Motor and cognitive function in Lewy body dementia: Comparison with Alzheimer's and Parkinson's diseases

Department of Old Age Psychiatry, Withington Hospital, West Didsbury, Manchester, UK.
Journal of Neurology Neurosurgery & Psychiatry (Impact Factor: 5.58). 04/1997; 62(3):243-52. DOI: 10.1136/jnnp.62.3.243
Source: PubMed

ABSTRACT Motor and cognitive function were compared in patients with Lewy body dementia, Parkinson's disease, or Alzheimer's disease, to identify features that may be clinically useful in differentiating Lewy body dementia from Alzheimer's disease and Parkinson's disease.
A range of neuropsychological function and extrapyrimidal signs (EPS) was assessed in 16 patients with Lewy body dementia, 15 with Parkinson's disease, 25 with Alzheimer's disease, and 22 control subjects.
The severity of total motor disability scores increased in the following order: controls approximately = Alzheimer's disease < Parkinson's disease < Lewy body dementia. Compared with patients with Parkinson's disease, patients with Lewy body dementia had greater scores for rigidity and deficits in the finger tapping test, but rest tremor and left/right asymmetry in EPS were more evident in Parkinson's disease. Patients with Lewy body dementia were also less likely to present with left/right asymmetry in EPS at the onset of their parkinsonism. "Sensitivity" to neuroleptic drugs was noted in 33% of patients with Lewy body dementia. Alzheimer's disease and Lewy body dementia groups had greater severity of dementia compared with the Parkinson's disease group and controls. Neuropsychological evaluation disclosed severe but similar degrees of impaired performances in tests of attention (digit span), frontal lobe function (verbal fluency, category, and Nelson card sort test) and motor sequencing in both Lewy body dementia and Alzheimer's disease groups, than Parkinson's disease and controls. In the clock face test, improved performance was noted in the "copy" compared to "draw" part of the test in controls, patients with Alzheimer's disease, and those with Parkinson's disease, but not in the patients with Lewy body dementia, who achieved equally poor scores in both parts of the test.
EPS in Lewy body dementia resemble those seen in idiopathic Parkinson's disease, although less rest tremor and left/right asymmetry but more severe rigidity favours a diagnosis of Lewy body dementia. The unique profile of patients with Lewy body dementia seen in the clock face test suggests that this simple and easy to administer test may be useful in the clinical setting to differentiate Lewy body dementia and Alzheimer's disease.

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Available from: Kanna K Gnanalingham, Jul 08, 2015
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    • "Others showed that the Parkinsonian features in LBD are more severe than Alzheimer's disease and closely resemble Parkinson's disease (Louis et al, 1995; Gnanalingham et al, 1997). Other features, depression, delirium and halluci nations are not uncommon in dementia and are often seen in LBD. "
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    ABSTRACT: Current concepts on the clinical presentations, diagnosis and treatment of dementia with Lewy bodies (DLB), that makes up 10% percent of dementia cases, are considered. The nosological status of DLB and the correlation between DLB and Parkinson's disease are reviewed in the historical context. The authors suggest approaches to the formulation of diagnosis and coding of DLB in according to ICD-10. A role of cholinesterase inhibitors, antipsychotic drugs, levodopa, razagiline and other drugs in the treatment of DLB is analyzed.
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    • "The role of levodopa in patients with DLB is under debate and only a few studies have assessed the potential benefits of levodopa on motor symptoms of this condition [7] [8]. Moreover, since chronic administration of levodopa can induce or exacerbate behavioral symptoms, longterm studies to evaluate potential benefits and risks of levodopa in these patients are needed [9] [10]. Two previous studies have reported the possible predictive usefulness of a positive response to acute levodopa in DLB patients [7] [8]. "
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    ABSTRACT: To evaluate levodopa responsiveness in patients with probable dementia with Lewy bodies (DLB) compared to early Parkinson's disease (PD) patients. Twenty four cases with DLB and 21 with PD underwent a baseline assessment with UPDRS (sub-item II and III) and an acute levodopa challenge test. Positive response to acute levodopa test was defined as an improvement of at least 15% in the tapping test, and at least 25% in the walking test and rigidity or tremor score. Subsequently, all patients were treated continuously with levodopa and evaluated after 6 and 12 months by means of UPDRS II/III. Positive response to the acute levodopa test was observed in 55% of DLB patients (acute DLB responders), and in 90% of PD patients (acute PD responders). Acute DLB responders showed increased latency, and reduction of both duration and amplitude of response to acute levodopa in comparison with acute PD responders. At the 6-month follow-up visit, acute DLB responders showed a greater motor benefit compared with acute DLB non-responders. This improvement was similar to that observed in PD patients. However, at 1-year follow-up acute DLB responders showed a faster worsening of UPDRS III scores compared with acute PD responders, implying a reduction of levodopa efficacy. Positive response to acute levodopa test can occur in DLB patients and may be predictive of long-term benefit of chronic levodopa therapy, although the motor improvement is less impressive than in PD patients.
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    • "patients. Studies comparing AD and DLB patients have pinpointed some differences in cognitive performance: memory impairment is less severe in DLB than AD (e.g., Calderon et al., 2001; Salmon et al., 1996; Shimomura et al., 1998), while visual–perceptual and spatial abilities are more impaired (e.g., Ala et al., 2001; Calderon et al., 2001; Gnanalingham et al., 1997; Salmon et al., 1996). Consistent with the neuropsychological profile, functional imaging studies show that patients with DLB more commonly have reduced perfusion in the occipital lobes than AD patients (Ishii et al., 1999; Lobotesis et al., 2001). "
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    ABSTRACT: Although semantic memory impairment is well documented in patients with dementia of the Alzheimer's type, questions remain as to whether the deficit extends to other forms of dementia and whether it differentially affects different domains of knowledge. We examined category naming on two tasks (picture naming and naming-to-description) in patients with Alzheimer's disease (AD: n = 11), Lewy body dementia (DLB: n = 11) and healthy elderly matched controls (n = 22). The DLB and AD groups showed significantly worse naming on both tasks, although the AD patients were more impaired than the DLB patients. Like some AD patients, some DLB patients showed evidence of category-specific naming deficits, and strikingly, all 25 significant category dissociations were for living things. The latter finding accords with the preponderance of living deficits previously documented for AD patients, but extends this finding to DLB patients. The implications of this category bias is discussed in relation to relevant models of category specificity.
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