Cognitive differences in dementia patients with autopsy-verified AD, Lewy body pathology, or both

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
Neurology (Impact Factor: 8.29). 06/2005; 64(12):2069-73. DOI: 10.1212/01.WNL.0000165987.89198.65
Source: PubMed


To examine the neuropsychological profile of dementia patients from a community-based autopsy sample of dementia, comparing Alzheimer disease (AD), Lewy body pathology (LBP) alone, and LBP with coexistent AD (AD/LBP).
The authors reviewed 135 subjects from a community-based study of dementia for whom autopsy and brain tissue was available. Diagnostic groups were determined according to standard neuropathologic methods and criteria, and the presence of LBs was determined using alpha-synuclein immunostaining. Neuropathologically defined diagnostic groups of AD, AD/LBP, and LBP were examined for differences on neuropsychological test performance at the time of initial study enrollment.
There were 48 patients with AD alone, 65 with LB and AD pathology (AD/LBP), and 22 with LBP alone (LBP alone). There were no significant differences between groups demographically or on performance of enrollment Mini-Mental State Examination (MMSE) or Dementia Rating Scale (DRS). AD patients performed worse than the LBP patients on memory measures (Fuld Object Memory Evaluation Delayed Recall, Wechsler Memory Scale Logical Memory Immediate and Delayed Recall; p < 0.05) and a naming task (Consortium to Establish a Registry for Alzheimer's Disease Naming; p < 0.05). LBP patients were more impaired than AD patients on executive function (Trail Making Test Part B; p < 0.05) and attention tasks (Wechsler Adult Intelligence Scale-Revised Digit Span; p < 0.05). Decline in MMSE and DRS scores over time were greatest in the patients with AD/LBP.
In a community-based sample of older, medically complicated patients with dementia, there are neuropsychological differences between dementia subtypes at the time of diagnosis. In particular, patients with Alzheimer disease (AD) alone and AD/Lewy body pathology (LBP) had more severe memory impairment than patients with LBP. LBP alone was associated with more severe executive dysfunction. Patients with AD/LBP had the most rapid rate of cognitive decline.

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    • "However, these findings are contrast the findings of Sahgal et al.[18] where the authors found that visual set-shifting abilities were equally impaired in both DLB and AD patients. Divided attention has been more specifically studied by Kraybill et al.,[50] who found that Part A of the TMT did not differ among groups, but DLB patients performed much more poorly on Part B of the TMT than did the AD patients. These findings suggested that LBP patients were actually more impaired in terms of divided attention and not overall just slow-performers due to their motor slowing. "
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    ABSTRACT: Dementia is a chronic neurodegenerative disorder characterized by progressive cognitive loss. Alzheimer's disease (AD) and the Lewy body disease are the two most common causes of age-related degenerative dementia. Visuo-cognitive skills are a combination of very different cognitive functions being performed by the visual system. These skills are impaired in both AD and dementia with Lewy bodies (DLB). The aim of this review is to evaluate various studies for these visuo-cognitive skills. An exhaustive internet search of all relevant medical databases was carried out using a series of key-word applications, including The Cochrane Library, MEDLINE, PSYCHINFO, EMBASE, CINAHL, AMED, SportDiscus, Science Citation Index, Index to Theses, ZETOC, PEDro and occupational therapy (OT) seeker and OT search. We reviewed all the articles until March 2013 with key words of: Visual skills visual cognition dementia AD, but the direct neurobiological etiology is difficult to establish., Dementia of Lewy body disease. Although most studies have used different tests for studying these abilities, in general, these tests evaluated the individual's ability of (1) visual recognition, (2) visual discrimination, (3) visual attention and (4) visuo-perceptive integration. Performance on various tests has been evaluated for assessing these skills. Most studies assessing such skills show that these skills are impaired in DLB as compared with AD. Visuo-cognitive skills are impaired more in DLB as compared with AD. These impairments have evident neuropathological correlations, but the direct neurobiological etiology is difficult to establish.
    Annals of Indian Academy of Neurology 03/2014; 17(1):12-18. DOI:10.4103/0972-2327.128530 · 0.60 Impact Factor
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    • "In contrast, patients with AD pathology showed a decline between first and second recall, consistent with impaired learning or rapid forgetting as has been described previously in the literature [29] [30]. Our findings are consistent with neuropsychological studies showing that patients with AD perform more poorly on delayed recall than patients without AD diagnosed by neuropathologic finding [2] [4] [5] [7] [10]. They are also consistent with the power of delayed recall as well as cued recall tests to distinguish cerebrospinal fluid profiles consistent with AD [31]. "
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    ABSTRACT: We compared the sensitivity and specificity of two delayed recall scores from the Modified Mini-Mental State (3MS) test with consensus clinical diagnosis to differentiate cognitive impairment due to Alzheimer's disease (AD) versus non-AD pathologies. At a memory disorders clinic, 117 cognitively impaired patients were administered a baseline 3MS test and received a contemporaneous consensus clinical diagnosis. Their brains were examined after death about 5 years later. Using logistic regression with forward selection to predict pathologically defined AD versus non-AD, 10-min delayed recall entered first (p = 0.001), followed by clinical diagnosis (p = 0.02); 1-min delayed recall did not enter. 10-min delayed recall scores ≤4 (score range = 0-9) were 87% sensitive and 47% specific in predicting AD pathology; consensus clinical diagnosis was 82% sensitive and 45% specific. For the 57 patients whose initial Mini-Mental State Examination scores were ≥19 (the median), 3MS 10-min delayed recall scores ≤4 showed some loss of sensitivity (80%) but a substantial gain in specificity (77%). In conclusion, 10-min delayed recall score on the brief 3MS test distinguished between AD versus non-AD pathology about 5 years before death at least as well as consensus clinical diagnosis that requires much more comprehensive information and complex deliberation.
    Journal of Alzheimer's disease: JAD 11/2013; 39(3):575-582. DOI:10.3233/JAD-130524 · 4.15 Impact Factor
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    • "Les perspectives d'une telle e ´ chelle sont multiples. Dans la MA, les ré percussions de la pathologie de Lewy associé e sur le phé notype clinique (Johnson et al., 2005) et le pronostic (Kraybill et al., 2005 ; Olichney et al., 1998) restent mé connues. Le dé ficit cholinergique pré coce et sé vè re des maladies a ` corps de Lewy interroge e ´ galement sur l'influence de la pathologie de Lewy sur la ré ponse thé rapeutique aux inhibiteurs de l'acé tylcholinesté rase dans la MA (Samuel et al., 2000 ; Touchon et al., 2006). "
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    ABSTRACT: Dementia with Lewy bodies (DLB) is the second cause of degenerative dementia in autopsy studies. In clinical pratice however, the prevalence of DLB is much lower with important intercenter variations. Among the reasons for this low sensitivity of DLB diagnosis are (1) the imprecision and subjectivity of the diagnostic criteria; (2) the underestimation of non-motor symptoms (REM-sleep behavior disorder, dysautonomia, anosmia); mostly (3) the nearly constant association of Lewy bodies with Alzheimer's disease pathology, which dominates the clinical phenotype. With the avenue of targeted therapies against the protein agregates, new clinical scales able to apprehend the coexistence of Lewy pathology in Alzheimer's disease are expected.
    Revue Neurologique 11/2013; 169(11):844–857. DOI:10.1016/j.neurol.2013.05.004 · 0.66 Impact Factor
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