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Clinical phenotype of Parkinson disease dementia

From the Departments of Neurology (J.E.G., J.P., J.C.M.), Anatomy and Neurobiology (J.R.G.), and Pathology and Immunology (J.C.M.) and Alzheimer Disease Research Center, Washington University School of Medicine, St. Louis, MO.

Address correspondence and reprint requests to Dr Galvin, Alzheimer Disease Research Center, Washington University School of Medicine, 4488 Forest Park, Suite 130, St. Louis, MO 63108; e-mail: galvinj{at}neuro.wustl.edu

Objective: To determine which clinical features best characterize Parkinson disease dementia (PDD), compared with Alzheimer disease (AD) and dementia with Lewy bodies (DLB), and to determine the pathologic basis for PDD.

Methods: We examined 103 participants enrolled in a longitudinal study (nondemented control = 10, PD = 42, DLB = 20, AD = 31) who were followed to autopsy using standardized protocols. We characterized the features of PDD using published criteria for AD and DLB as a framework. Statistical analysis was performed using ² and Fisher exact tests, Kaplan–Meier curves, and logistic regression models.

Results: The sample's mean age was 74.0 years (range 53 to 91 years), and individuals were followed for a mean of 3.4 visits (range 1 to 12 visits). During longitudinal follow-up, 83% of subjects with PD developed dementia, defined as a Clinical Dementia Rating score of 0.5. Features that distinguished PDD from AD included cognitive fluctuations (p = 0.001), visual (p < 0.001) and auditory (p = 0.006) hallucinations, depression (p = 0.003), and sleep disturbance (p = 0.003). These PDD features were identical to those observed for DLB. The pathologic substrates for PDD included DLB (38%), AD (32%), and nigral LB alone (24%). Clinical predictors of PDD were visual hallucinations (odds ratio [OR] 21.3; 95% CI: 1.5 to 309.6) and male gender (OR 9.6; 95% CI: 1.3 to 71.4).

Conclusions: Parkinson disease dementia (PDD) shares identical clinical features with dementia with Lewy bodies (DLB); both entities can be distinguished from Alzheimer disease. The presence of PDD/DLB features at any time during the course of PD is highly predictive of dementia and the presence of LB at autopsy; in particular, male gender and visual hallucinations in PD predict dementia.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the November 14 issue to find the title link for this article.

Supported by grants from the National Institute on Aging (K08 AG20764, P01 AG03991, and P50 AG05681), the American Federation for Aging Research, and the Alan A. and Edith L. Wolff Charitable Trust. Dr. Galvin is a recipient of the Paul Beeson Physician Faculty–Scholar in Aging Research Award.

Disclosure: The authors report no conflicts of interest.

Received April 17, 2006. Accepted in final form July 5, 2006.

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