| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Departments of Neurology (Drs. Lopez, Becker, Kaufer, and DeKosky), Psychiatry (Drs. Lopez, Becker, Kaufer, and DeKosky), Pathology (Division of Neuropathology) (Dr. Hamilton), and Epidemiology (Dr. Wisniewski), Alzheimer’s Disease Research Center, University of Pittsburgh School of Medicine, PA.
Address correspondence and reprint requests to Dr. Oscar L. Lopez, Neuropsychology Research Program, 3600 Forbes Avenue, Suite 502, Pittsburgh, PA 15213.
OBJECTIVE: 1) To examine the clinical differences between AD and AD with Lewy bodies (AD+LB); and 2) to determine the accuracy of Consensus guidelines for the clinical diagnosis of dementia with Lewy bodies (DLB) at different levels of dementia severity.
METHODS: The authors examined the clinical characteristics of 185 patients with pathologically diagnosed AD alone and 60 with AD+LB. The relationship between clinical symptoms and AD+LB was determined by multivariate analyses, controlled by age, duration of symptoms, presence of cerebrovascular disease, and dementia severity.
RESULTS: Mild dementia syndrome: No specific clinical symptom was associated with the presence of AD+LB. The sensitivity of the diagnosis of DLB was 62% and specificity was 54%. Moderate dementia syndrome: Extrapyramidal signs (EPS), especially cogwheel rigidity, and major depression were associated with AD+LB. The sensitivity for DLB was 82% and specificity was 31%. Severe dementia syndrome: Cogwheel rigidity and diurnal hypersomnia were associated with AD+LB. The sensitivity for DLB was 93% and specificity was 16%.
CONCLUSIONS: The presence of EPS is not useful in differentiating AD+LB from AD in patients with mild dementia. However, as the disease progressed, they emerge as defining features, especially cogwheel rigidity. The accuracy of AD+LB diagnosis varies according the severity of the dementia syndrome. The low sensitivity and specificity in AD+LB patients with mild dementia suggest that in early stages AD+LB patients do not present the clinical characteristics of DLB. By contrast, the high sensitivity and low specificity for the diagnosis of DLB in moderate/severe dementia stages suggests that AD patients can also have characteristic symptoms of DLB. These results indicate that the antemortem diagnosis of AD+LB is difficult in all dementia stages, and better clinical and biologic differentiations of these entities are needed.
Key words: Cognitive impairment—Clinical diagnosis—AD—Lewy bodies
This article has been cited by other articles:
|
|
 |
|
  J. A. Levy and G. J. Chelune Cognitive-Behavioral Profiles of Neurodegenerative Dementias: Beyond Alzheimer's Disease J Geriatr Psychiatry Neurol, December 1, 2007; 20(4): 227 - 238. [Abstract] [PDF]
|
|
|
|
 |
|
 K. Stavitsky, A. M. Brickman, N. Scarmeas, R. L. Torgan, M.-X. Tang, M. Albert, J. Brandt, D. Blacker, and Y. Stern The progression of cognition, psychiatric symptoms, and functional abilities in dementia with lewy bodies and Alzheimer disease. Arch Neurol, October 1, 2006; 63(10): 1450 - 1456. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. L. Lopez, J. T. Becker, R. A. Sweet, F. J. Martin-Sanchez, and R. L. Hamilton Lewy bodies in the amygdala increase risk for major depression in subjects with Alzheimer disease. Neurology, August 22, 2006; 67(4): 660 - 665. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Tiraboschi, D. P. Salmon, L. A. Hansen, R. C. Hofstetter, L. J. Thal, and J. Corey-Bloom What best differentiates Lewy body from Alzheimer's disease in early-stage dementia? Brain, March 1, 2006; 129(3): 729 - 735. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J M Olichney, C Murphy, C R Hofstetter, K Foster, L A Hansen, L J Thal, and R Katzman Anosmia is very common in the Lewy body variant of Alzheimer's disease J. Neurol. Neurosurg. Psychiatry, October 1, 2005; 76(10): 1342 - 1347. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Sweet, M. I. Kamboh, S. R. Wisniewski, O. L. Lopez, W. E. Klunk, D. I. Kaufer, and S. T. DeKosky Apolipoprotein E and Alpha-1-Antichymotrypsin Genotypes Do Not Predict Time to Psychosis in Alzheimer's Disease J Geriatr Psychiatry Neurol, April 1, 2002; 15(1): 24 - 30. [Abstract] [PDF]
|
|
|
|
|
|
R. A. Sweet, V. L. Nimgaonkar, B. Devlin, O. L. Lopez, and S. T. DeKosky Increased familial risk of the psychotic phenotype of Alzheimer disease Neurology, March 26, 2002; 58(6): 907 - 911. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Takahashi, E. Stanton, J. I. Moreno, and G. Jackowski Immunoassay for Serum Glutamine Synthetase in Serum: Development, Reference Values, and Preliminary Study in Dementias Clin. Chem., February 1, 2002; 48(2): 375 - 378. [Full Text] [PDF]
|
|
|
|
|
|
O. L. Lopez, J. T. Becker, D. I. Kaufer, R. L. Hamilton, R. A. Sweet, W. Klunk, and S. T. DeKosky Research Evaluation and Prospective Diagnosis of Dementia With Lewy Bodies Arch Neurol, January 1, 2002; 59(1): 43 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. L. Lopez, S. Wisniewski, R. L. Hamilton, J. T. Becker, D. I. Kaufer, and S. T. DeKosky Predictors of progression in patients with AD and Lewy bodies Neurology, May 9, 2000; 54(9): 1774 - 1779. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
