Article

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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    • "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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    • "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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