More severe functional impairment in dementia with lewy bodies than Alzheimer disease is related to extrapyramidal motor dysfunction.
ABSTRACT The objective of this study was to compare functional impairments in dementia with Lewy bodies (DLB) and Alzheimer disease (AD) and their relationship with motor and neuropsychiatric symptoms.
The authors conducted a cross-sectional study of 84 patients with DLB or AD in a secondary care setting. Patients were diagnosed according to published criteria for DLB and AD. The Bristol Activities of Daily Living Scale (BADLS) was used to assess functional impairments. Participants were also assessed using the Unified Parkinson's Disease Rating Scale (motor section), the Neuropsychiatric Inventory, and the Mini-Mental Status Examination.
Patients with DLB were more functionally impaired and had more motor and neuropsychiatric difficulties than patients with AD with similar cognitive scores. In both AD and DLB, there were correlations between total BADLS scores and motor and neuropsychiatric deficits. There was more impairment in the mobility and self-care components of the BADLS in DLB than in AD, and in DLB, these were highly correlated with UPDRS score. In AD, orientation and instrumental BADLS components were most affected.
The nature of functional disability differs between AD and DLB with additional impairments in mobility and self-care in DLB being mainly attributable to extrapyramidal motor symptoms. Consideration of these is important in assessment and management. Activities of daily living scales for use in this population should attribute the extent to which functional disabilities are related to cognitive, psychiatric, or motor dysfunction.
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ABSTRACT: The British Association for Psychopharmacology (BAP) coordinated a meeting of experts to review and revise its first (2006) Guidelines for clinical practice with anti-dementia drugs. As before, levels of evidence were rated using accepted standards which were then translated into grades of recommendation A to D, with A having the strongest evidence base (from randomized controlled trials) and D the weakest (case studies or expert opinion). Current clinical diagnostic criteria for dementia have sufficient accuracy to be applied in clinical practice (B) and brain imaging can improve diagnostic accuracy (B). Cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) are effective for mild to moderate Alzheimer's disease (A) and memantine for moderate to severe Alzheimer's disease (A). Until further evidence is available other drugs, including statins, anti-inflammatory drugs, vitamin E and Ginkgo biloba, cannot be recommended either for the treatment or prevention of Alzheimer's disease (A). Neither cholinesterase inhibitors nor memantine are effective in those with mild cognitive impairment (A). Cholinesterase inhibitors are not effective in frontotemporal dementia and may cause agitation (A), though selective serotonin reuptake inhibitors may help behavioural (but not cognitive) features (B). Cholinesterase inhibitors should be used for the treatment of people with Lewy body dementias (Parkinson's disease dementia and dementia with Lewy bodies (DLB)), especially for neuropsychiatric symptoms (A). Cholinesterase inhibitors and memantine can produce cognitive improvements in DLB (A). There is no clear evidence that any intervention can prevent or delay the onset of dementia. Although the consensus statement focuses on medication, psychological interventions can be effective in addition to pharmacotherapy, both for cognitive and non-cognitive symptoms. Many novel pharmacological approaches involving strategies to reduce amyloid and/or tau deposition are in progress. Although results of pivotal studies are awaited, results to date have been equivocal and no disease-modifying agents are either licensed or can be currently recommended for clinical use.Journal of Psychopharmacology 11/2010; 25(8):997-1019. DOI:10.1177/0269881110387547 · 2.81 Impact Factor
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ABSTRACT: Eating problems occur frequently in patients with dementia, and almost half of all patients with Parkinson's disease have such problems. It has therefore been assumed that eating problems are also common in patients with dementia with Lewy bodies (DLB). However, few systematic studies have investigated eating problems in DLB patients. The aim of this study was to clarify the frequency and characteristics of eating problems in patients with DLB. We examined 29 consecutive patients with DLB and 33 with Alzheimer's disease (AD) in terms of age, sex, education, Mini-mental State Examination, clinical dementia rating (CDR), neuropsychiatric inventory (NPI), Unified Parkinson disease rating scale (UPDRS), fluctuations in cognition, and usage of neuroleptic drugs / antiparkinsonian drugs. We employed a comprehensive questionnaire comprising 40 items and compared the scores between the two groups. DLB patients showed significantly higher scores than AD patients for "difficulty in swallowing foods," "difficulty in swallowing liquids," "coughing or choking when swallowing," "taking a long time to swallow," "suffering from sputum," "loss of appetite," "need watching or help," and "constipation". Only the UPDRS score significantly affected the scores for "difficulty in swallowing foods," "taking a long time to swallow" and "needs watching or help" score, whereas only the NPI score affected the score for "loss of appetite." The scores for UPDRS, NPI and CDR significantly affected the scores for "difficulty in swallowing liquids." No significant independent variables affected the scores for "coughing or choking when swallowing," "suffering from sputum" and "constipation." Although DLB patients show many eating problems, the causes of each problem vary, and the severity of dementia or Parkinsonism is not the only determinant.International Psychogeriatrics 04/2009; 21(3):520-5. DOI:10.1017/S1041610209008631 · 1.89 Impact Factor
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ABSTRACT: This thesis describes a program of research that investigated the sensitivity of healthy young adults, healthy older adults and individuals with Alzheimer’s disease (AD) to happiness, sadness and fear emotion specified in facial expressions. In particular, the research investigated the sensitivity of these individuals to the distinctions between spontaneous expressions of emotional experience (genuine expressions) and deliberate, simulated expressions of emotional experience (posed expressions). The specific focus was to examine whether aging and/or AD effects sensitivity to the target emotions. Emotion-categorization and priming tasks were completed by all participants. The tasks employed an original set of cologically valid facial displays generated specifically for the present research. The categorization task (Experiments 1a, 2a, 3a, 4a) required participants to judge whether targets were, or were not showing and feeling each target emotion. The results showed that all 3 groups identified a genuine expression as both showing and feeling the target emotion whilst a posed expression was identified more frequently as showing than feeling the emotion. Signal detection analysis demonstrated that all 3 groups were sensitive to the expression of emotion, reliably differentiating expressions of experienced emotion (genuine expression) from expressions unrelated to emotional experience (posed and neutral expressions). In addition, both healthy young and older adults could reliably differentiate between posed and genuine expressions of happiness and sadness, whereas, individuals with AD could not. Sensitivity to emotion specified in facial expressions was found to be emotion specific and to be independent of both the level of general cognitive functioning and of specific cognitive functions. The priming task (Experiments 1b, 2b, 3b,4b) employed the facial expressions as primes in a word valence task in order to investigate spontaneous attention to facial expression. Healthy young adults only showed an emotion-congruency priming effect for genuine expressions. Healthy older adults and individuals with AD showed no priming effects. Results are discussed in terms of the understanding of the recognition of emotional states in others and the impact of aging and AD on the recognition of emotional states. Consideration is given to how these findings might influence the care and management of individuals with AD.