Family Caregiver Comorbidities in Lewy Body Dementia Versus Alzheimer Disease and Associated Disorders.

BACKGROUND: Family caregivers of people living with dementia have high caregiver strain and poor health consequences. Limited research exists on Lewy body dementia (LBD) caregivers and their specific comorbidities. This study aimed to (1) identify the prevalence of self-reported comorbidities among LBD caregivers and (2) contextualize these findings with historical data on caregivers of persons living with Alzheimer disease and associated disorders (ADADs). METHODS: In a national, online survey, LBD family caregivers completed the Self-Administered Comorbidity Questionnaire and we compared these findings with extant literature on ADAD caregiver comorbidities. RESULTS: Among 217 LBD caregivers, 84.3% were female, 39.1% were 64 years old or younger, and 66.8% had >2 years of caregiving experience. Caregivers self-identified as current (83.9%) or former (16.1%) caregivers. The most frequent comorbidities were hypertension (38.2%), depression (35.0%), back pain (34.1%), and arthritis (27.7%). LBD caregivers, particularly younger caregivers, had a higher prevalence of depression compared with ADAD caregivers and older adult populations, and back pain prevalence nearly equivalent to spinal cord injury caregivers. CONCLUSIONS: Our study is the first to illustrate and contextualize specific comorbidities among LBD caregivers. Understanding the causality and impact of these conditions will be critical in designing effective interventions to improve the lives of families affected by LBD.

Measurement and characterization of distinctive clinical phenotypes using the Frontotemporal Lobar Degeneration Module (FTLD-MOD).

INTRODUCTION: The Frontotemporal Lobar Degeneration Module (FTLD-MOD) was designed as a research neuropsychological battery to evaluate clinical symptoms associated with FTLD. This study investigated whether the FTLD-MOD could differentiate between primary progressive aphasia (PPA) and behavioral variant frontotemporal dementia (bvFTD), two distinct FTLD-related syndromes. METHODS: Retrospective analysis was conducted on data collected from the initial visit of 165 subjects with PPA, 268 with bvFTD, and 251 cognitively normal controls from the National Alzheimer's Coordinating Center. Generalized linear models were used to compare group performance patterns on FTLD-MOD tasks of language, behavior, and memory. RESULTS: PPA participants showed significantly poorer performances on all language tasks whereas bvFTD participants demonstrated poorer performances on most behavioral measures. There were no differences in memory performances. Descriptive data on participant groups are provided for reference. DISCUSSION: Findings from this multi-center sample suggest that the FTLD-MOD can differentiate between distinctive clinical phenotypes commonly associated with FTLD.

Eosinophilia and Adverse Effects of Dupilumab for Respiratory Indications: A Real-World Setting.

BACKGROUND: Dupilumab has been used with significant benefit in the treatment of asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Phase 3 clinical trials have demonstrated transient eosinophilia and rare eosinophil-related and other adverse effects. OBJECTIVE: To characterize dupilumab-associated eosinophilia (absolute eosinophil count [AEC] ≥ 1.5 x 103/µL within 36 weeks of dupilumab initiation) and adverse effects associated in real-world patients with asthma and CRSwNP in the United States. METHODS: Retrospective chart review of 251 patients on dupilumab for asthma and/or CRSwNP seen at a single institution. RESULTS: Among the 142 patients who had AECs checked before and after treatment, 16 (11.3%) patients had post-treatment eosinophilia, including 11 (7.7%) patients who had new eosinophilia upon dupilumab initiation. Thirteen patients with post-treatment eosinophilia remained on dupilumab, 10 of whom had resolution of eosinophilia. Eosinophil-related adverse effects were rare and cases of eosinophilic granulomatous polyangiitis (EGPA) were limited to 1 patient with eosinophilia and 1 patient with normal eosinophil levels on systemic steroids. Other adverse effects included arthralgias (13/251, 5.2%), rash (8/251, 3.2%), and conjunctivitis (7/251, 2.8%). All patients with pre-treatment eosinophilia and the majority of patients with post-treatment eosinophilia received significant treatment benefit for their respiratory disease with dupilumab. CONCLUSION: While dupilumab-associated eosinophilia is seen in a subset of patients, persistent eosinophilia or eosinophil-related adverse effects are rare. Furthermore, treatment benefit on dupilumab despite eosinophilia supports its continued use in both asthma and CRSwNP.