in Lewy body dementia (LBD). The purpose of this study is to investigate the distributions of Apolipoprotein E (APOE) ε4 and geriatric symptoms, and explore their associaitons in Dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). METHODS: A retrospective study with 185 mild-moderate probable DLB (n = 93) and PDD (n = 92) patients was assigned. Demographic and clinical characteristics, neuropsychological assessments, and APOE genotypes were recorded. Description, correlation and logistic regression models were used to analyze the presence of geriatric symptom complaints and their associations with APOE ε4. RESULTS: DLB patients displayed more frequency of fluctuating cognition, visual hallucination, rapid eye movement sleep behavior disorder, delusion, depression, anxiety, apathy, and loss of appetite, whereas the PDD cases had constipation, fear of falling, and insomnia more frequently. The APOE ε4 allele was more common in DLB than PDD (29.9% vs. 7.0%, p < 0.001), and the patients with DLB + APOE ε4 (+) were presented more delusions (p = 0.005) and apathy (p = 0.007) than patients with PDD + APOE ε4 (+). We also found that the APOE ε4 allele was significantly associated with hyperhidrosis (OR = 3.472, 95%CI: 1.082-11.144, p = 0.036) and depression (OR = 3.002, 95%CI: 1.079-8.353, p = 0.035) in DLB patients, while there were no significant associations between APOE ε4 allele and the age at visit, the age at onset, scores of MDS-UPDRS III, H&Y stage, ADL, MMSE, MOCA and NPI, as well as the presences of fluctuating cognition, VH, parkinsonism and RBD in both groups. CONCLUSION: The presence and co-incidence of geriatric symptoms are common in patients with mild-moderate LBD. The presence of APOE ε4 allele is associated with hyperhidrosis and depression, but not global cognition, activitives of daily life, motor function and other neuropsychitric symptoms in DLB. These findings improve the awareness of geriatric symptoms, and contribute to the healthcare management of mild-moderate DLB and PDD.


Alzheimer Disease , Dementia , Hyperhidrosis , Lewy Body Disease , Parkinson Disease , Accidental Falls , Aged , Alzheimer Disease/complications , Apolipoprotein E4 , Apolipoproteins E , Dementia/complications , Dementia/epidemiology , Dementia/genetics , Fear , Humans , Hyperhidrosis/complications , Incidence , Lewy Body Disease/complications , Lewy Body Disease/epidemiology , Lewy Body Disease/genetics , Parkinson Disease/complications , Retrospective Studies , Syndrome
16.
Alzheimers Res Ther ; 14(1): 137, 2022 09 22.
Article En | MEDLINE | ID: mdl-36138485

BACKGROUND: This study aimed to identify cases of potential prodromal DLB in very late-onset schizophrenia-like psychosis (VLOSLP), using indicative biomarkers of dementia with Lewy bodies (DLB), and to evaluate the characteristics of psychosis as prodromal DLB. METHODS: Data of patients with VLOSLP without dementia and Parkinsonism, who underwent testing for at least one indicative biomarker of DLB, were retrospectively collected from the database of the psychiatry clinic at the Osaka University Hospital. Patients were divided into two groups based on the positive (VLOSLP+LB) and negative (VLOSLP-LB) results of the indicative biomarkers of DLB. Age, gender, cognitive battery scores, prevalence of each type of delusions and hallucinations, cerebral volume, and cerebral perfusion were compared between the two groups. RESULTS: Eleven VLOSLP+LB and 23 VLOSLP-LB participants were enrolled. There were no significant differences in age, proportion of females, and MMSE scores between the two groups. The standardized score of the digit symbol substitution test was significantly lower in the VLOSLP+LB than in VLOSLP-LB group (6.9 [3.1] vs. 10.0 [2.7], p = 0.005). The prevalence of visual hallucinations was significantly higher in the VLOSLP+LB group than in the VLOSLP-LB group (81.8% vs. 26.1%, p = 0.003). Auditory hallucinations were prevalent in both groups (43.5% in VLOSLP-LB, and 45.5% in VLOSLP+LB). Among patients with auditory hallucinations, auditory hallucinations without coexistent visual hallucinations tended to be more prevalent in VLOSLP-LB (7 out of 10) than in VLOSLP+LB patients (1 out of 5). Although cerebral volume was not different in any region, cerebral perfusion in the posterior region, including the occipital lobe, was significantly lower in the VLOSLP+LB group. CONCLUSIONS: Psychomotor slowing, visual hallucinations, and reduced perfusion in the occipital lobe may be suggestive of prodromal DLB in VLOSLP patients, even though the clinical manifestations were similar in many respects between VLOSLP+LB and VLOSLP-LB. Although auditory hallucinations were prevalent in both groups, most patients in VLOSLP+LB complained of auditory hallucinations along with visual hallucinations. Future studies with a larger number of patients without selection bias are desirable.


Lewy Body Disease , Psychotic Disorders , Schizophrenia , Biomarkers , Cross-Sectional Studies , Female , Hallucinations/epidemiology , Humans , Lewy Body Disease/complications , Lewy Body Disease/epidemiology , Psychotic Disorders/epidemiology , Retrospective Studies , Schizophrenia/diagnosis , Schizophrenia/epidemiology
17.
Parkinsonism Relat Disord ; 103: 50-55, 2022 10.
Article En | MEDLINE | ID: mdl-36041278

BACKGROUND: Pisa syndrome (PS) is rarely reported in Dementia with Lewy bodies (DLB). The aim of this article is to investigate the prevalence rate of PS and the correlation with clinical features evaluated in patients with DLB. METHODS: A total of 209 DLB patients were consecutively recruited and underwent standardized clinical evaluation in our multicenter study. The associations between PS and clinical factors were evaluated. RESULTS: The prevalence rate of PS in patients with DLB was 15.3%, which was higher in the moderate and severe stages than mild cognitive impairment and mild stages (81.2% vs. 18.8%). Patients with PS had a longer duration of disease (P = 0.020) and parkinsonism (P = 0.003), higher scores of NPI (P = 0.028), ADL (P = 0.002) and UPDRS part III (P < 0.001), lower scores of clock drawing test (P = 0.009), visuospatial/executive abilities (P = 0.018), attention (P = 0.020), language and praxis (P = 0.020), registration (P = 0.012), greater H&Y stage (P < 0.001), and higher proportion of cholinesterase inhibitors used (P = 0.044) than those without PS. Longer disease duration (OR = 1.166, P = 0.023), presence of parkinsonism (OR = 7.971, P = 0.007), moderate and severe dementia (OR = 3.215, P = 0.021) were associated with the presence of PS. Patients had a longer duration of PS (P = 0.014) and lower mean age of onset (P = 0.040) in the group with severe lateral trunk flexion. CONCLUSION: The development of PS may be associated with longer disease duration, the presence of parkinsonism and severe stages of dementia in DLB. Cholinesterase inhibitors may have a correlation with PS. The severity of lateral flexion is related to the duration of PS and mean age of onset.


Alzheimer Disease , Dementia , Lewy Body Disease , Parkinsonian Disorders , Humans , Lewy Body Disease/complications , Lewy Body Disease/epidemiology , Lewy Body Disease/psychology , Cholinesterase Inhibitors , Language , Dementia/complications , Parkinsonian Disorders/complications , Syndrome , China , Alzheimer Disease/complications
18.
J Sleep Res ; 31(5): e13589, 2022 10.
Article En | MEDLINE | ID: mdl-35366021

Sleep apnea (SA) is potentially a modifiable risk factor for dementia. However, its associations to specific aetiologies of dementia remain uncertain. A systematic review and meta-analysis of cohort studies investigating the association between sleep apnea and specific aetiologies of dementia, including Alzheimer's disease (AD), Parkinson's disease (PD), Lewy body dementia (LBD), vascular dementia (VaD), and frontotemporal dementia (FTD) was performed. The use of biomarkers to support clinical diagnoses in eligible studies was collected. Eleven studies were included, comprising 1,333,424 patients. Patients with sleep apnea had an increased risk of developing any type of neurocognitive disorder (HR: 1.43 [95% CI 1.26-1.62]), Alzheimer's disease (HR: 1.28 [95% CI 1.16-1.41]), and Parkinson's disease (HR: 1.54 [95% CI 1.30-1.84]). No statistically significant association was found for vascular dementia. One study reported a two-fold increased risk for Lewy body dementia (HR: 2.06 [95% CI 1.45-2.91]). No studies investigated the risk for frontotemporal dementia and none of the studies reported results pertaining to biomarkers. Sleep apnea is associated with a significantly increased risk of dementia, particularly for Alzheimer's disease and Parkinson's disease, but not for vascular dementia. Future studies should look at the impact of sleep apnea on specific dementia biomarkers.


Alzheimer Disease , Dementia, Vascular , Frontotemporal Dementia , Lewy Body Disease , Parkinson Disease , Sleep Apnea Syndromes , Alzheimer Disease/diagnosis , Alzheimer Disease/epidemiology , Alzheimer Disease/etiology , Biomarkers , Frontotemporal Dementia/complications , Frontotemporal Dementia/epidemiology , Humans , Lewy Body Disease/complications , Lewy Body Disease/diagnosis , Lewy Body Disease/epidemiology , Parkinson Disease/complications , Parkinson Disease/epidemiology , Sleep Apnea Syndromes/complications , Sleep Apnea Syndromes/epidemiology
19.
Curr Med Res Opin ; 38(7): 1177-1188, 2022 07.
Article En | MEDLINE | ID: mdl-35442134

OBJECTIVE: To describe the trends in epidemiology, healthcare resource use (HCRU), and costs associated with Lewy body dementia (LBD), dementia with Lewy bodies (DLB), and Parkinson's disease dementia (PDD) in the United States. METHODS: This retrospective study used administrative claims data for Medicare fee-for-service (2010-2018) and commercially-insured beneficiaries (2010-2017). The annual prevalence and incidence were calculated among the Medicare beneficiaries by dividing the number of prevalent or incident LBD, DLB, and PDD patients by the total eligible population of that calendar year. Baseline patient characteristics, HCRU, and costs over time were described for Medicare and commercially insured patients with continuous health plan enrollment for ≥12 months before and ≥24 months after first cognitive impairment (CI) diagnosis. RESULTS: From 2010 to 2016, the incidence and prevalence rates of LBD among Medicare beneficiaries ranged from 0.21%-0.18% and 0.90%-0.83%, respectively. Of 9019 Medicare patients with LBD who met other inclusion criteria, 4796 (53.2%) had DLB and 4223 (46.8%) had PDD. The mean age was 78 years and the mean Charlson Comorbidity Index score was 1.6. On average, patients with LBD incurred $18,309 in medical costs during the 1-year pre-diagnosis and $29,174 and $22,814 at years 1 and 5 after diagnosis, respectively. The main cost drivers were inpatient and outpatient visits. Similar trends were observed for DLB and PDD as well as for commercially-insured patients. CONCLUSIONS: Our findings highlight the substantial epidemiological and economic burden across the LBD spectrum and underscore a high unmet need for effective treatments to improve patient outcomes.


Alzheimer Disease , Dementia , Lewy Body Disease , Parkinson Disease , Aged , Dementia/epidemiology , Financial Stress , Humans , Lewy Body Disease/complications , Lewy Body Disease/diagnosis , Lewy Body Disease/epidemiology , Medicare , Retrospective Studies , United States/epidemiology
20.
Geriatr Gerontol Int ; 22(5): 418-424, 2022 May.
Article En | MEDLINE | ID: mdl-35373438

AIM: Alzheimer's disease (AD) and dementia with Lewy body (DLB) constitute the most common types of dementia, and are two common geriatric syndromes; however, sarcopenia has not been elaborately evaluated in DLB so far. Therefore, this study aimed to investigate the relationship between sarcopenia and DLB in older adults. METHODS: In this retrospective and cross-sectional study, 662 participants, who were followed in a memory clinic at the Geriatrics department of a university hospital, were included. Comprehensive Geriatric Assessment, including the activities of daily living, malnutrition and malnutrition risk, frailty, cognition, and sarcopenia were assessed. Sarcopenia was defined according to the revised European Working Group on Sarcopenia in Older People-2 criteria. RESULTS: A total of 662 participants (461 healthy controls, 133 with AD and 68 with DLB) with a mean age of 73.60 ± 7.50 years were included. The prevalence of probable sarcopenia and sarcopenia was 53.4% and 19.5%, respectively, in patients with AD, whereas it was 55.9% and 19.1%, respectively, in patients with DLB. After adjustment analyses, probable sarcopenia, sarcopenia and low muscle mass were related to AD (P < 0.001, P = 0.001, P < 0.001, respectively). Probable sarcopenia and slow gait speed were associated with DLB (P < 0.01, P < 0.001, respectively). CONCLUSIONS: Sarcopenia is common in patients with DLB and in those with AD, and seems to be closely related to low muscle strength and slow gait speed in DLB patients. Considering sarcopenia-related negative health outcomes in older adults, the evaluation of sarcopenia, therefore, should also be among the follow-up and treatment goals of DLB patients. Geriatr Gerontol Int 2022; 22: 418-424.


Alzheimer Disease , Lewy Body Disease , Malnutrition , Sarcopenia , Activities of Daily Living , Aged , Aged, 80 and over , Alzheimer Disease/complications , Alzheimer Disease/epidemiology , Cross-Sectional Studies , Humans , Lewy Body Disease/complications , Lewy Body Disease/epidemiology , Malnutrition/complications , Retrospective Studies , Sarcopenia/complications , Sarcopenia/diagnosis , Sarcopenia/epidemiology
...