HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 73, Number 14, October 6, 2009 Data Supplement Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Nelson, P. T. Articles by Markesbery, W. R. PubMed PubMed Citation Articles by Nelson, P. T. Articles by Markesbery, W. R. Related Collections All Cognitive Disorders/Dementia Alzheimer's disease Dementia with Lewy bodies Cognitive aging Assessment of cognitive disorders/dementia

Relative preservation of MMSE scores in autopsy-proven dementia with Lewy bodies

From the Department of Pathology and Division of Neuropathology, University of Kentucky Medical Center and Sanders-Brown Center on Aging, University of Kentucky, Lexington.

Address correspondence and reprint requests to Dr. Peter T. Nelson, Department of Pathology, Division of Neuropathology, and the Sanders-Brown Center on Aging, Rm 311, Sanders-Brown Center Building, 800 S. Limestone, University of Kentucky, Lexington, KY 40536-0230 pnels2{at}email.uky.edu.

Background: Recent studies raised questions about the severity of cognitive impairment associated with dementia with Lewy bodies (DLB). However, there have been few analyses of large, multicenter data registries for clinical–pathologic correlation.

Methods: We evaluated data from the National Alzheimer's Coordinating Center registry (n = 5,813 cases meeting initial inclusion criteria) and the University of Kentucky Alzheimer's Disease Center autopsy series (n = 527) to compare quantitatively the severity of cognitive impairment associated with DLB pathology vs Alzheimer disease (AD) and AD+DLB pathologies.

Results: Mini-Mental State Examination (MMSE) scores showed that persons with pure DLB had cognitive impairment of relatively moderate severity (final MMSE score 15.6 ± 8.7) compared to patients with pure AD and AD+DLB (final MMSE score 10.7 ± 8.6 and 10.6 ± 8.6). Persons with pure DLB pathology from both data sets had more years of formal education and were more likely to be male. Differences in final MMSE scores were significant (p < 0.01) between pure DLB and both AD+DLB and pure AD even after correction for education level, gender, and MMSE–death interval. Even in cases with extensive neocortical LBs, the degree of cognitive impairment was most strongly related to the amount of concomitant AD-type neurofibrillary pathology.

Conclusions: Dementia with Lewy bodies can constitute a debilitating disease with associated psychiatric, motoric, and autonomic dysfunction. However, neocortical Lewy bodies are not a substrate for severe global cognitive impairment as assessed by the Mini-Mental State Examination. Instead, neocortical Lewy bodies appear to constitute or reflect an additive disease process, requiring Alzheimer disease or other concomitant brain diseases to induce severe global cognitive deterioration.

Abbreviations: AD = Alzheimer disease; ADC = AD Center; CERAD = Consortium to Establish a Registry for Alzheimer's Disease; DLB = dementia with Lewy bodies; LBs = Lewy bodies; MMSE = Mini-Mental State Examination; NACC = National Alzheimer's Coordinating Center; NF = neurofibrillary; NIA-RI = National Institute of Aging-Reagan Institute; UK ADC = University of Kentucky Alzheimer's Disease Center.

Supplemental data at www.neurology.org.

Supported by grants R01 NS061933, K08 NS050110, P30 AG028383, and U01 AG016976 from NIH.

Disclosure: Author disclosures are provided at the end of the article.

Received March 13, 2009. Accepted in final form July 16, 2009.